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10 Early Signs of an Eating Disorder: A Guide for Professionals

by | Jan 16, 2025 | Dietitian Supervision

Whether you’re an eating disorder specialist or a professional who claims to not work with eating disorders, I can guarantee that you have come across a patient or client with an eating disorder in your career. Some might have been obvious right away. Others might have slid under your radar. Regardless if eating disorders are your specialty, it is important to know how to pick up on early warning signs. If you are not comfortable treating this patient yourself, you can always refer out. But catching an eating disorder early could change your patient’s life for the better. Research on prevention and early intervention shows that it can significantly reduce ED risk factors, as well as increase self awareness and motivation to seek help and treatment (1). When intervention efforts happen within the first 3 years of the onset of an eating disorder, it may increase motivation and help-seeking behaviors (1). In this blog, we will break down early warning signs into behavioral, emotional and medical categories.

Behavioral Signs

Behavioral signs of eating disorders will be most easily noticed by people your client spends a lot of time with. Whether this be parents, siblings, friends, partners, roommates. These may be the first things that someone notices. But not always the first thing to occur. Behavior changes might seem harmless at first. Or they might start out as small and gradually increase. And if they are not addressed early on, they can escalate and become more severe. Some common behavioral signs of an eating disorder developing include but are not limited to the following:

1. Drastic changes in eating habits

      • Removing whole food groups from one’s diet

      • Fixation on “healthy” or “clean” foods
      • No longer eating one’s favorite foods
      • Skipping meals or eating drastically smaller meals than normal
      • Playing with food, moving it around on the plate to make it look like food was eaten
      • Increased interest in preparing their own food instead of eating out or having someone cook for them

2. Noticeable changes in exercise patterns 

      • Dramatic increase in exercise frequency 
      • Change in type of exercise (someone who enjoys yoga suddenly beginning to run)
      • Exercise habits that are not age appropriate (i.e. a school aged child getting up early in the morning to exercise before school)
      • Exercising without appropriate fueling and recovery
      • Exercising even when ill or injured
      • Exercising with the intention of changing the way ones body looks

Emotional Signs

Emotional signs are not visible with the naked eye. But that does not mean you cannot pick up on them as a provider. Or that loved ones won’t catch on. Early signs of eating disorders often begin with subtle emotional shifts that can be hard to detect at first. Many people focus on the physical symptoms like the ones listed above. However, these emotional signs often occur before any noticeable physical symptoms appear. Understanding them is key to identifying the problem early and getting your client appropriate help and support.

3. Anxiety

      • Nervousness around food, meals, or events that involve food
      • Talking about food excessively
      • Asking a lot of questions about meals that are being prepared for them

4. Irritability 

      • Defensiveness when confronted about possible food struggles
      • Frustration and anger when exercise can’t happen as planned
      • Strong emotional reactions to otherwise minor stressors

5. Depression

      • Decrease in social engagements
      • Isolating from friends and family
      • Low interest in things that one used to love

6. Perfectionism

      • Setting unrealistic expectations for one self
      • Fear of losing or not having control over food, exercise or body
      • Increased guilt or shame when making a mistake

 

Medical Signs

Eating disorders are a mental health condition with physical consequences. And when I say physical consequences, I am referring to medical complications. While there are other reasons that someone could experience these complications, it is better to be safe than sorry. If you are noticing any of these medical symptoms or a client shares them with you, refer your client to their primary care doctor or an eating disorder specialist for a physical exam to rule out other contributing diagnoses. Some examples of medical signs to look for include:

7. Drastic changes in weight (including weight gain or weight loss)

      • A child has fallen off their growth curve
      • Failure to gain weight in alignment with normal age appropriate growth
      • Weight loss is still concerning and important to note if a client is in a larger body
      • Even intentional weight loss is something to be concerned about

8. Menstrual irregularities

      • Losing a period for 3 months or more
      • Irregular periods when they were once regular
      • Needing birth control pills in order to get a period

9. GI Distress

      • Nausea
      • Constipation
      • Diarrhea

10. Abnormal Vital Signs

      • Low HR or drastic drop in HR
      • Orthostatic vials
      • Increased fatigue, even with seemingly adequate sleep
      • Dizziness when standing up
      • Difficulty falling asleep or staying asleep

Final Thoughts on 10 Early Signs of an Eating Disorder: A Guide for Professionals

Thank you for taking the time to read this blog. By recognizing the behavioral, emotional, and medical signs, professionals can help detect these issues before they escalate. Timely intervention can significantly improve outcomes and motivate individuals to seek treatment. . Staying vigilant and informed helps ensure individuals get the support they need for healthier, more fulfilling lives.

(1) Koreshe, E., Paxton, S., Miskovic-Wheatley, J. et al. Prevention and early intervention in eating disorders: findings from a rapid review. J Eat Disord 11, 38 (2023). https://doi.org/10.1186/s40337-023-00758-3

Contact Us

Courage to Nourish is a group of eating disorder specialized dietitians. We have in person locations in Alexandria, Virginia, Columbia, Maryland. and College Park, Maryland. We offer virtual services across the state of Virginia, Washington DC, Pennsylvania, Colorado, Florida, Arizona and Georgia. We offer individual nutrition therapy. As well as support groups. We would love to guide you in building a better relationship with food.

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Kathryn Karukas

Kathyrn Karukas, MS, RD, LD

Kathryn is a weight-inclusive, anti-diet eating disorder dietitian at Courage to Nourish. She specializes in working with adolescents and families, athletes, and individuals recovering from ARFID. Kathryn sees clients in person at the Columbia, Maryland office and virtually throughout Virginia, Pennsylvania, DC, and Maryland. To schedule a discovery call with Kathryn, click here.