Rachel Cantrell, MFT Intern

Anorexia Nervosa

• Dramatic weight loss.
• Dresses in layers to hide weight loss.
• Is preoccupied with weight, food, calories, fat grams and dieting.
• Refuses to eat certain foods, progressing to restriction against whole categories of food . (e.g no carbohydrates, etc.)
• Makes frequent comments about feeling “fat” or overweight despite weight loss.
• Complains of constipation, abdominal pain, cold intolerance, lethargy, and excess energy.
• Denies feeling hungry.
• Develops food rituals. (e.g., eating foods in certain orders, excessive chewing, rearranging food on plate)
• Cooks meals for others without eating.
• Consistently makes excuses to avoid mealtimes or situations involving food.
• Maintains an excessive, rigid exercise regiment- despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in.
• Withdraws from usual friends and activities and becomes more isolated, withdrawn, and secretive.
• Mood swings.
• Seems concerned about eating in public.
• Has limited social spontaneity.
• Resists maintaining body weight at or above a minimally normal weight for age and height.
• Has intense fear of weight gain or being “fat, even though underweight.
• Has disturbed experience of body or shape, undue influence of weight or shape on self- evaluation, or denial of the seriousness of low body weight.
• Post puberty female loses menstrual period.
• Feels ineffective.
• Has strong need for control.
• Shows inflexible thinking.
• Has overly restrained initiative emotional expression.

Bulimia Nervosa

• In general behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns.
• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
• Evidence or purging behaviors, including frequent trips to the bathroom after meals, signs and or smells of vomiting, presence of wrappers packages of laxatives or diuretics.
• Scars around knuckles on hand from purging.
• Calluses on the back of the hands and knuckles from self induced vomiting.
• Appears uncomfortable eating around others.
• Develops foot rituals (e.g., eats only particular food or food group e.g., condiments, excessive chewing, doesn’t allow food to touch).
• Skips meals or takes small portions of food at regular meals.
• Steals or hoards food in strange places.
• Drinks excessive amounts of water or diet soda.
• Use excessive amounts of mouthwash, mints, and gum.
• Hides body with baggy clothes.
• Maintains excessive, rigid exercise regime-despite weather, fatigue, illness, or injury, the need to “burn off” calories trumps everything.
• Shows unusual swelling of the cheeks or jaw area.
• Teeth are discolored, stained.
• Creates lifestyle schedules or rituals to make time for binge-and-purge sessions.
• Withdraws from usual friends and activities.
• Looks bloated from fluid retentions.
• Frequently diets.
• Shows extreme concern with body weight and shape.
• Has secret recurring episodes of binge eating; feels lack of control over ability to stop eating.
• Purges after a binge.
• Body weight is typically within the normal weight range; may be overweight.

Binge Eating Disorder

• Binges on food (eating large amounts in a short period of time) in secret
• Does not compensate for binges by purging, fasting or overexercising
• Tends to be overweight
• Binging feels comforting in the moment but feels shameful afterwards
• Binges interfere with work or social life
• Spends lots of time planning out binges and/or thinking about food
• Spends significant amounts of money on binge food
• Eats mostly “diet” foods in public

Food and Body Image Continuum Link

Eating Disorders and disordered eating is a continuum. Here is a helpful illustration of the range of symptoms from the research of the University of Arizona and adapted by Cornell University Health Services.