The first warning signs that your college-age child, or your friend in college, may have an eating disorder is often not what she does but what she says.

Try tuning in to how she talks (and how much she talks) about herself.

“I’m so fat. I’m a pig.”

“I wish I looked like her.”

“I’m on a diet.”

Of course not everyone who wishes she was thinner or looked a bit more like a supermodel has an eating disorder, but this kind of self-loathing language can be a warning flag. When someone begins to show constant preoccupation with thinness, diet, or body image it might be time to listen a little more closely.

Hating her body

“I couldn’t stop comparing myself to every girl I saw,” says Jessica, who struggled with anorexia during her late teens and early twenties. ” ‘Am I thinner than her? Am I fatter?’ It was endless, and I was almost always the fat one. It was all I thought about so it was all I wanted to talk about.”

This kind of constant self-criticism is pretty common, and can be a clue to friends, parents, and clinicians that an eating disorder may be developing.

“Eating disorders are not about vanity or just the desire to be thin,” explains Dr. Alison Baker, “but it’s important not to dismiss that piece of it because it can be the language of distress. In a lot of cases this is the first clue. People express their anxieties and complaints by wishing they looked more like someone in their community or a movie star.”

College is a place where you can find people to participate in almost anything you’re interested in, and criticizing your body is no exception. Now 25 and in recovery, Jessica says it was easy to get other girls talking about how much they hated their bodies—even if they didn’t have an eating disorder. “We were all worried about our weight. Someone was always willing to go down the rabbit hole with me,” she says.

Related: Eating Disorders and College

Weighty worries

While some weight concerns are normal, the mix of anxiety and the constant pressure to be thin can be a very dangerous mix for some. A history of serious anxiety is a strong indicator for eating disorders during college.

Dr. Baker, a child and adolescent psychiatrist, notes that if a student seems very stressed out, or down, and has been obsessing over losing weight, it’s important to intervene.

“If she’s reporting that she’s unhappy or very anxious, and she looks very different than the last time you saw her, then it’s time to ask,” says Dr. Baker. Eating disorders include anorexia, bulimia, and binge eating disorder, and each disorder has a different set of signs.

Anorexia

Anorexia is characterized by an intense fear of gaining weight. People with anorexia go to extremes, restricting food and over-exercising to prevent weight gain.

Signs that someone might be anorexic include:

Obsession with getting thinner: Constant preoccupation with gaining weight, calories, food intake, or food ingredients that might be “fattening.” A general obsession with body size and weight.

Excessive exercising: This goes way beyond being a gym rat. If someone spends hours running on the treadmill to “work off” a small snack, or insists on going jogging outside even when she’s sick or the weather’s bad, that may be cause for concern.

Food avoidance, hiding and lying: People with eating disorders often try to hide what’s happening from friends and family, which can make it harder to spot a problem. This might mean:

  • Skipping meals, or parties where eating or drinking are the main event.
  • Avoiding the dining hall
  • Always saying she’s had a big breakfast or is in “too much of a hurry” to eat.
  • Wearing baggy clothes to hide weight loss.

A need for control: People at risk for anorexia are perfectionists and often set impossible goals for themselves, whether it’s getting straight A’s, having a super-clean room, or being the president of every club on campus. When the chaos of college makes it hard to control their environment, people with anorexia try to alleviate stress and anxiety by controlling the one thing they feel in charge of—their bodies.

Serious weight loss: Losing a ton of weight, especially in a short period of time, is a sign of real danger. If someone looks painfully thin it’s time to seek help.

Bulimia

Like anorexia, bulimia is a serious eating disorder characterized by an overpowering obsession with body image and desire to lose weight. However, it takes a very different form when it comes to signs and symptoms.

Bulimia is a cycle of binging—eating large amounts of food in a short period of time—and purging, which could include self-inducing vomiting, abusing laxatives or diuretics, over-exercising, or a combination of all three. People with bulimia aren’t necessarily noticeably thin, which can make it harder to spot.

Signs someone might be bulimic include:

Binging and purging:

  • Buying and hiding large amounts of food
  • Hiding uneaten food or wrappers from binges
  • Inventing reasons to go to the bathroom to purge—if someone is always disappearing after a meal, that’s a big tip-off.
  • Bad breath, swelling under the jaw or cheeks, tooth discoloration, acid reflux, or even knuckle calluses from self-induced vomiting.

Obsessing about weight: Talking about weight and size more than is usually considered normal. Constantly comparing her body to the bodies of friends, strangers, and movie stars—and always finding herself wanting.

Withdrawal from social events:

  • Skipping parties where eating is important
  • No longer engaging in things she used to enjoy.
  • Passing on activities that interfere with the routine of binging and purging.

Binge eating disorder

People who struggle with binge eating disorder (BED) will frequently eat large amounts of food, but unlike a person with bulimia, they don’t engage in any of the “purging” behaviors. The disorder is different from anorexia and bulimia because people with BED are not preoccupied with thinness, although they may struggle with poor self-esteem and often feel guilty and ashamed over any weight they’ve gained from their binges.

People with binge eating disorder may be feeling overwhelmed or out of control—they may struggle with managing stress or difficult emotions—and use food as a way to comfort themselves. Binge eating disorder is often associated with depression.

Signs that someone may have BED include:

Rapid weight gain: Binge eating leads to weight gain and can cause serious health problems including heart disease, diabetes, high blood pressure, and others. Kids who are binge eating may be wearing really baggy clothes to hide weight gain.

Hiding out: For people with BED, binging is usually done in private. If someone is making excuses to eat alone, hiding food around her room, or you’ve notice large amounts of food missing from the dorm, it might be a sign of trouble.

Depression and withdrawal: People with BED often struggle with feelings of guilt and shame after a binge, becoming depressed and isolated which perpetuates the binge-eating cycle.

Related: Helping College Kids With Depression

Eating disorders don’t discriminate

Recognizing an eating disorder sometimes means looking beyond the typical stereotype.

Eating disorders are more prevalent in females, but approximately 10% of people with anorexia and 40% of those with binge eating disorder are male. Boys and men with an eating disorder often go overlooked. If the signs are there, don’t discount the possibility of an eating disorder because someone doesn’t fit the stereotype.

Read More:
How to Help Someone With an Eating Disorder in College

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