Eating problems fall within a broad range of eating-related feelings, attitudes, and behaviors. Consider the following continuum:

confidence about body shape/size; flexible eating

preoccupation with body shape/size and eating

distress about body shape/size and eating

eating disorders

Body image confidence is characterized by mostly positive feelings about your body shape and size. In this range, your body is seen as a good part of you that can help you enjoy life. For body confident people, all foods are seen as fitting into an overall healthy diet, without feeling that some foods are “good” and some “bad.” Given the messages we all receive daily about what we “should” look like, it can be challenging to maintain your place at this end of the continuum.

Preoccupation with body shape/size and eating involves frequently thinking about food, eating, and your body. In this range of the continuum, you may find yourself thinking about what you ate at your last meal and feeling that you’ll need to “make up for it.” You may be a little inflexible about what you “allow” yourself to eat. There may be moments where you feel guilty or bad for what you’ve eaten. In addition, you may not like the way certain parts of your body look or you may consistently feel that you could lose a few pounds. In general, however, these feelings do not interfere with enjoying life and engaging in situations involving food.

Eating or Body Image Distress refers to a level where your preoccupation with eating and body size/shape does interfere with daily interactions and activities. You may find yourself thinking a great deal about food or your looks. In this range of the continuum, you may be fairly rigid in your eating patterns, you may work hard to change your body size/shape, and/or you may do some compensating for eating (e.g. vomiting, fasting, extreme exercising). Typically, however, you will not have experienced a significant amount of weight loss.

Eating Disorders most commonly refer to Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder.

Anorexia Nervosa involves a significant fear of gaining weight or becoming fat and a restriction of food intake to the point of significant weight loss. Women with Anorexia Nervosa stop menstruating. People who struggle with Anorexia Nervosa may or may not engage in compensating behaviors such as extreme exercising.

Bulimia Nervosa involves binge eating episodes during which the person eats large amounts of food and feels unable to control the eating. The person may also engage in behaviors (e.g., vomiting, use of laxatives, over exercising) to try to offset food eaten. Bulimia Nervosa describes a pattern where cycles of binge eating and compensating occur at least twice a week for three months. People struggling with Bulimia Nervosa often evaluate themselves extremely critically on the basis of their body shape and weight.

Binge Eating Disorder describes a pattern where binge eating occurs at least 2 days a week for a 6 month period, but without compensating behaviors.

Difficulties Often Associated with Eating Problems

People who struggle at the Preoccupation, Distress, or Eating Disorder levels often experience a number of behavioral, emotional, psychological, social, and/or physical symptoms. The following checklist includes many of these symptoms. The checklist is not intended to determine whether you have an eating disorder. Its purpose is to help you think more specifically about your behaviors and feelings, regardless of your problem level. If you feel concerned about any of these items, you might want to speak with a counselor, physician, or nutritionist about your concerns. To help in that discussion, you may want to place a check next to the symptoms you experience, and then bring the checklist with you.


Routinely restricting calorie or food intake for the primary purpose of feeling more in control (e.g. “I’m going to limit how many calories I eat” or “I will only eat ‘good’ things”).

Eating episodes during which you feel out of control regarding your eating.

Feeling compelled to exercise (sometimes excessively) in order to compensate for food eaten.

Self-induced vomiting.

Temporary fasting in order to compensate for food eaten.

Drug use to control eating or weight gain (e.g. diet pills, amphetamines, laxatives, diuretics, etc.)

Rituals around food (e.g. not allowing food to touch your lips; cutting your food into small pieces).

Frequently weighing yourself.

Counting calories.


Depressed mood

Mood swings


Guilt about eating

Intense fear of fat

Low self-esteem

Eating when upset

Emotional discomfort after eating

Difficulty tolerating the feeling of being full

Shame about eating behaviors



Preoccupation with food

High need for structure

Rigid eating schedule

Alternating between being in control of eating and “letting go”

Difficulty concentrating

Fluctuating body image (i.e. having “fat days” and “thin days”)


Frequently eating alone

Eating in secret

Avoiding friends

Avoiding situations where food is involved

Strained relationships due to food related issues.

Difficulty being assertive


Amenorrhea (i.e. menstruation has stopped)

Throat problems

Frequent weight fluctuations

Significant weight loss or gain

Swollen glands

Hair loss

Puffy cheeks

Broken blood vessels under eyes



Unexplained tooth decay

Development of fine hairs all over your body

How Do People Overcome Eating Problems?

It is important to remember that there is hope for those who suffer from eating problems. A variety of treatment approaches have been effective in preventing, reducing, or stopping the troublesome behaviors and in developing new ways of coping with underlying feelings.

An important first step in overcoming an eating problem is to acknowledge that you have an eating problem. Often this can be the most difficult step. An important aspect of this step is to realize that your distressing eating behaviors and feelings are about more than just food.

The next step is to talk with professionals who are experienced in working with people who have eating problems. Treatment for eating problems can be composed of many elements including

medical monitoring, nutritional counseling, education, and individual and/or group counseling. Along with providing relief from having to keep such an important issue secret, these professionals can help you improve self-esteem, challenge negative body image messages, and develop healthy and supportive relationships, as well as guide you toward a healthier lifestyle.

Finally, some people, after having regained balanced eating attitudes and behaviors, find it helpful to take some proactive steps to change things that contribute to the development of eating problems. These steps may include working to change cultural expectations and oppressive attitudes about size and shape as well as encouraging others to find coping strategies that are healing and productive.


Center for the Study of Anorexia and Bulimia

1841 Broadway 4th Floor

New York, NY 10023


National Association of Anorexia Nervosa and Associated Disorders (ANAD)


National Eating Disorders Association

Toll-Free Information & Referral Helpline 1-800-931-2237


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