What Disorders Look Like

I had a comment asking, not quite so politely, why I wasn't skinny if I'd had an eating disorder so long. Why is there an assumption that eating disorder sufferers must be thin? Many aren't.

In this post, I will describe the general trends in weight of sufferers of the four main eating disorders COE, binge-eating, bulimia and anorexia. I won't discuss EDNOS, since the sufferers can have a wide range of symptoms and fall just about anywhere on the spectrum.

I would like to emphasize that I'm generalising. With the number of eating disorder sufferers in the world, there are bound to be exceptions.

Compulsive Over-Eating Disorder

Trying to find a clear definition of this disorder, I've found a lot of sites trying to tell me that this is the same thing as binge-eating. It's not There are similarities and there are wide grey areas between the two where sufferers might be classified as one or the other, but they're not the same.

With COE, the sufferer has an addiction to food. They will use it as a means of coping with emotions. They will eat when they're not hungry, eat until they feel uncomfortably feel uncomfortably full and spend excessive amounts of time thinking about food. COE sufferers might binge, which is why this disorder is often confused with binge-eating disorder, but they also might graze. Grazing refers to constantly picking at food.

Almost all sufferers are overweight or obese. Some might exercise or try to graze only on healthy foods, so the affects might not always be obvious. Generally though, these people are consuming far more calories than is healthy and so will be overweight.

COE is possibly the most misunderstand disorders, because people assume sufferers are just greedy or lazy.

Binge-Eating Disorder and Bulimia

I'm discussing these two together because I feel they fall at either end of a range. With both disorders, the sufferer will binge, where they eat vast quantities of food in a short period of time. With bulimia, the sufferer will try to compensate for their behaviour by various means such as induced vomiting, diet pills, exercise and fasting. With binge-eating disorder, there are no compensatory methods. I say they fall at either end of a range because it's hard to put discrete values on these compensatory methods. There is no clear line where binge-eating disorder becomes bulimia. A sufferer of BED might occasionally exercise or try diets, but not classify as bulimic. A bulimia sufferer might not use some of the more extreme methods and so be closer to being a BED sufferer than others. With these definitions, we are dividing a continuous scale into discrete sections.

Sufferers of binge-eating disorder will be overweight or obese. They will consume large quantities of food in their binges but there will be no purging activities to bring their weight down between binges or to prevent digestion of the food.

If someone displays the symptoms of binge-eating disorder but is not particularly overweight, it is more likely that they are bulimic, even if they don't induce vomiting after binges.

Bulimics can be overweight, or even obese. Bulimia often starts when a person tries to diet but ends up depriving their body of too much food and causing instinctive cravings for fat and sugar. A large number of bulimics will be a healthy weight or slightly overweight. Even with the purging form of bulimia (where the sufferer induces vomiting after a binge) it is impossible to empty the stomach completely and some of the food will be digested. Since the body is in "starvation mode" all the food will be stored as fat. Between binges, the metabolism will be slowed so fewer calories will be burned than for a normal person.

Some bulimics are underweight. This group will almost always perform extreme purging methods and many will have strong anorexic tendencies. Again, we get back to the problem of indistinct boundaries. Where do you draw the line between bulimia with anorexic behaviours and anorexia of the binge-purging type?

So, bulimics might be underweight, sometimes severely, or they might be a healthy weight, or they might be overweight, sometimes severely. That makes it rather difficult to tell if someone is a sufferer just by appearance, though there are more subtle signs.

Purging bulimics will usually have damaged teeth from the vomiting. This is very often not obvious, particularly if the sufferer is aware of the damage and tries not to open their mouth too wide.

Purging bulimics may also have cuts on the back of their hands. However, they could easily try using something other than a finger to induce vomiting if they wish to leave not visible marks.

A large number of bulimics suffer malnutrition or nutrient deficiency. This is because the foods used in binges are often high in fat and sugar. These junk foods are often lacking in nutrients so even if they don't purge, they won't gain any goodness from what they do eat. If the bulimia sufferer fasts or skips healthy meals, they will miss out on essential vitamins. The signs of nutrient deficiency are often invisible. A bulimic may be pale or tired-looking, but this is difficult to judge. If someone tans easily or has a naturally darker complexion, paleness will not be to any extent which makes it noticeable.

Another sign is brittle hair. Sometimes the hair will fall out. This is a symptom that the disorder has in common with anorexia, but because the bulimics get some food, this symptom usually sets in after the disorder has been present a lot longer than would be the case with anorexia.

A person can be bulimic for years before the signs ever become visible.

I think this is one of the major problems that needs to be overcome when a bulimia sufferer seeks help. Generally, they will not look ill. This can lead to people believing they are putting it on for attention or the sufferer being scared to ask for help because they fear that's how it will seem.

Anorexia

This is what people think of when they think of eating disorders: people so thin that their bones are poking through their skin. The physical signs of anorexia are much harder to hide than with bulimia, though sufferers will often try, wearing baggy clothes and severe make-up.

The obvious sign of anorexia is weight. To be classified as anorexic, a person has to be noticeably underweight.

There are other signs, but by the time these are visible, the weight will usually be enough of a giveaway. An anorexic will be pale, tired-looking and will have brittle hair, sometimes falling out in clumps.

There are plenty of other physical symptoms, such as bad teeth and lack of menstruation, but in terms of appearance, you won't need to see these to know that there's a problem.

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So there you have it. A person with an eating disorder may be any weight and the problem may be almost invisible if you don't know the precise signs to look for.

Never assume that a person doesn't have an eating disorder simply because they look a normal weight.