• Rigid, limited diet.
• Frequent weighing.
• Excessive thinking and talking about food and related issues.
• Lying about food intake, claiming to have already eaten or to have plans to eat elsewhere.
• Chasing food around the plate, taking a long time over meals.
• Cooking for others.
• Reading and collecting recipes.
• Rituals around food and eating.
• Increased use of spices, condiments, chewing gum.
• Increased consumption of fluids.
• Episodes of bingeing or perceived overeating.
• Secret disposal of food.

Note: It is important to know that many of the symptoms associated with anorexia, such as the extreme ‘black and white’ thinking, and the preoccupation with food and cooking, and difficulty making decisions for example, are triggered by and exacerbated by a lack of nutrition. Many of these symptoms are as a result of starvation, and as such, will reduce and disappear as the person becomes more nourished.

A person may start skipping meals, avoiding eating with family, go on a diet, start eliminating food / food groups, becoming vegetarian / vegan, faddy eating. At first, this can resemble a normal diet or lifestyle choice, but the relentless drive behind the behaviour becomes more and more obvious as the disorder progresses. Other means of maintaining low body weight might include fasting, excessive exercise, self-induced vomiting, the use of laxatives, diuretics or appetite suppressants.

• Weight loss
• Being cold with bad circulation
• Bloating of stomach, fluid retention.
• Constipation and abdominal pain.
• Restlessness, inability to settle.
• Difficulty sleeping, tiredness.
• Dry, thinning hair.
• Dry, discoloured skin.
• Growth of fine, downy hair (lanugo) on the face and body resulting from the body’s efforts to keep warm.
• Loss of periods.
• Decreased interest in sex.

What often raises concern is a change to the personality of a person, where they start to withdraw from life and socialising, where they seem to turn inwards and develop strict routines around all they do. It is this together with changes in weight and eating behaviours that often ring alarm bells.

• Low self-esteem. This may not be obvious as a person develops an eating disorder is often quite perfectionistic and focuses on achieving
• Irritability and mood swings. The swinging from feeling in control to out of control, depending on how they are eating, together with a tendency to ‘all or nothing’ thinking makes moods swings very common. A person can feel fine one moment and totally out of control the next. This can manifest in anger and irritability.
• Difficulty resolving conflict. There are a number of reasons for this:
  •  A person often thinks in all or nothing ways and finds it difficult to exist in the middle ground.
  •  Super sensitivity to other people’s feelings. A person with anorexia nervosa is very sensitive to how other people are feeling and they find it very challenging to cope with difficult feelings and others being upset.
• Social isolation. When a person has anorexia, they begin to construct their lives according to a very strict routine that is structured to ensure as little food is eaten as possible. The more underweight they become, the more black and white their thinking becomes. In this way, socialising becomes more and more difficult because it involves coping with many variables (other people, different foods, different times). The more the person gets trapped within an eating disorder, the more likely they are to become isolated socially.
• Difficulty coping with change and frustration. The more underweight a person becomes, the longer they live with an eating disorder, the stricter their routine comes, and the less able they are to cope with change.
• Inflexible ‘black or white’/ ‘right or wrong’ thinking. A person with an eating disorder usually has a tendency to all or nothing or black and white thinking. This is exacerbated and made worse by not eating and being underweight. An aspect of recovery is the person being able to bring their thinking into a more flexible ‘grey’ area and being bale to think in a less extreme way.
• Depression. Not always obvious when eating disorder is ‘working’ because the eating disorder helps the person to feel better.
• Obsessive and/or compulsive behaviour. This is very common when someone has an eating disorder and this type of thinking and behaviour can be exacerbated by starvation. Often, as a person a begins to recover and becomes more nourished, these behaviours can subside and reduce.