It's no secret that anorexia causes extreme thinness, but many of the other signs are much more subtle, according to Marisa Sherry, MS, RD, a New York-based nutritionist who specializes in eating disorders.
"Anorexia is very personal and is often hidden," she says. "If the subtler signs are missed the person may already be ingrained in their eating disorder and at high risk for medical complications"
So here's Sherry's guide of 12 signs that someone you love might be hiding an eating disorder.
Anorexia is a serious medical disorder. If you suspect you or a loved one are suffering from it, immediately seek help from a doctor, mental health professional or dietician who specializes in the disorder.
Distorted Body Image
It's no secret that anorexia causes extreme thinness - often in a short period of time. Yet despite being extremely thin, women with anorexia are often talk about feeling fat and express worry about gaining weight.
Does she wear a coat even in warm weather? Young women with anorexia often try to hide their weight loss by wearing coats and baggy clothes and dressing in layers. Despite bundling up, women with anorexia often complain of feeling cold.
Young women with anorexia often withdraw from friends and regular activities. Many anorexia sufferers experience major changes in personality, going from happy and energetic to listless.
Bizarre Eating Rituals
Does she seem to spend more time cutting up her food and pushing it around her plate than actually eating it? Does she insist on chewing each mouthful of food a specific number of times? Those can be signs of anorexia. Ditto if she lives almost exclusively on low-calorie foods, like rice cakes, raw vegetables, and so on.
Eager to burn off as many calories as possible, many women with anorexia seem to exercise almost continuously - often to the point of exhaustion - and to have trouble sitting still. When seated, they often fidget or tap their feet.
Loss of Menstrual Periods
The severe weight loss anorexia triggers can put an end to menstrual periods. If she loses her periods, be suspicious.
Pale Skin, Dull Hair
A healthy young woman has a normal complexion and shiny hair. Pale or dull skin might be a sign of anorexia, so might thinning or brittle hair.
Eating in Privacy
Does she like to eat her meals in privacy - in her room rather than at the kitchen table, for example? Does she often say she's not hungry or make other excuses as to why she's not eating? She might be doing that to hide her unusual eating habits from others' prying eyes. If you seem never to see her eating, be suspicious.
Some women with anorexia take laxatives to help them lose weight.
Some anorexia sufferers develop a condition doctors call lanugo - soft, downy hair on their arms and legs. It's the body's strategy to protecting itself against heat loss associated with extreme thinness.
Does she often complain of stomach pain after eating? Does she sometimes vomit? She may be showing evidence of a condition known as delayed stomach emptying, or gastroparesis. That's an anorexia-related disorder in which severe weight loss damages the stomach muscles and nerves to the point that the process of digestion is affected.
Anorexia often goes hand in hand with an intense interest in food, dietary fat, caloric intake, dieting, and, of course, with food itself. Young women with the disorder often collect recipes, read cookbooks, and look at pictures of food and watch TV programs about food. They may become extremely interested in food shopping and preparation.