Disordered eating: warning signs, and where to get help

Why we wrote this, and the tension inside it

I am Jonah. I did eating-disorder peer support for years before I had ever heard of these medicines, and when they arrived in the lives of people I was already sitting with, I did not have a tidy answer for anybody. I still do not. I have a practice and I have this page.

Here is the tension, said plainly, because pretending it is not there would be worse than naming it. A drug that reduces appetite is not a neutral object in a life that has had a difficult relationship with appetite. Some members of this community have found it steadying — the negotiation quietened, the day got its hours back, eating became an ordinary thing they did rather than a subject. Other members have found it dangerous, because it handed them a way to do something they had spent years learning not to do, and it handed it to them with a prescription attached. Both of those are true. Neither cancels the other. Anyone who tells you this question is simple is selling you something, and there is a great deal being sold.

So this guide is not a warning about the medicine. It is a way of noticing direction of travel — yours, or someone else’s — early, while noticing is still cheap.

What a warning sign actually is

People expect a warning sign to be a behaviour. Something dramatic and visible, a thing you could point at across a kitchen. In my experience it almost never announces itself like that, and waiting for the dramatic version is how years go by.

A warning sign is a direction of travel. It is the answer to a quieter question: is my life getting bigger or smaller? Am I doing more of the things I care about, or fewer? Is there more room in my head for other people, or less? Something can be going well by every external measure and be going in the wrong direction on that question, and the external measures will not save you, because they are the very thing that will be congratulated.

This is why I will not give you a checklist of things people do. A checklist of behaviours is, for some readers, a set of instructions, and I have watched that happen. What I can describe is what a life starts to look like from the outside and what a mind starts to sound like from the inside, and let you sit honestly with whether any of it is familiar.

If it is familiar, that is information, not a verdict. Nobody is in trouble here.

What a life starts to look like

The first thing that tends to go is the calendar. Invitations get declined for reasons that are individually reasonable and collectively a pattern. A trip becomes something to be managed rather than looked forward to. Occasions that involve other people gathering around a table start to feel like a problem set rather than an evening, and eventually the easiest solution is not to go.

The next thing is flexibility. Days that used to be improvised acquire rules, and the rules acquire a kind of authority nobody voted for. Being taken somewhere unplanned stops being a nice surprise. Someone changing arrangements at short notice provokes a reaction out of all proportion to the change.

Then the interests thin out. Hobbies drift. Reading stops. The friend you used to ring on the way home gets rung less. There is a strange bookkeeping quality to the day, a sense of accounts being kept, even if nothing is written down anywhere.

And the subject expands. It stops being one part of your life and becomes the weather that everything else happens in. Ada has a good question for this that has nothing to do with food at all: what did you think about on the bus this week? If the honest answer is the same thing every day, that is worth knowing.

What a mind starts to sound like

The inside of it is harder to describe and easier to recognise. Members in the recovery-aware circle have offered these over the years and I have kept them because people hear themselves in them.

A running commentary that never really switches off, even during things you are enjoying. A sense of having earned or not earned something ordinary. Relief that curdles quite quickly into fear — the relief of the quiet, then the fear of the quiet ending, then a plan to protect the quiet at any cost. That last movement is the one I ask people to watch for most closely, because it is the point at which a medicine stops being a treatment and starts being a defence.

Secrecy is the other reliable one. Not lying exactly. Editing. Deciding what to mention to your prescriber and what to leave out, on the grounds that they would not understand, or that they would take something away. If you have ever rehearsed an appointment so that a particular subject does not come up, that is worth telling somebody about, and the somebody can be us before it is anyone official.

And underneath a lot of it: the belief that this is fine because it is working. Working and safe are different words.

What other people notice first

The people around you usually notice before you do, and usually say nothing, because the culture we live in has taught them that saying something would be rude, or that what they are seeing is a triumph they should be pleased about. That silence is one of the reasons this gets so far.

What they tend to notice is not the eating. It is the cold. A person who is suddenly always cold, who sits in a coat indoors, whose hands are freezing in a warm room. Tiredness that has changed character. Irritability that is unlike you. A shortening fuse and a lengthening quiet. Dizziness on standing. Hair on the pillow. A period that stops. A pulse that feels wrong to you when you lie still. Bruises that arrive from nothing.

Those are physical facts and they belong to a clinician, not to a forum, and some of them are urgent rather than interesting. If you are faint, if your heart feels erratic, if you cannot keep fluids down, that is a same-day matter — see when a symptom needs a clinician and act on it rather than reading further.

If somebody who loves you has said something careful to you recently and you found it annoying, that is data too.

Where to get help, and how to find it from where you are

We are a peer community across a lot of countries, so we cannot hand you the right door. We can tell you which doors exist nearly everywhere and how to find yours.

A national eating-disorder charity. Most countries have one, and they are the single best first move. They typically offer support by email or webchat, moderated online groups, information written for the person and separate information written for families, and — crucially — people who will talk to you before you meet any diagnostic threshold. You do not have to be ill enough. Search your country’s name and the phrase eating disorder charity, or ask us in circle and someone from your region will know the name.

Your GP or family doctor. Unglamorous and still the route to assessment, to bloods, and to specialist services. You can say very little and still start this: I think my relationship with eating has changed since starting this medicine, and I would like to talk to someone. That sentence is enough.

Urgent and crisis support. Every national health service has a page describing how to get urgent mental health help in that country. Find that page rather than a number someone posted once. If you are in immediate danger, an emergency department is the answer.

Free routes people forget. University counselling services. Employer assistance schemes, which are confidential and usually unused. Student unions. Community mental health teams. Our own support resources page describes the kinds of service worth looking for, region by region.

If it is not you but someone you love

The instinct is to police, and policing does not work. It converts a person with a difficulty into a person with a difficulty and an adversary, and it drives the whole thing underground where you can no longer see it.

What tends to work better is being specific, being about you, and being repeatable. I have noticed you seem cold all the time and you have stopped coming out with us, and I have been worried, and I am not going anywhere. Then say nothing else. Then say it again in a fortnight, unchanged.

Do not comment on their body, in any direction, ever. Praise lands as instruction. Concern lands as commentary. Both keep the subject alive when what you want is for the subject to stop being the weather.

Get support for yourself, separately. National charities almost all run family and carer lines precisely because this is exhausting, and Wren holds carers for people who are looking after someone and have not been asked a single question about how they are. Ask someone how you are.

What we do here, and what we will not do

I hold ed-recovery-aware, and it is not a fragile room. Recovery-aware does not mean fragile. It means careful. We do not talk in numbers, we do not compare intakes, and we notice out loud when a conversation has quietly turned into a competition, which happens without anyone intending it. Food-noise-quiet and body-image sit alongside it, and grief-and-eating exists because loss changes eating and almost nobody says so.

When a member says something that sounds like restriction wearing the clothes of a health plan, I say so — kindly, once, in the open — and then I stay with them afterwards. The staying is the part that matters and the part most communities skip. Our moderation page sets out how we handle this in public, because a rule you cannot read is not a rule.

What we will not do is be your treatment. We are volunteers with peer-support training and a serious respect for the line. If what you need is assessment and care, we will sit with you the whole way to the door and we will not pretend to be what is behind it.

You can come to circle before you have decided anything. Most people do.