- Person refuses to maintain normal body weight for age and height.
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- Weighs 85% or less than what is developmentally expected for age and height.
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- Young girls do not begin to menstruate at the appropriate age. Puberty is delayed in both sexes.
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- In women, menstrual periods stop. In men, levels of sex hormones fall. Sex drive disappears or is much diminished.
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- Person denies the dangers of low weight.
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- Is terrified of becoming fat.
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- Is terrified of gaining weight even though s/he is alarmingly underweight.
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- Reports feeling fat even when emaciated.
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- In addition, anorexia nervosa often includes depression, irritability, withdrawal, and peculiar behaviors such as compulsive rituals, strange eating habits, and division of foods into "good/safe" and "bad/dangerous" categories. Person may have low tolerance for change and new situations; may fear growing up and assuming adult responsibilities and an adult lifestyle. May be overly engaged with or dependent on parents or family. Dieting may represent avoidance of, or attempts to cope with, the demands of a new life stage such as adolescence or adulthood.
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- Person diets, becomes hungry, and then binge eats in response to powerful cravings and feelings of deprivation.
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- Feels out of control while eating.
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- Fears gaining weight and frantically tries to "undo" the binge. Vomits, abuses laxatives, exercises, or fasts to get rid of the calories.
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- Swears to "be good," to never binge eat again, but then continues to restrict food intake which starts yet another repeat of the deprivation-hunger-binge-purge cycle.
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- Believes self-worth requires being thin. (It does not.)
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- May shoplift, be promiscuous, and abuse alcohol, drugs and credit cards. May engage in risk-taking behavior and have other problems with impulse control. Person acts with little thought of consequences.
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- Weight may be normal or near normal unless anorexia is also present.
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- Like anorexia, bulimia can kill. Even though bulimics put up a brave front, they are often depressed, lonely, ashamed, and empty inside. Friends may describe them as competent, glamorous, adventurous and fun to be with, but underneath, where they hide their guilty secrets, they are hurting. Feeling unworthy, they have great difficulty talking about their feelings, which almost always include anxiety, depression, self-doubt, and deeply buried anger.
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- The person binge eats large amounts of food frequently and repeatedly.
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- Feels out of control and unable to stop eating during binges.
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- May eat rapidly and secretly, or may snack and nibble all day long.
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- Feels guilty and ashamed of binge eating.
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- Has a history of diet failures
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- Tends to be depressed and obese.
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- People who have binge eating disorder do not regularly vomit, overexercise, or abuse laxatives like bulimics do. They may be genetically predisposed to weigh more than the cultural ideal (which at present is exceedingly unrealistic), so they diet, make themselves hungry, and then binge in response to that hunger.
Or they may eat for emotional reasons: to comfort themselves, avoid threatening situations, and numb emotional pain. Regardless of the reason, diet programs are not the answer. In fact, diets almost always make matters worse. Information reported in the March 2003 New England Journal of Medicine suggests that for some people, but not all, a genetic flaw in combination with lifestyle factors can predispose to binge eating and subsequent obesity.
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