The Signs and Symptoms of Anorexia: Early, Behavioural and Physical

Anorexia does not always look the way people expect it to. In its early stages, there may be no dramatic weight loss or obvious physical signs. Instead, the first changes are often subtle shifts in somebody’s thoughts, behaviour and relationship with food.

This can make anorexia particularly difficult to recognise. Someone may appear to be eating more “healthily”, exercising more or becoming interested in nutrition, while underneath these changes their eating is becoming increasingly restricted and anxiety around food, weight or body shape is growing.

People may also try to hide what is happening because they feel ashamed, fear being judged or worry that other people will try to make them change their eating.

In summary: the earliest signs of anorexia are usually behavioural and psychological. These might include increasing preoccupation with food, weight or shape, rigid eating rules and avoiding meals. Physical signs such as weight loss, tiredness, dizziness and feeling cold may develop later, so you do not need to wait for visible weight loss before seeking help.

The Early and First Signs of Anorexia

The early signs of anorexia can initially look relatively ordinary. A diet, health kick or new exercise routine may gradually become more restrictive and difficult to deviate from.

Some of the first changes you might notice include:

• becoming increasingly interested in calories, nutritional information or weight
• starting to cut out foods or entire food groups
• describing more and more foods as “bad”, “unhealthy” or unacceptable
• developing strict rules about when, what or how much to eat
• skipping meals or giving reasons for not eating
• eating noticeably smaller portions
• becoming anxious, irritable or distressed around meals
• increasing exercise or feeling guilty when unable to exercise
• weighing themselves or checking their body more frequently
• becoming increasingly dissatisfied with their body or fearful of weight gain.

None of these behaviours individually proves that somebody has anorexia. What matters is the pattern and progression: food and weight begin to take up more mental space, rules become increasingly rigid and everyday life starts to organise itself around eating, exercise or avoiding weight gain.

You can read more about how anorexia develops through its stages.

Early Signs of Anorexia in Teenagers

Recognising the early signs of anorexia in teenagers can be particularly difficult. Adolescence naturally brings changes in appetite, body shape, independence and mood, so parents may initially assume changes around food are simply a phase.

Signs worth paying attention to include:

• regularly skipping breakfast, lunch or family meals
• saying they have already eaten or will eat somewhere else
• suddenly becoming highly focused on “clean eating”, nutrition, vegetarianism or veganism where this also results in increasing restriction
• cutting out previously enjoyed foods
• exercising excessively or becoming distressed about missing exercise
• withdrawing from friends or activities involving food
• wanting to eat alone rather than with the family
• becoming increasingly secretive around food
• frequently criticising their body
• wearing loose or baggy clothing to hide their body
• increasing irritability, anxiety, low mood or social withdrawal.

For children and teenagers, changes in growth and development can also be important. A young person does not necessarily have to lose large amounts of weight: failure to gain weight or grow as expected, or delayed puberty, may also be warning signs.

If several of these changes are happening together, it is reasonable to seek an assessment rather than waiting to see whether the situation becomes more serious. We also have further guidance for parents worried about their child.

Behavioural and Psychological Signs of Anorexia

As anorexia becomes more established, changes around food, control, body image and social life often become increasingly noticeable.

Changes around food

Someone may:

• miss meals or eat very little
• avoid particular foods or food groups
• eat extremely slowly
• cut food into very small pieces
• develop rituals around preparing or eating food
• cook or bake for other people without eating themselves
• repeatedly claim to have eaten earlier
• become uncomfortable eating in front of other people.

Eating can increasingly become a source of tension, negotiation or anxiety.

Increasing need for control

There may be a strong preoccupation with calorie intake, exercise, weight and food.

Someone may repeatedly weigh themselves, plan food very precisely or become distressed when a meal is different from what they expected. Exercise can also become increasingly compulsive, with guilt or anxiety if they cannot complete a planned session.

Changes in body image

Anorexia can significantly affect how somebody perceives their body.

They may:

• frequently check their body in mirrors or photographs
• repeatedly pinch or measure parts of their body
• compare their body with other people’s
• express intense fear about gaining weight
• believe they are larger than other people perceive them to be
• feel increasingly positive about themselves as their weight falls
• minimise or deny the seriousness of weight loss.

They may also become angry or defensive when friends or relatives raise concerns.

Withdrawal and secrecy

Eating disorders often become progressively isolating.

Someone may avoid restaurants, parties, family meals or other situations involving food. They may make excuses not to attend events and spend more time alone.

Secrecy may increase too, including hiding food, misleading others about what they have eaten or concealing changes in weight.

What Are the Physical Signs and Symptoms of Anorexia?

Physical signs of anorexia can include weight loss or failure to grow as expected, feeling cold, dizziness, tiredness, digestive problems, hair and skin changes and changes to menstruation or puberty.

Possible physical symptoms include:

• significant or rapid weight loss
• becoming increasingly tired or weak
• feeling lightheaded, dizzy or faint
• feeling cold much of the time
• poor circulation, particularly in the hands and feet
• dry skin
• thinning or loss of hair
• growth of fine, downy hair on the body, known as lanugo
• bloating, constipation or abdominal discomfort
• headaches or difficulties sleeping
• periods becoming irregular or stopping
• delayed puberty or faltering growth in younger people.

It is important, however, not to wait for these signs before taking concerns seriously.

A person can have a clinically significant eating disorder without appearing extremely thin, and weight or BMI alone cannot tell you how unwell somebody is. This is one reason specialist assessment considers changes in eating behaviour, psychological symptoms, physical health and the wider pattern of what has been happening.

Warning Signs of Anorexia: A Quick Checklist

Some of the most common warning signs of anorexia nervosa include:

Early signs

• increasing interest in calories, weight or nutrition
• cutting out foods or food groups
• smaller portions or skipped meals
• increasing anxiety around eating
• rigid food or exercise rules.

Behavioural and psychological signs

• frequent weighing or body checking
• compulsive exercise
• intense fear of gaining weight
• secrecy or lying about eating
• avoiding meals with other people
• distress when eating routines change
• withdrawal, irritability or low mood.

Physical signs

• weight loss or failure to gain weight as expected
• tiredness or weakness
• dizziness or faintness
• feeling cold
• hair or skin changes
• digestive problems
• menstrual changes
• delayed growth or puberty.

You do not need to recognise every sign on this list for there to be a problem.

Early Detection: What Should You Do Next?

If you recognise several of these signs in yourself, your child, your partner or somebody close to you, it is usually better to ask for help early rather than waiting for the picture to become clearer.

An assessment does not automatically mean that somebody will be diagnosed with anorexia. Its purpose is to understand what has been happening, assess physical and psychological risk and identify whether specialist support would be helpful.

At The London Centre, we provide specialist assessment and anorexia nervosa treatment for children, adolescents and adults. Depending on the person’s needs, treatment can involve psychology, dietetics, family work and psychiatry for eating disorders as part of multidisciplinary care.

For people who cannot easily attend one of our clinics, we can also provide specialist eating disorder therapy online, allowing people across the UK to access assessment and treatment while continuing with school, university, work and family life.

Where standard weekly outpatient treatment is not providing enough support, our specialist team can also consider whether a more intensive outpatient approach may be appropriate.

Are there self-assessment tools for detecting an eating disorder?

Eating disorder questionnaires and informal online self-checks can sometimes help somebody recognise that their eating or thoughts around food have changed.

However, a self-assessment cannot diagnose anorexia or establish how medically or psychologically unwell somebody is. If a questionnaire, checklist or your own observations raise concerns, it is better to use this as a reason to seek a professional eating disorder assessment.

You also do not have to be certain that somebody has anorexia before asking for help.

Frequently Asked Questions

What’s the difference between anorexia and dieting?

Dieting tends to be relatively flexible and time-limited, whereas anorexia involves increasingly rigid restriction and a growing impact on thoughts, emotions and everyday life. Intense anxiety about eating or gaining weight, compulsive behaviours, secrecy and difficulty breaking food rules are all reasons to seek specialist advice.

At what age does anorexia usually start?

Anorexia commonly develops during adolescence or early adulthood, although it can occur at any age. Because some of the earliest changes can overlap with ordinary teenage behaviour, it is particularly important to pay attention when restriction, anxiety around food and changes in mood or social behaviour begin occurring together.

Can anorexia affect men and boys?

Yes. Anorexia can affect people of any gender. Men and boys can sometimes be diagnosed later because eating disorders are still wrongly associated primarily with girls and women. The London Centre assesses and treats people of all genders.

Getting Help for Possible Anorexia

If you are concerned about your own eating, or you have noticed changes in somebody close to you, you do not need to wait until they are visibly underweight or until every symptom of anorexia is present.

Early behavioural changes can be significant in their own right.

A specialist assessment can help establish whether there is an eating disorder, understand how serious the current difficulties are and recommend the most appropriate next steps.

If you recognise some of the early signs described above, contact The London Centre to arrange a specialist eating disorder assessment in person or online.