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During their recovery, your loved one may be learning a specific set of skills called “distress tolerance” skills to manage the emotions and feelings that arise during their journey. Distress tolerance skills are often used to tolerate negative emotions, sit through difficult sensations that may arise in the body, and distract from certain eating disorder urges until they pass. Distress tolerance, however, is not just a set of skills for your loved one to use. It’s not even just for anyone going through a mental health crisis. Ultimately, distress tolerance is a helpful skill to learn for all of us, especially for those dealing with a loved one in recovery.

It can be hard to see your loved one in pain. It can be hard to see them struggling. Often, you may be tempted to let things go — just once. To give your loved one a break from the difficult process of recovery for a few days. After all, it’s so hard for all of you.

In other words, recovery can be distressing for everyone involved. This is where you need to use your own distress tolerance skills — to realize that you need to sit through the discomfort and stress and anxiety of seeing your loved one in pain. Allowing them to deal with their stress is what leads them to realize how competent they really are. It is only by going through their own discomfort that they will learn they can do hard things — like pushing back against their ED and survive.

Practicing distress tolerance skills can help you come to the understanding that you and your loved ones can sit through the darkness of pain together and emerge into the light. You cannot save your loved one from that experience and you don’t 

 to do that, either — allowing them to traverse their own path is an essential part of recovery.

Equip’s interdisciplinary care team includes a family mentor specifically to emotionally support family members as they increase their distress tolerance, and to help parents and caregivers develop specific skills to manage frustration and emotionally regulate as a means to decrease distress for everyone involved in the recovery journey.

 on tolerating your child’s distress is a great explanation of this topic.

Distress tolerance is a vital piece of the recovery journey, and it’s one that you can’t escape — it can only be conquered by moving forward together.

A smiling mom looks over her young son's shoulder while he works at the computer

Eating disorder recovery isn't just hard for the patient, it's also difficult for the loved ones supporting them, like parents. Distress tolerance skills make it easier for supports to manage the challenges of recovery.

Distress Tolerance for Caregivers in Eating Disorder Recovery

Distress Tolerance for Caregivers

I’ve had countless conversations with parents, partners, siblings, and friends of people suffering from eating disorders, and all of them desperately want the same thing: to help their loved one feel supported in their recovery. Yet they often feel overwhelmed, helpless, and unsure how to be there in the way they’d like.

Honestly, eating disorders are complex illnesses that are hard to understand unless you’ve been there—but it 

 possible to learn about what can be harmful to your loved one’s healing, and how to help them feel safe and thrive in recovery. In this article, we’ll explore how you can not only avoid triggering your loved one, but also actively support their recovery. Read on to learn some of the most common food- and body-related triggers, guidance on what to say and do (and what to avoid), along with strategies and resources to help create a safer space for people struggling with eating disorders.

The word “trigger” has become ubiquitous in recent years, but it’s often used pretty loosely, and in ways that don’t reflect its original meaning. When it comes to eating disorders, however, it’s important to understand that triggers are very real, and can have real consequences. “Triggering someone with an eating disorder means saying or doing something, often unintentionally, that activates thoughts, emotions, or behaviors tied to their struggles with food, body image, or exercise,” says dietitian 

According to Equip dietitian Stephanie Kile, MS, RDN, eating disorder triggers often cause “thoughts that align more with the eating disorder side of the brain than the recovery side.” Kile describes the eating disorder side as the part consumed by thoughts about food and body image, urges to engage in behaviors like restriction or purging, and black-and-white beliefs, like the idea that 

certain foods are good and others are bad

. It’s the side of the brain a person in recovery is working to quiet, which is why it can be helpful for others to understand how to avoid activating it.

Common triggers for people with eating disorders

While each individual will have different triggers, there’s one giant and pretty universal trigger: 

. Diet culture is a system of social beliefs and expectations that values thinness above all, and everything about diet culture aligns with and reinforces the eating disorder mindset. It’s in our everyday conversations, 

, classrooms, social media, mass media, and even doctors’ offices. Here are several specific eating disorder triggers that are rooted in diet culture:

“Social media is a huge trigger source for my clients, because they often see unrealistic expectations of how they should look or what they should be eating,” shares dietitian 

Several of my clients also find it difficult to use social media without their recovery being derailed by food- and body-focused posts, including “What-I-eat-in-a-day” reels, fear-mongering messages by self-proclaimed nutrition experts, and photos showcasing weight loss or body ideals.

Moreover, there’s ample research surrounding the negative effect that social media can have on young people’s body image and eating habits. One 

 of people ages 10 to 24 showed that social media can promote negative social comparison, thin ideal internalization, and self-objectification, all of which can lead to eating disorders. One 

 of adolescents showed a link between a greater number of social media accounts and disordered eating, thoughts, and behaviors. The same study also linked greater daily time spent using Instagram and Snapchat to increased disordered eating behaviors in girls. Other 

 shows content labeled with “fitspiration” and “thinspiration” (content intended to inspire viewers to achieve fitness or thinness) can trigger young people already struggling with eating disorders.

In my practice, perhaps the largest trigger for my clients are the words of (usually) well-meaning and unaware partners, friends, family, colleagues, coaches, or teachers. Here are several typical examples of triggering food language (all of which are often and unfortunately viewed as normal in our culture):

Commenting about the food on someone else’s plate: “Wow, she must be hungry.”

Talking about how much you did or didn’t eat today: “I haven’t eaten all day.”

Tying morality to foods: “I was so bad today—I had pizza” or “I was good at lunch—I had a salad.”

Discussing plans to restrict: “I get one ‘cheat meal’ this weekend and then I’m back to skipping carbs” or “I’m going to save my calories for tonight’s dinner.”

Talking negatively about calories: “That must be loaded with ‘empty calories.’”

Describing your new diet: “I just started 

Making claims about food and “health”: “It’s not healthy to eat dessert” or “Sugar is unhealthy.”

Such comments are typically triggering for eating disorder diagnoses like 

. The triggers for ARFID, which is not tied to body image distress, are usually a bit different. De la Cruz explains that triggering someone with 

 “could look like teasing them for resorting to safe foods at a restaurant or making fun of them for being nervous to try a new food, which validates their fear, causing them to be more hesitant in trying fear foods.”

Unfortunately, triggering food comments don’t stop with friends and family—healthcare providers are, in fact, one of the most common sources of harmful comments I see in my practice. Some of my clients leave their medical appointments upset and confused, because their doctors recommend 

 based on their weight or lab work, without asking questions about their relationships to food or knowing about their eating disorder history. “I have had restricting patients being told to limit their sugar intake, which inhibits their progress significantly,” adds De la Cruz.

Body-based comments can also be detrimental.

“It could be as simple as a common greeting many people use, such as ‘Wow you look like you lost weight,’” Kile says. Even saying something like “you look so healthy” can activate the eating disorder part of the brain, according to De la Cruz. “This can cause someone to believe they may have gained weight and cause them to overthink or want to restrict,” she explains.

Speaking negatively about your own body or other people’s bodies (like “He needs to lose weight,” “She lost weight since I last saw her,” or “I need to lose weight”) can also trigger the eating disorder sufferer. Such comments are examples of 

—negative attitudes and beliefs about and towards others because of their weight.

Like food language, weight language is an issue within healthcare settings, because many providers also have weight bias. In fact, I have spent many sessions with clients helping to reverse damage after medical appointments, because their doctors are operating from a weight bias lens and making recommendations harmful to eating disorder recovery. Unfortunately, doctors often 

 for disordered behaviors (like counting calories) and mindsets (like striving for weight loss) that would be concerning for smaller-bodied people. While such treatment is problematic for anyone, those with eating disorders are especially vulnerable. In fact, a 2024 

, or discrimination against people based on their weight and size, is associated with increased disordered eating outcomes, like binge eating, drive for thinness, unhealthy weight control behaviors, and dietary restraint.

Problematic messaging and behaviors about exercise

Unfortunately, diet culture also dominates societal beliefs and behaviors surrounding exercise, often under the guise of health. The term “healthy” is “skewed to mean restrictive and overworked, where someone is praised for working out for hours in the gym and eating as little as possible to achieve weight loss,” Kile says. While it’s everywhere, 

eating disorder triggers related to exercise

 are common in gyms, yoga studios, and on social media. Here are some examples of words and actions that could trigger someone in recovery:

Using exercise to justify or to punish yourself for eating fun foods (like French fries or cake)

Discussing your exercise routine in detail

Idolizing someone for being “disciplined” because they exercise every day

Talking about burning or “earning” calories

Belittling lower-intensity forms of exercise (e.g. “Walking doesn’t count.”)

Depending on how far along someone is in recovery, spontaneity can be difficult, especially when eating is involved. Here are a few examples of situations that can be triggering:

Stopping for ice cream or dessert without talking about it beforehand

Surprising your loved one with a meal out at a restaurant

Making pancakes for breakfast on a weekday when they’re typically made on weekends

While such scenarios are fun, healthy, and normal (and ideally will one day become natural for the person struggling), for people who are still working toward recovery, they can cause significant distress and rouse the eating disorder brain.

How to help your loved one feel safe in recovery

While society-at large is steeped in diet culture and you can’t totally protect anyone from it, you can take steps to help create safe environments and relationships that support healing. Here are some strategies to consider as you navigate your loved one’s eating disorder recovery:

On social media, you can’t control what other people post, but you can control what you’re sharing online for your loved one to see. Before posting something, run it through an eating disorder trigger filter. Ask yourself, “Could this cause someone distress about food, body or exercise?” If the answer is maybe or yes, reconsider sharing it. Plus, unfollowing diet culture content from your own feed and following recovery-aligned content can help your own shifting mindset. If you’re a parent or guardian for a young person with an eating disorder who uses social media, have a discussion and set boundaries with them about who they follow and how much time they spend online.

Remember, diet culture runs rampant in movies and shows, too, and can impact eating disorder sufferers. For example, one of my larger-bodied clients was struggling with her parents and sister always wanting to watch 

 and laughing during scenes when Monica was wearing a fat suit and was portrayed in a negative light and the brunt of many jokes. Once she got her feelings out in the open, her family understood why it made her uncomfortable and decided to choose another show to watch together.

As you now know, many eating disorder triggers happen in conversations. “I encourage loved ones to shift from diet talk, body scrutiny, and food moralization to a more neutral, supportive way of discussing food and bodies,” Rothschild shares. Take an honest look at how you talk about food, body, and exercise, especially around your loved one. If you realize you may be adding fuel to the eating disorder fire, work to start learning how to speak about these topics without diet culture coloring everything. Here are some ways to help shift your language and behavior for the better:

Resist commenting on other people’s food or body (including your own). Instead, comment on other aspects of them, like their style or personality.

Strive for balance in your diet, allowing room for all foods, including more nutritious foods (like veggies) and fun foods (like pizza).

If you must adjust your diet for medical reasons (e.g. high cholesterol or diabetes), let your loved one know.

If you talk about food, focus on taste, texture, and smell, not nutritional content.

Refrain from sharing any dieting plans or talking about disordered behaviors (like counting calories or restricting certain foods).

, which is a non-restrictive way of eating that prioritizes mental and physical well-being.

, a public health framework that deconstructs the belief that weight equals health, and emphasizes that people of all body sizes are worthy of respect and care.

If you talk about exercise around your loved one, do so from a lens of 

, instead of coupling it with food and calories.

Try talking about anything else in life. Kile suggests “leaning into new topics of interest to talk about, [like] hobbies, and other aspects of life such as work or school and what new song they’re listening to these days.”

“Focus on neutral, supportive conversations about food and bodies, respect boundaries, and validate your loved one's experiences without trying to ‘fix’ them,” Rothschild recommends. “Educating yourself on eating disorders and diet culture, fostering a non-judgmental food environment, and emphasizing connection over appearance or food-based comments can make a meaningful difference and create a safe space.”

If any suggested strategies make you feel uncomfortable or don’t feel realistic, it may be time to look at your own relationships to food, body, and exercise, and to seek professional help if necessary.

Not every person with an eating disorder has the same triggers, so it’s important to get to know your loved one’s specific vulnerabilities and what feels helpful to them. Ask them to share what feels supportive and what doesn’t, and ask for permission if you’re unsure about discussing a specific topic or partaking in a certain activity. “Asking permission is also a really helpful way to support an individual going through recovery and avoid causing a triggering moment for them,” Kile says.

Additionally, communicating with your loved one’s treatment team can help you build an even deeper understanding of how you could hinder and help their recovery.

While you can’t control how others speak to your loved one, you can spread awareness and set boundaries in places like schools, gyms, and doctor’s offices. If you’re a parent, consider talking to your child’s school or doctor’s office about their health curriculum and practices (

). If your loved one is an adult, advocate for them at doctor’s appointments if necessary and help them to eventually do so on their own (

check out these medical self-advocacy cards

). Taking such measures will help your loved one feel safer as they go out in the world.

While planning food-related surprises or being spontaneous might feel helpful, try to meet your loved one where they are. Perhaps they aren’t ready to try a new restaurant, but they make that a goal with their dietitian for the future, or maybe they don’t want to stop at the ice cream shop, but will have some at home with you. Openly talk about what they are and are not ready for, and discuss it with their dietitian if they have one. “I met with a parent who didn’t realize that forcing her daughter to try new foods was actually inhibiting her progress,” De la Cruz says. “A simple conversation helped make a huge difference in her recovery.” She suggests learning about your loved one’s safe and 

. “For parents, this could mean making sure safe food is around, but also supporting your child in facing fear foods and expanding their diet,” she says.

Does this mean I have to walk on eggshells forever?

When you’re supporting someone with an eating disorder, all the do’s and don’ts can feel overwhelming and a bit paralyzing—but these guidelines are important, and they not only help your loved one but also potentially help you develop a better relationship with food and body image. What’s more, it’s not forever.

“Supporting someone with an eating disorder doesn’t mean loved ones have to walk on eggshells forever,” Rothschild says, “but it does require mindfulness and consideration, especially in the early stages of recovery.” De la Cruz compares learning how to speak and act around someone with an eating disorder to becoming fluent in a new, healthier language and mindset. In fact, many of my clients’ friends and family end up addressing and improving their own food and body relationships in the process.

Plus, the further along people are in recovery, the less triggering everyday diet culture comments and actions become. “Those individuals will get to a better, more solid footing in their recovery where those topics are no longer triggering, but that timeline varies for everyone,” Kile explains. Eventually, they become less impacted by triggering, diet culture-based comments, and can even speak up about it. “Hopefully, through counseling and education, those with eating disorders will feel confident enough to correct others or know that those comments do not have to impact their own view of themselves and health,” De La Cruz says.

There are an abundance of tools available to help support people with eating disorders. Here are some of my favorite resources:

How to Nourish Your Child Through an Eating Disorder

By Their Side: A Resource for Caretakers and Loved Ones Facing an Eating Disorder

Loving Someone with an Eating Disorder: Understanding, Supporting, and Connecting with Your Partner

 (Families Empowered and Supporting the Treatment of Eating Disorders)

National Alliance for Eating Disorders Virtual Support for Loved Ones

Eating disorder recovery takes a village. If you’re struggling to support a loved one, reach out for professional and personalized guidance. The resources above are a great place to start, or you can 

Dane, A., & Bhatia, K. (2023). The Social Media diet: a Scoping Review to Investigate the Association between Social media, Body Image and Eating Disorders Amongst Young People. 

(3). https://doi.org/10.1371/journal.pgph.0001091

‌ Wilksch, S. M., O’Shea, A., Ho, P., Byrne, S., & Wade, T. D. (2019). The relationship between social media use and disordered eating in young adolescents. 

International Journal of Eating Disorders

(1). https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.23198

‌ Nawaz, F. A., Riaz, M. M. A., Banday, N. ul ain, Singh, A., Arshad, Z., Derby, H., & Sultan, M. A. (2024). Social media use among adolescents with eating disorders: a double-edged sword. 

https://doi.org/10.3389/fpsyt.2024.1300182

https://nedc.com.au/eating-disorders/eating-disorders-explained/weight-stigma

Westby, A., Jones, C. M., & Loth, K. A. (2021). The Role of Weight Stigma in the Development of Eating Disorders. 

https://www.aafp.org/pubs/afp/issues/2021/0700/p7.html

Levinson, J. A., Shruti Kinkel-Ram, Myers, B., & Hunger, J. M. (2024). A systematic review of weight stigma and disordered eating cognitions and behaviors. 

https://doi.org/10.1016/j.bodyim.2023.101678

https://nutritionbycarrie.com/2024/03/non-diet-approach-2.html

The Health at Every Size® (HAES®) Principles

Guide for Loved Ones: How to Avoid Triggering Someone with an Eating Disorder

,” you’ll get back countless websites listing warning signs and common symptoms, but these lists aren’t comprehensive. And while some eating disorder signs are pretty intuitive and might raise eyebrows on their own—like, say, significant changes in body weight and extreme dieting—there are many more subtle signs of an eating disorder, which often go unnoticed.

 was diagnosed fairly quickly, it would have happened even faster if I was aware that a newfound obsession with interacting with food in a non-eating way was a sign of an eating disorder,” says J.D. Ouellette, Equip’s Director of Lived Experience. “I’ve always cooked and baked a lot, so looking up and making new recipes seemed normal to me. What wasn’t normal was the scale of it all: Food Network 24/7, Pinterest for recipes, organizing all our family recipes, cooking and baking amazing, delicious food… but not eating any of it.”

This behavior that Ouellette observed is just one of many less obvious eating disorder behaviors. Raising awareness around these symptoms is extremely important, as a huge number of eating disorders go undiagnosed: 

, just 10% of college students reporting symptoms got a diagnosis. What’s more, many of the eating disorders that do get diagnosed could have been caught earlier if loved ones had known the less conspicuous warning signs, which matters because 

 significantly increases the likelihood of recovery.

Read on to learn 11 subtle signs of an eating disorder you might not be aware of, and what to do if you’re concerned about yourself or a loved one.

Why do some eating disorder signs go unnoticed?

It can be tricky to spot an eating disorder for a number of reasons. Firstly, many eating disorder behaviors are done in secret, and the person struggling often goes to great lengths to hide their eating disorder. But even some red flags that happen in public go unnoticed—or we notice, but don’t think it’s anything to be concerned about. There are a few potential reasons for this:

Our inability to see certain disordered behaviors can, in many ways, be chalked up to the fact that a lot of these behaviors are praised in our society, which is steeped in 

. “So many signs of eating disorders are socially normal and even applauded,” says Ouellette. “

Working out twice a day, seven days a week

? Go you! Restricting calories and categories of food? Wish I had your self-discipline! Lost a few pounds? Living the dream!”

Jessie Menzel, Equip’s VP of Clinical Programs, agrees, explaining that society has normalized behaviors that could be red flags, “things like changing one’s diet to be ‘healthier,’ deciding to become a vegetarian, trying to eat fewer sweets, starting to skip meals, or even forgetting to eat.”

Eating disorder warning signs might also be ignored because trusted figures dismiss them. “Parents are often directly assured ‘nothing is wrong’ by their medical provider,” says Menzel. She explains that concerned parents might hear things like, “picky eating is normal,” “they’ll grow out of it,” or “it’s a good thing that they’re trying to eat healthier.” These providers are not ill-intentioned—this kind of response is a natural result of the fact that most healthcare providers receive very little training on eating disorders, and may have a very narrow idea of what an eating disorder might look like.

Another reason signs of an eating disorder might get missed is because someone doesn’t fit society’s stereotype of who gets an eating disorder. “I think the most common reason eating disorder signs tend to go unnoticed is that someone doesn’t ‘look’ the part of someone with an eating disorder,” says Menzel. “Whether it be because they aren’t white or wealthy or because their body is larger or because they aren’t a cis girl or woman. There are entire groups of people who we think ‘can’t’ get eating disorders, and therefore, we don’t ask.”

The truth is that eating disorders affect people equally across age, gender, race, class, and body size, and—despite what the media has told us for decades—you just can’t tell if someone has an eating disorder by looking at them.

Hidden signs of eating disorders that are often missed

For a thorough look at the more straightforward symptoms of eating disorders, our 

 is a great resource. Here we’ve outlined some of the less intuitive, often missed, and less obvious signs of eating disorders. This list isn’t exhaustive, and eating disorders manifest differently in every person, but it’s a good place to start.

1. Cooking and baking food without eating it

In addition to the behaviors Ouellete shared above, one particular memory stands out to her: her daughter prepared 50 cellophane gift bags for school Valentine’s Day, each filled with candy and immaculately decorated heart-shaped cookies—but she didn’t eat a single bite herself. At the time, this stood out to Ouellette as confusing, but she didn’t flag it as related to an eating disorder. However, preparing food without eating it is actually a fairly common eating disorder behavior.

Ouellette remembers thinking that her daughter’s desire to eat anywhere but home was just typical teenage behavior, but eventually realized that it was a ruse not to eat at all. Someone with an eating disorder might also want to 

 because of the shame they feel around eating. This could be true for all types of eating disorders, not just those associated with 

3. Encouraging other people to eat high calories foods they’re not eating

People with eating disorders might try to satisfy their own hunger by watching others eat the foods they won’t allow themselves. (In fact, 

 that so-called “mukbang videos,” live-streamed videos where viewers watch someone eat, are associated with disordered eating.)

If you’re worried you or a loved one may have an eating disorder, you can take a screener here.

Free eating disorder screener

Eating disorder thinking tends to put a high value on precision, especially when it comes to food. Because of this, those struggling may refuse things with trivial caloric content, like a piece of gum or a small bite of a dish. This can also go the other way: they may refuse to share food because they have exactly accounted for what is on their plate, no more and no less.

5. Excessive interest in what other people are eating

Similar to cooking for others and watching others eat high-calorie foods, this sign likely emerges out of the fact that eating disorders cause people to become 

. Those who are struggling might show an abnormal interest in the food of others, asking questions about what they ate that day, what something tastes like (without accepting a bite of it), etc.

Just as a person with an eating disorder might refuse tiny amounts of food because of their precise accounting, they may also become incredibly upset if the food they receive is “wrong” or “off” in any way. That might mean that a parent buys a different brand of crackers from the store, or a server at a restaurant puts dressing on the salad rather than on the side.

Ouellette remembers thinking that the change in her teen daughter’s attitude was “developmentally appropriate teen moodiness.” And in some cases, that might be true—which is why it can be extra tricky to identify 

—but significant personality changes can also be a red flag. Malnourishment combined with uncontrollable eating disorder thoughts make it impossible for a person’s mind to function normally, and their behaviors and mood will reflect that.

It’s not uncommon for people with eating disorders to become more childlike in some ways. For Ouellette, that meant her daughter suddenly calling her “Mommy” instead of “Mom” at age 17. This is usually a coping strategy to manage the overwhelming stress, anxiety, and emotions caused by the eating disorder.

This might have to do with food schedule, or simply the schedule in general. Ouellette remembers her daughter developing “extreme punctuality, to the point where 30 seconds early or late was distressing.” (As a person in recovery from 

, I remember breaking down crying if dinner slipped to 6:05 rather than 6 p.m. sharp).

, so those who are restricting their food intake might have difficulty sleeping through the night (plus 

, a hormone that helps us regulate our circadian rhythms). If your loved one is suddenly experiencing chronic sleeplessness or feeling tired all the time, disrupted eating patterns might be behind it.

While there are certainly legitimate and even positive reasons that someone might decline an invitation, frequently opting out of social gatherings could mean that a person is prioritizing their eating disorder behaviors over the relationships in their life, or going out of their way to avoid social events that involve food. Social isolation isn’t just a potential red flag, it can also worsen the eating disorder, since these illnesses thrive in secrecy.

None of these signs on their own definitively means that someone has an eating disorder, and someone can have an eating disorder without exhibiting any of these signs. But by being aware of the less obvious signs of eating disorders and remaining alert to anything that seems amiss, you’ll ensure you’re doing all that you can to catch a potential problem early on. Says Menzel, “anytime you notice a shift in a loved one’s eating—no matter the reason—it warrants paying close attention and asking questions.”

How to address early warning signs of an eating disorder

If you’re concerned about a loved one (or yourself), don’t ignore it. Eating disorders don’t go away on their own, and get worse when left unaddressed. As intimidating as it might be, it’s important to take the first step toward getting the help you or your loved one need. The guidance below can help you get started.