Eating disorders often start off with good intentions: You decide to drop a few pounds and maybe join the office weight-loss pool for motivation. You count calories, join a gym and watch as the pounds fall off and the compliments roll in. But after you reach your goal weight, something clicks. You continue to diet even though you're now at a healthy weight. You skip social outings in lieu of exercise and dread eating in front of friends. Or you discover laxatives as a way to rid yourself of last night's binge.

"While only a small proportion of women who begin a diet end up with an eating disorder, dieting can be a trigger," says Douglas Bunnell, Ph.D., clinical director of The Renfrew Center, an eating disorder treatment clinic with nationwide locations. Diagnosing an eating disorder goes beyond a checklist of certain behavior, however. "It's more about how your weight and shape affects your sense of well-being and self-esteem," says Bunnell. "To what extent is your diet and preoccupation with food dominating your mood, your relationships, your career?" Could you be at risk for one of the three major eating disorders?

Anorexia

Anorexia nervosa affects nearly 1 percent of women, according to a study in Biological Psychiatry [1,2] and has the highest mortality rate of any psychiatric disorder. A bodyweight below 85 percent of normal for weight and height and a preoccupation with food indicates a potential problem. "People with anorexia nervosa lose perspective on what their body's doing and what they're doing with food," says Bunnell. "They don't see themselves as others see them." Once considered a young woman's issue, anorexia now affects more women in their 30s, 40s and 50s as well as men, says Bunnell. Major life changes such as divorce can trigger an eating disorder. "Women who've had an eating disorder at an earlier age are particularly at risk of relapsing during times of stress," says Bunnell. Research also points to a possible hereditary link, making the child of an eating disordered parent more likely to have the disorder.

The motivation behind the behavior may be more telling than the behavior itself, says Katherine A. Beals, Ph.D., R.D., FACSM, CSSD, associate professor of clinical nutrition at the University of Utah and the author of Disordered Eating Among Athletes (Human Kinetics, 2004). Although excess exercise may be indicative of an eating disorder (as a way to burn off a recent binge), it's not always a sign of a problem. "Many athletes train at levels that may seem excessive to most people," says Beals. How you feel after missing a day of exercise is a better indicator. "You should not have feelings of guilt, stress and self-hatred if you skip a workout," says Beals. Similarly, if you eat a well-balanced diet most of the time, occasionally splurging on sweets shouldn't bring up similar negative feelings. You may be at risk if you answer yes to these questions:

  • Do you refuse to eat even when friends tell you you're thin?
  • Do you fear eating in public or with others?
  • Do you have strict "food rules" which, when broken, trigger feelings of  guilt, self-hatred or anxiety?
  • Do you count calories out of a need for "control"?
  • Do you find it hard to concentrate due to intrusive thoughts about eating and food?
  • Do you have extreme body weight/shape obsession or dissatisfaction?
  • Do you have a history of perfectionism?
  • Do you maintain an unhealthy low body weight that compromises normal bodily functions (i.e. menstrual dysfunction, low bone mineral density, prolonged illnesses, injuries)?
  • Does anyone else in your family have an eating disorder?