As eating disorders go, anorexia nervosa is one of the most common types, affecting millions of adolescents and young adults every year. Because it can run concurrent with other mental health disorders, and because it often manifests during a time of extreme social and emotional turbulence, it can be difficult to identify. When the manifestation is difficult to spot, this delays treatment and can result in a more difficult time to recover and a greater potential for physical harm.

While anorexia is usually typified by restrictive eating patterns and obsession over body image, the outward behavior of the patient might not in any way betray their inner conflict. As a parent or loved one, you serve as the front line to identify and help get your child into treatment, but it can be difficult to bring the subject up, even when the disorder is readily apparent.

We will take a look at the causes of anorexia and some of the most common symptoms, as well as how they might manifest to a lesser degree to help you identify them. From there we will discuss lesser-known signs of anorexia nervosa, as well as social cues and stressors that often run concurrently with eating disorders, as sometimes secondary factors are all you have to go on. Finally, intervention and treatment options will be outlined in a way that can direct you to systems that will help your loved one recover and move into a positive mindset.

Typical Symptoms Of Anorexia Nervosa

Eating disorders manifest usually out of a desire for control in a person’s life. This is especially true in adolescents and teenagers because as they develop, they yearn for autonomy but are still socially and societally constrained. Additionally, children in these age groups have a tremendous amount of social and familial pressure to succeed in school, find a job, get into college and still participate in extracurriculars. While a tremendous amount of the population suffers from anxiety or depression, these can occur in addition to an eating disorder. Because the emotional and psychological expression of both types of disorders can be remarkably similar, it’s not uncommon for a patient being treated for anxiety to have a concurrent eating disorder go undiagnosed.

Anorexia is as much a physical disease as it is psychological, and though mood and behavioral affect will be present, the true danger is damage to the body. Because eating disorders disrupt nutrition and metabolism, every single system in the body is subject to peril. In particular, anorexia is about the restriction of caloric intake in most cases, and results in a nutrition deficit through simply not eating enough, though there are other manifestations as well.

Over time, severe restriction of calories – particularly calories from nutrient and protein-dense sources – will result in a varying number of physical symptoms, including:

Fluctuations in weight
Complaints of coldness or bluish coloration of the extremities
Anemia
Recurring sickness and difficulty healing due to reduced immune response
Muscle weakness and fatigue
Hair loss
Heart palpitations, syncope (fainting) and other cardiac problems

Behavioral changes such as nervousness, irritability, and apathy are extremely common among people suffering from an eating disorder. While it’s relatively easy to draw a line between a child who won’t eat and is then having weight problems, it can be difficult when the patient is in denial or actively trying to hide their difficulties.

People with anorexia sometimes use different methods to hide physical manifestations of the disorder, but if you suspect something, these behaviors can be identifiers themselves. For instance, a person who suddenly starts wearing sweats and baggy clothing might be trying to hide body shape changes. Let’s discuss some lesser-known signs of anorexia and contextual clues that can help you identify them.

Less Common Signs Of Anorexia Nervosa

Eating disorders often manifest in times of high stress – in particular, high-performing, lean athletes are at a greater risk of developing anorexia than the general public. Patients being treated for PTSD are at a remarkably higher potential for developing an eating disorder, and teens are also in a high-risk category.

All three of these factors, however, are considered confounding variables, because all three have manifestations of their own that obscure an eating disorder diagnosis. For anorexia nervosa patients, it can come down to using contextual clues along with the mild presentation of physical symptoms to identify a problem. Understanding how malnutrition can affect the body, along with being diligent about looking for these clues can help you get your loved one into treatment.

Insomnia – hunger pangs tend to occur at night, which is one of the reasons we’re driven to snack before bed. A person who isn’t eating will have difficulty sleeping because of this, but also because our body uses certain fatty acids and nutrients to make hormones that help us sleep. Insufficient tryptophan, an essential amino acid, prevents melatonin production, which affects the body’s ability to sleep fully. Chronic insomnia along with physical manifestations of malnutrition can be a dead giveaway for anorexia.
Extreme preoccupation with types of food – while millions of people diet every year, sudden, drastic changes in a person’s way of eating can be a signal that there’s something else going on. Common changes in behavior regarding food are things like claims of going vegetarian or vegan seemingly without good cause or restricting various food groups in general. The popularity of carb-cutting diets like keto or the rise in awareness of gluten-sensitivity has provided a convenient excuse for a person with disordered eating to simply cut out a macronutrient from their diet.
Dramatic social shifts – changing social groups can often be a catalyst for the development of an eating disorder, as a means to fit in or to handle social stress. Peer pressure is another common factor, particularly if your child goes from one social peer group to a highly rigid one, a commonality when a student starts a sport. Specifically, if your child begins to compare their body to other people, this can be a very expressive sign that they’re suffering from an eating disorder when it’s paired with physical symptoms. Difficulty at school is another causal factor when paired with social shifts and eating behavior changes.
Ritualized food behavior – beyond shifting their nutritional focus on or off certain food groups, ritualized behavior will affect everything the patient does surrounding meals. They may avoid eating with the family, using excuses like “I’m not very hungry” or “I just ate” as ways to assure you that everything is fine. They may also be extremely preoccupied with a specific food, usually one with very positive health connotations (carrots, for instance) or extremely negative ones (junk food). These behaviors can manifest as narrowly eating only one type of food or as pathological avoidance of certain foods, to the point it causes distress. Finally, these rituals can create a rigid structure around eating – when, how much, and with whom are all types of rules a person with anorexia might impose on their eating behaviors.
Excessive exercise – anorexia typically manifests as a restrictive disorder regarding food, some patients tend to over-exercise to compensate for any food they eat. High-stress situations may also trigger a period of extreme amounts of exercise, and coupled with malnutrition, this can cause a severe potential for injury, fainting or other complications. Social changes, moodiness, and withdrawal that are suddenly joined by long periods of intense exercise are very clear manifestations of anorexia, if you know to look for them.
Extreme attention to how and what other people eat – this might manifest as questions about how your food tastes or they may simply be preoccupied with how much and what other people are eating in general. A person exhibiting this particular sign might also get into the habit of cooking elaborate meals for their family but not eating with them. This is often due to a desire to stay connected and make their family happy, but also to experience food without actually eating it.
Sabotaging food – this is a strategy to avoid “overeating” in the mind of the patient. They might overly salt foods or use too much sugar or spice, then using that as an excuse to take a few bites and then not eat anymore. It’s effectively an exit strategy from the meal or the responsibility of eating.

These seemingly innocuous behavioral changes – in the context of some physical symptoms of anorexia – should push you to intervene. While intervention into the psychological health of a loved one is tricky, here are some tips to help you broach the subject with them.

How To Discuss Eating Disorders With Your Loved One

If the evidence is present in sufficient quantity to suggest that your loved one might be suffering from anorexia nervosa, the first step is in your hands. You want to discuss the possibility that they need help, and then discuss treatment options from there.

But that first step can be incredibly difficult for both of you, and going into it with the wrong demeanor or questions can derail treatment before it ever begins.

Approach your loved one alone, not in a public or even moderately social setting. One-on-one interaction in a comfortable environment is the best way to get them to feel at ease enough to discuss deeply personal issues like an eating disorder.
Ask questions along the lines of “is there anything you’ve been dealing with lately that has you fearful or stressed particularly?” or “is there anything I can do to help you, as you seem to be having some struggles lately”. The goal is to be both available to them but also nonjudgmental when you inquire about their health and wellbeing.

Once you and your loved one have discussed their situation, you can work on finding reliable, proven therapies to help them move towards recovery.

Effective Treatment For Anorexia Nervosa

Once your loved one has an eating disorder diagnosis, you can move on to a treatment strategy. In some cases, in-patient hospitalization can be necessary – situations where the physical deterioration has progressed to needing medical intervention, for instance. Unfortunately, people who are treated for eating disorders in these settings do not have the same positive long term recovery prognosis that out-patient treatment provides. Studies have shown that inclusive treatment facilities like those at Oliver-Pyatt Centers put more control of recovery in the hands of the patient, and this feeling of self-efficacy more often leads to lifelong recovery.

Inclusive treatment centers use a comprehensive approach from multiple disciplines to treat eating disorders. Medical staff is there to help with physical symptoms of the eating disorder, and registered dietitians work with clients to reformulate their approach to food and nutrition. Group therapy and one-on-one counseling provide a healthy way to discuss the disorder and work on the mental and emotional aspects of recovery, and a robust aftercare plan ensures that the patient has monthly visits with professionals to help shoulder the burden of post-treatment adjustment.

The goal of a treatment facility is to show the patient that they are capable and worthy of taking control of their health and vitality. Therapy in a homelike setting is the most effective way to treat eating disorders without the harsh, clinical nature of in-patient hospitalization.

If you or a loved one are suffering from an eating disorder, an inclusive treatment facility can be the first step to long term recovery.