February hosts National Eating Disorders Awareness Week, and I believe it is essential to openly talk about healthy dietary habits and body image expectations. When most people think of eating disorders, the mental image is extreme.

The truth is, problematic eating and exercising habits typically start small and innocuous, often with good intent to be healthier. If these habits go unnoticed or unaddressed, they can manifest into something severe that reduces one’s quality of life and, potentially, becomes life-threatening. These are the truths left out of the exercise program advertisements or the often-well-intended ideals communicated by family, friends, culture, and media. Think about the messages we give one another, verbal or non-verbal. In my line of work, it is relatively common to hear about someone “throwing shade” or “reading” someone by attacking their appearance. It is also common to hear how someone feels or sees themselves because of the small “harmless” comments or snide looks they’ve received from people in their lives. This can be likened to bullying and its disastrous effects. However, our community is known for its pride. It is time our pride shines to illuminate the dark, insidious nature of eating disorders by learning how to identify early warning signs and what we can do on a personal level.

We are still in an ongoing pandemic that complicates our lives in ways we are still figuring out. Our community has been hit by eating disorders at a higher rate than the general population. The National Eating Disorder Agency (NEDA) offers research findings. Of males with eating disorders, 42 percent identify as gay and are seven times more likely to report binge eating and 12 times more likely to report purging than heterosexual males. Non-heterosexual females were approximately twice as likely to report monthly binging than heterosexual females in the last year. What is more concerning, as a psychologist, is that these statistics are from people willing to share their experiences and receive support. How many more of us live without support and are unable to share experiences and receive help?

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It is important to remember the many reasons for the higher occurrence of eating disorders in the LGBTQIA+ community. We have unique stressors that we are forced to face every day. Whether it's holding on to negative comments and feedback from others, including the media, intimidation by bullies, or being the target of discrimination, these stressors can trigger and encourage problematic eating and exercise habits that can lead to an eating disorder. These stressors can also lead to higher levels of anxiety and depression, reinforcing unhealthy coping practices such as poor eating habits, substance use, or other risky behaviors. Of greater importance is that what can be predicted can be prevented, and we can all help prevent adverse health outcomes by offering one another support and knowing warning the signs.

While eating disorders are commonly known for warning signs such as frequent dieting, noticeable under-eating, overeating, and more, they can also be present in hidden ways. Though these overlooked signs do not equal an eating disorder, spotting the lesser-known signs and talking about them to reduce stigma and offer support can significantly change someone’s life. Here are some examples:

Eating Rituals

Cutting or tearing food into small pieces, using excessive condiments, not allowing food to touch on the plate, and arranging food into groups are all signs of eating rituals that may be worth exploring. In many cases, these tactics may be used by those with eating disorders to distract others from noticing how little food they are consuming during a meal.

While these behaviors may provide temporary comfort and relief for individuals who engage in them, they can reinforce disordered eating by successfully going undetected or increasing anxiety, leading to alternative hidden behaviors.

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Extreme Exercising

Like most everything, exercise is great, in moderation. While exercise habits may appear healthy, in excess, they can be signs of an eating disorder. Some forms of purging involve excessive exercising or sweating, despite physical and mental limitations. Exercise may also be used to replace eating a meal, such as during a lunch hour. Some individuals may face guilt from missing a workout or abandoning other parts of their lives, such as family, friends, and responsibilities to meet weight loss goals, look a particular way, or make up for binge eating.

Food Concoctions

We hear about odd food pairings during pregnancies, but they may be a sign of binge eating among those not pregnant. Food pairings such as sugar on scrambled eggs or pickles with chocolate are concoctions. These concoctions are often eaten secretively due to fear of embarrassment or judgment from others. You may find hidden plates or remnants of the foods in their room or other locations in their living space.

Feeling Cold

While we all feel cold at times, those who have eating disorders can have trouble maintaining body temperature and may frequently complain of coldness due to malnutrition or a lack of body fat, which helps the body withstand cold.

grayscale photograph of person reaching to its back Photo by Olenka Kotyk on Unsplash

Body Image Insecurity

Hearing someone make frequent self-deprecating comments about their appearance may be a sign to explore. Those with poor or false perceptions of their physique, weight, or attractiveness may be susceptible to disordered eating and exercising habits. Direct challenges to their perceptions may be the first response; however, consider talking to them about where their perception comes from and if they're open to believing something different or seeking professional help.

Changes in Physical Appearance

Our bodies require nutrients to maintain healthy skin, strong nails, and thick hair. Someone malnourished may lack the necessary building blocks to have a visibly healthy appearance. Physical signs include eroded teeth, thin or fine powdery hair, dry and yellowed skin, nails, sunken cheeks or eye sockets, swollen jawline, or disturbed menstruation or libido.

Remember, prevention is the best medicine. The lack of control in the pandemic, in addition to the barrage of expectations to be a certain way, can be overwhelming, especially if there is no one to talk to about it and work through it. By reducing stigmas within our LGBTQIA+ community, we can offer hope to one another by asking how someone is doing or acknowledging a concern in a supportive way. Symptoms of eating disorders are not always apparent, and identifying warning signs in yourself or others and obtaining help can save lives.

Information and Resources:

National Eating Disorders Association (NEDA): https://www.nationaleatingdisorders.org/help-support/contact-helpline or call/text: (800) 931-2237

The Emily Program: https://www.emilyprogram.com/

Oliver-Pyatt Centers (Monte Nido Affiliate): https://www.oliverpyattcenters.com/lgbtq-community-and-eating-disorders/ or call: (866) 202-8260

National Lifeline: call (800) 273-8255

Dr. William Marsh

About the Author

Dr. William Marsh is a Clinical Director and a primary supervisor for the APA accredited clinical psychology internship program with Southwest Behavioral & Health Services. With all areas of his work, he incorporates his passion for fostering positive interpersonal dynamics that help others identify, support, and reach their goals and dreams. More information about programs and services is available at sbhservices.org.