Most early signs of anorexia center on preoccupation with food or dieting. Behavior may appear obsessive or compulsive, and begin to consume more time. Eventually, disordered eating patterns will become more noticeable to others and potentially disrupt schooling, career, and relationships with family and friends.
If you’re concerned that you or someone you love may have an eating disorder, watch for these early warning signs of anorexia:
- refusal to eat
- denial of hunger, even when starving
- difficulty concentrating
- obsession with body size and shape
- skipping meals
- making excuses for not eating
- eating only a few certain foods considered safe, usually those low in fat and calories
- adopting meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing
- weighing food
- cooking elaborate meals for others but refusing to eat
In men or women with an abnormal preoccupation with food, several other behaviors should also be recognized as clear warning signs of anorexia nervosa, or possibly other eating or body image disorders:
- excessive exercise
- flat mood, or lack of emotion
- repeated weighing of themselves
- frequent checking in the mirror for perceived flaws
- wearing baggy or layered clothing
- complaining about being fat
Much work remains to be done to understand the causes of anorexia nervosa. As with bulimia, other eating disorders, and addiction, anorexia involves complicated interaction among biological, psychological and social factors.
Doctors, therapists and staff at anorexia treatment centers have more recently acknowledged that genetics play a part in the development of anorexia. A young woman with a biological sibling or parent with an eating disorder is at higher risk, suggesting a possible genetic link. However, it’s not clear specifically how genetics may interact with other contributing factors. It may be that some people have a genetic tendency toward perfectionism, sensitivity and rigidity, all traits associated with anorexia nervosa.
Psychological and emotional characteristics may also leave some people more susceptible to seeking emotional relief through self-starvation. Common examples observed in anorexics are:
- Low self-esteem, which may stem from unresolved experiences of neglect or abuse during childhood
- Obsessive or compulsive personality traits, which make it easier to adhere to strict diets and resist hunger
- Perfectionism, when centered on the body leads to thought distortions such as “I’m never thin enough.”
- Low levels of serotonin, one of the brain chemicals involved in depression
Cultural influences can also contribute to the development of anorexia nervosa. Our society sends a constant stream of media reinforcing thinness as an ideal, especially for young women. Television, magazines, and billboards are filled with images of unrealistically thin models, athletes and actresses / actors. Success and worth are often equated with being thin. Peer pressure may fuel the desire to be thin, particularly among teen girls, who over time view anorexic symptoms as normal, even positive traits.
Anorexia nervosa is a complicated disease that affects each man or woman differently. There are several patterns of anorexia signs and symptoms that eating disorders treatment specialists know to look for:
Co-occurring Alcoholism
Adolescent women with anorexia show a dramatically greater incidence of alcoholism than the rest of their peer group. This can occur when efforts to numb feelings of inadequacy by restricting food intake fail to bring the control and emotional relief a woman with anorexia seeks. College-aged women in particular are much more likely to show symptoms of co-occurring alcohol addiction along with anorexia nervosa.
Abuse of Stimulants
Many over the counter energy boosters, dietary supplements and prescription stimulants, such as medication for ADHD, have appetite suppressing side effects. Because of the ready availability of these drugs in schools and on college campuses, adolescents with anorexia are particularly susceptible to the temptation to misuse them to suppress appetite.
Co-occurring Disorders
Anorexia nervosa often co-exists with major depression, anxiety disorders, or obsessive compulsive disorder (OCD).These are called co-occurring disorders, and they are difficult for many treatment providers to diagnose accurately and treat effectively in conjunction with an eating disorder. Patients whose anorexia nervosa treatment fails to address co-occurring disorders will face a vastly more difficult treatment path and more complex challenges in recovery.
Purging Behaviors with Starvation
Many with symptoms of anorexia show signs of a separate variation, the binge-purge type. Persons with this type of anorexia disorder will not only self-starve, but also take other actions to reduce their weight. This may include exercising obsessively, or abusing laxatives, diuretics / water pills, or other diet drugs.
Anorexia’s effects vary depending on the severity of the disease. They tend to worsen as thoughts about food crowd out more and more of an anorexic’s thoughts.
- Forced withdrawal from school or college
- Loss of connection to faith or religion
- Career disruption
- Isolation from friends and family
- Suicide
The physical effects of starvation are often irreversible, and reflect the extremely high rate of deaths associated with anorexia nervosa:
- Infertility
- Shutdown of major body systems
- Brain damage
- Heart attacks
- Death
Can I Possibly Talk To My Parents About This?
Whether your parents have suspected you have a problem with eating or cutting, or they are completely surprised, it will be difficult for them to hear how much you are hurting.
But having this conversation will not only help you overcome your own emotional struggles.
Most women in your situation have reported that sharing their secret and getting help for an eating disorder, self-injury or a mood disorder also brings them much closer to their family than they’ve been in years. This article contains input from multiple members of our treatment team, and attempts to answer some of the most common questions that keep young women from starting that process.
While this blog post is oriented primarily toward young women who are living at home with their parents, the principles apply to men and women of any age who need to seek support from loved ones to confront a major challenge.
Q: What’s the first step?
A: Consider the best way to approach your parents.
If you live with both parents, decide whether you want to talk with them together or separately.
Some young women find it helpful to write a letter or an email to one or both parents before talking in person. Writing a letter or email allows you time to include everything you want to say, so you won’t have to worry that you’ll forget something important. It also lets parents digest your message in private, and start to deal with their own feelings before talking with you. That might make it easier for them to ask questions that will allow them to help you.
Q: Should I talk to my parent or parents alone? If not, whom else should I include?
A: Whomever you need to make yourself feel safe and find the courage to be honest.
There is no right or wrong answer.
Asking a friend, a brother or sister, or another trusted family member or even a teacher to join you may reduce the chance that you change your mind at the last minute. It also makes sure that there will be someone in the room to support you no matter how your parents respond. They can help you remember important details or questions you want to ask, too.
Q: When should I talk to them?
A: If your family is busy, it may be best to ask them to plan a time a day or two in advance.
Otherwise, pick a time when neither of you will be rushed or interrupted. After dinner, a Saturday or Sunday afternoon, or a day off might give you the most time.
Mornings before school or right after they get home from work are probably not the best times.
There is no perfect time: the important thing is that you start your conversation as soon as possible.
Q: Where is the best place to tell them?
A: Somewhere private that makes you feel safe. Picking a place where you don’t have to worry about being interrupted while you’re talking is a good idea.
Some young women feel safest in their bedroom, the back yard, or even going for a walk or to a park.
It’s probably best to avoid telling them in the car while driving, or in front of your brothers or sisters. It can also be difficult to talk in public places like a restaurant where there’s lots of noise or strangers may overhear.
Q: What else should I do before the conversation?
A: The most important thing is to take some time by yourself to think about what you want to say.
Make some notes about how you’ve been feeling and what you’ve done in response. If you keep a diary or journal, look back at past entries for help describing your feelings.
Consider telling a close friend or sibling that you’re going to be having this conversation, and that you’re anxious or afraid. It may make you feel better knowing that you will have someone waiting to support you after you finish telling your parents.
Q: I’ve tried telling them before, but haven’t been able when the time comes. What do I say?
A: Be honest about how you’re feeling at the time – it’s okay to admit you’re feeling nervous, scared, sad, or lonely. If it helps, take your notes or a letter with you when you talk.
Tell them:
- What you have been doing and how it’s hurting you
- You want to stop, but haven’t been able to alone
- Eating disorders, mood disorders and cutting are medical illnesses, not choices
- You need their help now so you don’t hurt yourself even worse
- Young women with these problems can get better with counseling and treatment
- You need to see a doctor, and to find a counselor who is experienced at treating eating disorders and/or cutting
If you need to take a break during the conversation, tell them. Go outside for a few minutes, or go in your bedroom or another quiet place and say a short prayer.
Remember: this is the start of a process to help you help yourself. There will be many more conversations along the way. What’s important is you get your process started today.
Q: Can I help my parents with figuring out what to do after we talk?
A: Yes, they will appreciate this.
Several organizations offer free, high-quality online resources for getting help with self-injury or an eating disorder. Many of them are targeted specifically for parents, such as the Parents Toolkit offered by the National Eating Disorders Association (http://www.nationaleatingdisorders.org/get-help-today/)
This page discusses options for eating disorder treatment, which are also applicable to mood disorders and self-injury.
Self-injury.net can help parents and other loved ones to better understand urges to self-harm.
Q: I’m worried my mom or dad will blame himself or herself, how do I avoid that?
A: By educating themselves, parents will quickly realize that eating disorders, self-harming and mood disorders are real medical diseases that originate in genetics, biology and a number of other complicated factors.
Parents do not cause them, but they do have a critical role to play if their daughter is to be successful in recovery. If your parents are feeling guilty or ashamed, the best thing you can do is point them to resources to learn more. Printing off some of the articles you’ve read might be a good start.
It’s also helpful to remind yourself that you’re not responsible for your parents’ feelings or reactions. This will be a process for them, just like your recovery will be a process for you.
Q: I told them, now what?
A: Pat yourself on the back. You are incredibly strong and courageous. You may not feel like it right now, but you’ve taken a HUGE step.
Sharing your feelings with others is incredibly liberating. At TK, we often say that our secrets keep us sick. Now that you’ve told one or both parents, consider whether there are other family members or close friends you would like to tell. The more people you can draw support from, the better. It’s up to you to decide how much detail you share with each person, and whether you ask them to keep what you’ve told them private.
If you feel up to it, we encourage you to come back and tell your story in a comment on this blog post. You can leave your name, or post anonymously. Posts will be moderated and screened to make sure they aren’t triggering for other readers.
Q: Where else can I go for support from other young women who’ve been in my situation?
A: Other websites like Self-Injury.net and DailyStrength.org have forums or discussion boards where young women can seek support from each other.
Online support should never be a substitute for connecting with others in person.
12-step support groups can be found in most places across the country and also provide support online. Some examples are:
Anorexics and Bulimics Anonymous (www.anorexicsandbulimicsanonymousaba.com)
Eating Disorders Anonymous (www.eatingdisordersanonymous.org)
Self-mutilators Anonymous (www.selfmutilatorsanonymous.org)
NEDA also offers a listing of support groups for both young women and parents here: http://www.nationaleatingdisorders.org/get-help-today/treatment-referrals.php
Remember, you are strong, and you deserve to live a happy, healthy life. You don’t have to do it alone. Take the next step. Then, come back and share your story with others.