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Warning Signs
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 Warning Signs of an Eating Disorder

Below are some of the behaviors a parent might be observing as a loved one develops an eating disorder. Some are related to food, and some are not. Some are present before an eating disorder comes into the picture, and some increase in intensity as the illness progresses.
 

Around food:

  • Dieting
  • Avoiding a widening range of foods
  • Avoiding situations where communal eating is expected
  • New interest in "healthy," "low-fat," "low-carb" or "vegetarian" diets
  • Inflexibility about what or when or how much to eat
  • Unnatural focus on what others are eating
  • Need to know calorie content of all foods
  • Never available for family meals
  • New interest in cooking and recipes but avoiding eating the food
  • Foods, especially carbohydrates, disappearing quickly from the house (secret binging)
  • Secretive or ritualistic eating 
  • Avoiding food until certain hours
  • Anger at others if pressed to eat something
  • Fear of over-eating, or gaining weight from a particular meal or type of food

Around activity:

  • Exercising intensely but without pleasure
  • Needing to exercise to compensate for eating

Medically:

  • Failure to gain weight or height according to growth curve
  • Weight loss at any time during childhood or adolescence

Thinking:

  • A conviction that one is too large
  • Unnatural focus on the flaws of a particular body part or aspect of the body
  • Repetitive requests for reassurance about appearance
  • An inability to understand that they may be ill (anosognosia).

Socially:

  • Social withdrawal
  • Reports others are newly judgmental or "not connecting"
  • Inability to describe emotions

If a loved one shows only a few of the symptoms of an eating disorder, or denies that anything is wrong, this is NOT a reason to put the issue aside.

FACT: Resistance to treatment is normal.

Denying and concealing symptoms are a common symptom of brain changes associated with eating disorders and resulting malnutrition.

FACT: Early intervention increases the effectiveness of treatment.

Early detection and assertive treatment are the best way to prevent chronic illness and death from an eating disorder.

DEFINITION: Anosognosia / Anosognosic

Pertaining to an illness or disability in which the sufferer seems to be unaware of, or denies, the disability. Patients with anorexia nervosa are often "anosognosic" as they truly do not feel ill and they experience their own behaviors and thoughts as normal. This is not a choice or conscious denial, but rather a feature of brain dysfunction.  Also see Egosyntonic and Denial.

Research on

Early Intervention:

"Higher BMI prior to onset of AN, higher BMI at first discharge, and lower age at first admission predicted a normal BMI (>17.5) at follow-up in a model of logistic regression."
The relevance of body weight in the medium-term to long-term course of adolescent anorexia nervosa. Findings from a multisite study. International Journal of Eating Disorders, January 2009. 

"Moreover, the group with an onset in adolescence but who had been ill for over 3 years had a poor response to both family and individual therapy, suggesting that unless effective treatment is given within the first 3 years of illness onset, the outcome is poor."

The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. The British Journal of Psychiatry.
"The onset of eating disorder psychopathology is most common in the adolescent age group with acute psychopathology perhaps less intractable in these young patients. However, the maintenance of dysfunctional eating patterns over time appears to increase the likelihood for chronicity to develop. With chronicity appearing to be a reliable predictor for poor outcome, prevention through early intervention in younger age groups would likely lead to better outcomes with the prevention of chronicity as a key goal."
Early identification and treatment of eating disorders: prodrome to syndrome.  Early Intervention in Psychiatry Volume 1, Issue 1, pages 27–39, February 2007
"Early intervention in eating disorders (EDs) has been a neglected area. Peak onset is in adolescence, suggesting that early intervention should include parents. We synthesize findings from five key theoretical domains, and present pilot data from a phase-specific early intervention for new onset EDs in young people."
Early intervention in eating disorders: a parent group approach. Early Interv Psychiatry. 2012 Nov;6(4):357-67. doi: 10.1111/j.1751-7893.2012.00373.x. Epub 2012 Jul 3.

 

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