Diagnosing Eating Disorders

Being obsessed with body weight and body size are signs of an eating disorder. Learn about other symptoms and tests that can be performed for diagnosis.

Because consequences of eating disorders can be severe, early diagnosis is crucial. Between one and two of every 10 cases of anorexia leads to death from starvation, cardiac arrest, medical complications or suicide. Eating disorders in general can disrupt physical and emotional growth in teenagers and can lead to premature osteoporosis, a condition where bones are weakened and more susceptible to fracture; increase infertility; and raise the risk of miscarriages or low-birth-weight babies. Anorexia may be especially deadly for women with insulin dependent diabetes if they omit or under-use insulin to control their weight. Insulin therapy can, sometimes, cause weight gain but changing insulin dosages to lose weight can be very dangerous and life-threatening.

Among the physical effects of anorexia are:


  • anemia, often caused by iron deficiency, which reduces the blood's ability to carry oxygen and causes fatigue, difficulty breathing, dizziness, headache, insomnia, pale skin, loss of hunger and irregular heart beat
  • elevated cholesterol
  • low body temperature and cold hands and feet
  • constipation and bloating
  • shrunken organs
  • low blood pressure
  • slowed metabolism and reflexes
  • slowed heart rate, which can be mistaken as a sign of physical fitness
  • irregular heartbeat, which can lead to cardiac arrest

Women with anorexia have an intense dread of becoming fat. Food and body size become obsessions. It is common for women with anorexia, for example, to collect recipes and prepare gourmet meals for family and friends, but not eat any of the food themselves. Instead, they allow their bodies to wither away and "disappear," gauging their hunger as a measure of their self-control. Women with anorexia diet, not to lose a few pounds, but because they want to improve their feelings of self-esteem and love. Depression and insomnia often occur with eating disorders.

If you have anorexia, you may tend to keep your feelings to yourself, seldom disobey authority and are often described as "too good to be true". You also are likely to be a perfectionist, a good student, and excellent athlete. Anorexia is common in dancers and competitive athletes in sports such as gymnastics and figure skating where success depends not only on athletic performance, but on having the "perfect" body, as well.


Anorexia and Bulimia Nervosa Symptoms

Symptoms of anorexia nervosa can include:

  • distorted body image and intense persistent fear of gaining weight
  • excessive weight loss
  • menstrual irregularities
  • excessive body/facial hair
  • compulsive exercise

Bulimia nervosa involves using diet for emotional control. Binging becomes a way to relieve stress, anxiety or depression. Purging the calories relieves the guilt of overeating. It becomes a habit. Women with bulimia are usually more impulsive, more socially outgoing, and less self-controlled than those with anorexia. They are also more likely to abuse alcohol and other substances.


Bulimia is harder to recognize than anorexia. Generally, the symptoms are subtle, and bulimic women aren't necessarily thin. Even so, if you have bulimia, you may be starving nutritionally because you are not getting the vitamins, minerals and other nutrients you need.

Symptoms of bulimia include:

  • preoccupation with food
  • binge eating, usually in secret
  • vomiting and extreme use of laxatives or diuretics after binges
  • menstrual irregularities
  • compulsive exercise

Among the physical effects of bulimia are:

  • dehydration
  • chronic diarrhea
  • extreme weakness
  • damage to bowels, liver and kidneys
  • electrolyte imbalance and low potassium levels, which lead to irregular heartbeat, and in some cases, cardiac arrest
  • tooth erosion from repeated exposure to stomach acid
  • broken blood vessels in the eyes and a puffy face due to swollen glands, which are telltale signs of self-induced vomiting
  • cuts and calluses across the fingers from thrusting a hand into the throat
  • ruptured esophagus due to forced vomiting

Still, the outlook for bulimics is generally better than it is for anorexics. Women with bulimia are less likely to require hospitalization, although 20 percent of women still struggle with the disease after 10 years.

Symptoms of binge eating include:

  • episodes of binge eating when not physically hungry
  • frequent dieting
  • feeling unable to stop eating voluntarily
  • awareness that eating patterns are abnormal
  • weight fluctuations
  • depressed mood
  • feelings of shame
  • antisocial behavior
  • obesity

Medical consequences of binge eating are:

  • high blood pressure
  • high cholesterol
  • gall bladder disease
  • diabetes
  • heart disease
  • certain types of cancer


Eating Disorder Tests

Your health care professional may draw some of your blood to conduct the following tests to assess your likelihood of having an eating disorder:

  • Electrolyte balance - to check for dehydration, malnutrition, self-induced vomiting, and laxative and/or diuretic abuse. Electrolytes are a specific combination of minerals that your body needs to maintain balance to function properly. Common symptoms of imbalance are leg cramps, heart palpitations, high or low blood pressure and swelling in the legs and feet. An electrolyte imbalance can lead to kidney failure, heart attack and death.
  • B12 and folic acid intake assessment - because of the important role folic acid and the B complex vitamins play in the onset of depression and anxiety. Lack of B12 and folic acid can lead to, or be caused by problems with the metabolism of protein, carbohydrates and fat, and with the body's ability to absorb nutrients.
  • Blood glucose (blood sugar) level - can determine things like hypoglycemia and diabetes; a disturbance can be caused by dehydration and malnutrition; an elevated or low blood sugar level can be dangerous.
  • Liver function tests - can be important in determining things like gallbladder and liver disease
  • Cholesterol measurements - binge eating can affect blood cholesterol levels
  • Thyroid function tests - to rule out any possible problems with the thyroid, which can affect weight; this can also be an important test for a person in recovery who may be having a hard time gaining or losing weight.
  • Urine sample - for a complete analysis of your urine. This urinalysis will help accurately evaluate kidney function, urine sugar levels and ketone levels, as well as help diagnose systemic diseases and urinary tract disorders. Ketones, which can accumulate in the blood rather quickly when the body is starved of food and nutrients, indicate the body is "eating its own fat" for energy. Accumulation of ketones in the blood can lead to ketoacidosis, which can cause coma and death.

Your health care professional may also take a blood pressure reading, a bone density test and an electrocardiogram, which finds heartbeat irregularities.


Copyright 2003 National Women's Health Resource Center, Inc. (NWHRC)