I'm a psychologist - the subtle red flags someone you love has an eating ... trends now

Are you worried about someone's relationship with food – or, indeed, your own?

From an extreme obsession with 'clean' eating to point-blank refusing to touch certain foods, there are often obvious signs all is not right.

Not only that, but excessive exercise and gym-going can also be part of the wider picture.

But when is it just healthy living, and when should you be worried that it's become something more concerning?

Here, DR JOANNA SILVER, lead psychological therapist at Orri, an eating disorder treatment clinic, reveals the signs to look out for, how you can approach a loved one you're concerned about, and why – contrary to popular belief – eating disorders aren't just about food...

Eating disorders are on the rise  

Hospital admissions for eating disorders have increased by 84 per cent in the last five years, according to figures released last year by the Royal College of Psychiatrists.

Children and young people are the worst affected and there was a sharp rise in boys and young men being treated,

But there has been an alarming increase in adults, too.

These figures (and hospital admissions are just part of the story) highlight that, despite what many think, eating disorders don't just affect young, white girls.

In fact, you can be perceived as the pinnacle of health, be a normal weight and still be suffering with a hidden eating disorder.

Most eating disorders aren't actually about food  

An eating disorder (or exercise addiction) may develop when someone is going through a particularly challenging time in life.

This might include being bullied at school, going to university, being made redundant, menopause, going through a divorce, becoming a new parent or saying goodbye to children going to university.

The feeling of being overwhelmed by the experience, or a series of experiences, can prompt us to feel unsafe and uncertain in our lives – perhaps also triggering feelings such as anxiety or depression.

This, in turn, can trigger us to develop disordered behaviours that provide a false sense of security and safety, such as controlling our food or body weight.

Common signs of eating disorders  

It's crucial to remember these signs are not prescriptive. 

The person may not have all of them, but that doesn't mean that they don't have an eating disorder. 

Signs can also change and evolve over time, for example someone may initially be diagnosed with anorexia then develop bulimia later on in their illness.

OSFED: Other specified feeding/eating disorder

This actually accounts for the highest percentage of eating disorders – it's an umbrella term for when someone doesn't fit into any of the categories below but still has a valid eating disorder.

For example, a person may have all the signs of anorexia, but their weight might not be quite within the anorexic range. Or they may have symptoms of bulimia or binge eating, but don't have episodes often enough to meet the criteria for diagnosis.

This is really important as people can feel invalidated if they don't meet all the criteria – yet they are still very much suffering, and the implications of their eating disorder can be just as serious and dangerous.

Anorexia nervosa  

Anorexia typically involves restrictive eating due to an irrational fear of gaining weight and/or distorted body image.

It may also be accompanied by excessive exercise and/or cycles of binging and then purging (trying to 'undo' the effects of the binge through processes such as vomiting, laxative overuse, fasting or excessive exercise), as a way of compensating for any food eaten.

Common signs:

Food and/or exercising has started to dictate life decisions Preparing meals and eating them has become a challenge. The person may be counting calories, be trying to make the 'perfect' meal, or just generally extremely anxious around food The person has employed food 'rituals' in the preparation or eating of food such as eating at a very slow pace, using a very small knife and fork to eat, cutting food into tiny pieces, eating foods on their plate in a specific order, making sure that foods on a plate do not touch Social withdrawal and isolation Preoccupation with size and body image Insomnia or struggling to sleep/stay asleep Low self-esteem and insecurity Perfectionism, often at the expense of relationships May be accompanied by depression and anxiety

Bulimia nervosa 

With bulimia, people tend to eat large quantities of food – called bingeing – often to provide relief in times of stress, and then purge it from their system.

Purging doesn't always take the form of self-induced vomiting. 

Sometimes, someone might rid their system of calories by fasting, exercising compulsively, or taking laxatives or diuretics.

People who suffer with bulimia are often high-functioning individuals with a 'normal' weight' and who conceal their symptoms, so the illness goes undetected.

Common signs:

Eating uncontrollably (binging) and/or fear of eating uncontrollably Vomiting, excessive exercise Secretive eating and isolation The person will often feel disgusted, ashamed and repulsed by themselves after a binge and/or purge Perfectionism Depression and other conditions such as OCD Low self-esteem Preoccupation with body image and appearance

Binge eating disorder 

This is where people eat large quantities of food – bingeing – but don't typically engage in compensatory behaviours such as purging, as with bulimia.

People often talk of entering a trance-like state when bingeing, or becoming preoccupied with planning their binges as they go about their everyday lives.

Sometimes it can be hard to distinguish between

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