Researchers say acts of self-harm or personality problems may indicate a person is at high risk for an eating disorder in the future.

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Experts say people with an eating disorder will many times deny there is a problem. Getty Images

What happens before an eating disorder is actually diagnosed?

Researchers from Swansea University in Wales say they’ve found a host of conditions and markers associated with eating disorders that manifest themselves years before an eating disorder is officially diagnosed.

The findings, published this week in the British Journal of Psychiatry, come from a large-scale study of Welsh health records. In all, the records of 15,558 people with an eating disorder diagnosis were examined.

Researchers say they found that two years before people received an eating disorder diagnosis, they were more likely to have certain personality disorders, self-harm, and be prescribed diet or gastrointestinal pills.

While the presence of these conditions hardly guarantees a person will later develop an eating disorder, the findings should help health professionals better understand eating disorders.

Eating disorders encompass a range of symptoms that vary depending on whether a person is eating too much or too little.

While these diagnostic tools can help doctors make a diagnosis, a number of roadblocks can stand in the way.

Jacinta Tan, MBBS, DPhil, associate professor of psychiatry at Swansea University and the Welsh representative of the Eating Disorder Faculty in the Royal College of Psychiatrists, led the study. She told Healthline it can be tough to find a specialist.

“The majority of specialist services have criteria before they accept patients, which can be severity of illness and amount of loss of weight, which can exclude people who have early eating disorders who are motivated to receive help,” she explained.

Tan also points out that primary care physicians might not always have the specific expertise of a specialist.

In the United Kingdom, these shortcomings have prompted the Royal College of Psychiatrists to issue a report on the importance of early intervention in diagnosing eating disorders.

All of this adds up to the Swansea University study coming at a timely juncture, since it sheds new light on other conditions associated with an eventual eating disorder diagnosis.

“My research suggests that the majority of patients with eating disorders may never see an eating disorder specialist, so [doctors] need to have better training,” Tan said.

In the United States, the steps can differ.

Dr. Martin Fisher, chief of adolescent medicine at Cohen Children’s Medical Center in New York, specializes in eating disorders. He and his fellow specialists see hundreds of patients a year — but the process of getting to that specialist can vary.

“It’s a little different if you’re asking on the level of a specialist, or the pediatrician, or a generalist,” he explained. “It’s a step-by-step thing.”

Another difficulty with diagnosing and treating eating disorders is that the affected person often won’t recognize that something is wrong.

Fisher says family and friends are often the catalyst in getting someone to seek help.

“Generally speaking, way more often than not, where there’s smoke, there’s fire,” he told Healthline. “Whether it’s family getting that person to go to their physician, or friends, or even friends who have to convince a patient’s parents, it comes down to trying to work with the individual to get them to agree to go to be evaluated.”

To that end, it’s worth reviewing a list of eating disorder symptoms to identify a potential problem.

Once a person sees a doctor who can help them with their eating disorder, they can take steps to solve the problem.

Fisher says it boils down to approaching the issue on three fronts: medical, psychological, and nutritional. The mental aspect can be difficult to turn around.

“It’s about ultimately turning around the eating-disorder thinking that has crept into their brain,” Fisher said. “A person who would normally think about everything rationally may not be able to accept from everybody else that there’s a problem. So there needs to be a change in thinking, along with a change in eating and other behavior. We work on accomplishing all those changes.”

Tan agrees with Fisher, saying it’s important to seek and continue to push for help.

“There is increasingly consensus that early intervention is critical for good outcome, and so we need to advocate for systems where early intervention is emphasized,” she said.

While the study has given researchers and doctors new connections to help them better understand early warning signs of an eating disorder, there’s still work to be done.

Fisher says the data makes logical sense, but he’s interested in knowing more about how these connections manifest themselves in different age groups — especially considering the onset of an eating disorder often happens during adolescence.

“I’m not sure how well [the findings] would apply to a 12-year-old, a 16-year-old, or a person in their 20s or older,” he said.

He adds this information would help physicians better understand the mechanisms behind an eating disorder.

Tan says her team will be publishing a systematic review, along with more data, on the gaps between the primary and secondary system for treating eating disorders in Wales.

“We also need to do more research into early interventions, what’s effective, and how to support general practitioners in identifying these cases,” she said.

New research can help health professionals better understand potential early warning signs of an eating disorder.

This comes at an important time, as it can be difficult for someone with an eating disorder to get an early diagnosis — one that helps improve health outcomes.

For friends and family members, it’s important to be mindful of the symptoms of an eating disorder. It’s also important to recognize the patient may not recognize there’s a problem.