In Part 1 of this Guide, we focused on strategies for preventing the development of eating disorders in children. In Part 2, we will turn to the warning signs of eating disorders, how to get help, and some Internet resources for families in need.

Signs and Symptoms of Eating Disorders

Here are lists of some of the “red flags” you might notice with eating disorders.

Anorexia Nervosa:

• Weight loss;
• Loss of menstruation;
• Dieting with great determination, even when not overweight;
• “Fussy” eating -- avoiding all fat, or all animal products, or all sweets, etc.;
• Avoiding social functions that involve food;
• Claiming to “feel fat” when overweight is not a reality;
• Preoccupation with food, calories, nutrition, and/or cooking;
• Denial of hunger;
• Excessive exercising, being overly active;
• Frequent weighing;
• “Strange” food-related behaviors;
• Complaints of feeling bloated or nauseated when eating normal amounts;
• Intermittent episodes of binge eating;
• Wearing baggy clothes to hide weight loss; and
• Depression, irritability, compulsive behaviors, and/or poor sleep.

Bulimia Nervosa:

• Great concern about weight;
• Dieting followed by eating binges;
• Frequent overeating, especially when distressed;
• Binging on high calorie salty or sweet foods;
• Guilt or shame about eating;
• Using laxatives and/or vomiting and/or excessive exercising to control weight;
• Going to the bathroom immediately after meals (to vomit);
• Disappearing after meals;
• Secretiveness about binging and/or purging;
• Feeling out of control;
• Depression, irritability, anxiety; and
• Other “binge” behaviors (involving, for example, drinking, shopping, or sex).

Getting Help

Many parents or concerned others do not know how to approach a person they’re worried about and getting them the help they may need. People can feel very helpless, scared, and, at times, angry when someone they love develops an eating disorder. Help is available, however, and many people and families can grow stronger as a result of seeking help.

If you notice several “red flags,” tell the person displaying these behaviors that you are concerned about what you have observed. People with more restrictive (or anorexic) symptoms are much more likely to deny a problem and to resist suggestions that they eat more or see a therapist. The restriction may actually be making them feel “good” in a way, and they may be terrified of losing the “control” they feel they’ve begun to achieve. It can be helpful to provide information and educational materials, or to suggest that the person see a nutritionist for a consultation.

If denial of the problem persists, and the restricting behavior continues or worsens, younger people may have to be told that they need to see someone for help. They can be given choices: whether they are more comfortable seeing a female or male therapist, for example, or whether they prefer to go alone or with family. With older family members, intervention may not be so simple. In these cases, it may be like dealing with someone who has a drinking problem: you can repeatedly remind the person of your concern and encourage help, you can get help for yourself, but you may not be able to “make” that person change. If you are concerned about imminent dangers to health (as when a person has lost a great deal of weight and looks unwell), bringing a person to a doctor or even a hospital emergency room for evaluation is appropriate.

Individuals who binge and purge are often very distressed about what they are doing and may be afraid of confronting the problem (for example, they may be afraid that they will get fat if they st