How Do I Know If I Have an Eating Disorder?

By Leah Tully M.A. (Counselling Psychology), RN, IBCLC · Tully Counselling Psychology · Edmonton, Alberta

Eating disorders are among the most misunderstood mental health conditions. Many people who are struggling assume that what they’re experiencing doesn’t “count,” that it’s not serious enough, or that they don’t look the way they imagine an eating disorder should look. This misconception keeps a lot of people from getting help far longer than necessary.

The truth is that eating disorders exist on a wide spectrum, affect people of all body sizes, ages, and genders, and often don’t fit the narrow picture that’s been portrayed in media for decades. If your relationship with food, eating, or your body is causing you significant distress, that matters, regardless of whether it meets a clinical threshold.

This article walks through the different types of eating disorders, the signs to watch for, and when and how to seek support, particularly for those in Edmonton and across Alberta.

What Is an Eating Disorder?

An eating disorder is a serious mental health condition characterized by persistent disturbances in eating behaviour and a preoccupation with food, weight, or body image that significantly interferes with physical health, psychological wellbeing, or daily functioning. Eating disorders are formally diagnosed using criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), though many people experience significant distress and functional impairment without meeting the full criteria for any single diagnosis.

In Canada, it is estimated that between 840,000 and 1.75 million people have symptoms sufficient for an eating disorder diagnosis (Mental Health Research Canada, 2024; Deloitte, 2024). Eating disorder hospitalizations among children and youth in Canada increased significantly during the COVID-19 pandemic and remain elevated, highlighting the urgency of early identification and access to care (Toigo et al., 2024).

Eating disorders are not a lifestyle choice, a phase, or a reflection of vanity. They are complex mental illnesses with biological, psychological, and social roots and they are treatable.

Types of Eating Disorders

Anorexia Nervosa

Anorexia nervosa is characterized by restriction of food intake leading to significantly low body weight, an intense fear of weight gain, and a distorted experience of body weight or shape. It is important to note that anorexia can occur in people across all body sizes. “Atypical anorexia nervosa” is a recognized diagnosis for individuals who meet all criteria for anorexia but whose weight remains within or above the “normal” range due to a higher starting weight.

Bulimia Nervosa

Bulimia nervosa involves recurrent cycles of binge eating which means consuming a large amount of food in a discrete period with a sense of loss of control and is followed by compensatory behaviours such as self-induced vomiting, laxative use, fasting, or excessive exercise. These behaviours are typically accompanied by significant shame and secrecy. Bulimia nervosa often goes undetected because individuals may not show visible weight changes.

Binge Eating Disorder (BED)

Binge eating disorder is the most common eating disorder. It involves recurrent episodes of binge eating, which means eating a large amount in a short period, with a felt loss of control, without the compensatory behaviours seen in bulimia. Episodes are associated with feelings of shame, disgust, and distress. BED is not about a lack of willpower; it is a recognized mental health condition with strong evidence-based treatments.

Orthorexia

Orthorexia is not yet a formal DSM-5 diagnosis, but it is increasingly recognized by clinicians. It involves an obsessive focus on eating “clean,” “pure,” or “healthy” foods to a degree that becomes rigid, distressing, and life-limiting. While not about weight loss per se, it shares many psychological features with other eating disorders, including perfectionism, anxiety, and restriction.

ARFID (Avoidant/Restrictive Food Intake Disorder)

ARFID is characterized by highly restricted food intake that is not driven by concerns about weight or body image. It may involve extreme sensitivity to the sensory properties of food (texture, colour, smell), a fear of choking or vomiting, or a general lack of interest in eating. ARFID affects children, adolescents, and adults and can lead to significant nutritional deficiencies and psychosocial impairment.

Other Specified Feeding or Eating Disorder (OSFED)

OSFED is a diagnostic category for people who experience clinically significant eating disorder symptoms that cause real distress and functional impairment but do not fully meet the criteria for another specific diagnosis. OSFED is not a “lesser” diagnosis. It is associated with the same level of psychological suffering and medical risk as other eating disorders, and the people who receive it deserve the same quality of care.

What Are the Signs of an Eating Disorder?

Signs of an eating disorder can be physical, emotional, or behavioural — and they often appear in combination. It is important to remember that you do not need to exhibit all of these signs, and eating disorders do not always look the way they are depicted in popular media.

Behavioural Signs

• Restricting food intake, skipping meals, or cutting out entire food groups
• Eating in secret or hiding food
• Rigid rules around “safe” and “unsafe” foods
• Frequent trips to the bathroom during or after meals
• Using laxatives, diet pills, or other compensatory behaviours
• Excessive or compulsive exercise, particularly when injured or unwell
• Food rituals — cutting food into small pieces, eating in a specific order, excessive chewing
• Withdrawing from social situations involving food
• Preparing food for others but not eating oneself

Psychological and Emotional Signs

• Preoccupation with food, calories, weight, or body shape that feels intrusive or difficult to control
• Intense fear of weight gain or eating certain foods
• Feeling out of control around food
• Significant guilt, shame, or distress after eating
• Body image that does not reflect reality (seeing yourself as larger than you are)
• Low self-esteem that is closely tied to food choices or body size
• Feeling that your worth as a person depends on what or how much you eat
• Anxiety, depression, or irritability — particularly around mealtimes

Physical Signs

• Significant weight changes (loss or gain)
• Feeling cold frequently, fatigue, or dizziness
• Hair thinning or loss
• Gastrointestinal problems — bloating, constipation, acid reflux
• Loss of menstrual periods or irregular cycles
• Poor wound healing or frequent illness
• Swollen jaw or calluses on knuckles (signs of purging behaviours)

It is also worth noting that you do not need to be underweight to have an eating disorder. The majority of people with eating disorders are in bodies that fall within or above the “normal” weight range, and using weight as a screening tool misses the vast majority of those who need support (Balasundaram & Santhanam, 2023).

Do You Need a Diagnosis to Get Help?

No. A formal diagnosis is not required to benefit from eating disorder therapy, and many people who struggle significantly with food, eating, and body image do not meet the clinical criteria for a specific disorder.

If your relationship with food is causing you distress or if it takes up significant mental space, affects your quality of life, or shapes your self-worth, that is sufficient reason to seek support. Disordered eating exists on a continuum, and the suffering it causes is real regardless of where on that continuum you fall.

Reaching out early also makes a meaningful difference to outcomes. Research consistently shows that earlier intervention is associated with better recovery (Austin et al., 2022).

How Are Eating Disorders Treated?

Eating disorders are treated with a combination of psychological therapy, nutritional support, and when needed, medical care. The most well-researched psychological treatments include:

Cognitive Behavioural Therapy — Enhanced (CBT-E)

CBT-E is widely considered the first-line outpatient treatment for eating disorders across a range of diagnoses, including bulimia nervosa, binge eating disorder, and transdiagnostic presentations (Kaidesoja et al., 2022; de Jong et al., 2018). It works by addressing the specific thoughts, beliefs, and behaviours that maintain the eating disorder, including perfectionism, low self-esteem, and emotional dysregulation. In a head-to-head randomized trial comparing CBT-E to interpersonal psychotherapy, CBT-E produced a remission rate of 65.5% at post-treatment compared to 33.3% for IPT (Fairburn et al., 2015).

Acceptance and Commitment Therapy (ACT)

ACT focuses on developing psychological flexibility, which means the ability to experience difficult thoughts and feelings without being controlled by them. A systematic review of ACT for eating disorders found growing evidence for its effectiveness, particularly for improving body image, reducing dietary restraint, and enhancing quality of life (Linardon et al., 2022).

Dialectical Behaviour Therapy (DBT) Skills

DBT skills, particularly distress tolerance and emotion regulation, are especially useful for individuals whose eating disorder is closely connected to emotional distress, impulsivity, or difficulty managing intense feelings. DBT-informed approaches are increasingly incorporated into eating disorder treatment.

Intuitive Eating Principles

Intuitive eating is an evidence-supported framework that helps people reconnect with their body’s internal hunger and fullness cues, reject diet culture, and build a more peaceful relationship with food. A systematic review and meta-analysis found that intuitive eating interventions were associated with significant reductions in disordered eating and improvements in body image and quality of life (Babbott et al., 2022).

At Tully Counselling Psychology, treatment is always tailored to the individual. There is no one-size-fits-all approach to eating disorder recovery, and the pace and direction of therapy are always guided by you.

When Should I Seek Help?

If any of the following apply to you, it is worth reaching out to a therapist who specializes in eating disorders:

• You spend a significant portion of your day thinking about food, weight, or your body
• Eating (or not eating) is affecting your relationships, work, or daily life
• You feel out of control around food, or feel the need to control food very rigidly
• You are engaging in compensatory behaviours (purging, excessive exercise, restriction)
• You feel intense shame or guilt after eating
• Your self-worth is closely tied to what you eat or how your body looks
• You have been avoiding food situations, social events, or activities because of food or body concerns

You do not need to wait until things feel “bad enough.” You deserve support now.

Getting Support in Edmonton and Across Alberta

Eating disorder therapy in Edmonton is available at Tully Counselling Psychology, both in-person and virtually throughout Alberta. As a Registered Nurse and Counselling Therapist, Leah Tully brings a rare depth of understanding to this work, one that holds the physical and emotional dimensions of eating disorders together.

Recovery is not linear, and there is no single path. What matters is that you have knowledgeable, compassionate support alongside you. If you recognize yourself in anything you have read here, please reach out. A first conversation is always warm, confidential, and without pressure.