Ongoing and repetitive dieting – Counting calories, converting to vegetarianism or veganism, skipping meals and cutting out entire food groups, drinking coffee and diet fizzy drinks to feel full.

Obsession – obsessed with food. Looking up recipes, always cooking meals for others but not consuming them, rigidity (control) – not letting anyone else cook meals for them, eating at certain/set times, eating with small utensils e.g. tea spoon, taking extensive amounts of time to eat the food, constantly talking about food. Having the same/similar food every day.

Avoidance – avoiding certain food groups, social situations where food maybe involved, saying things such as ‘I’m not hungry, I’ll eat later’ or ‘I have already eaten’. Saying that they no longer like certain foods which they have previously enjoyed. Deceptive behaviour; throwing out food, hiding food and lying about the amount of food they have consumed.

Extensive and excessive exercise -This can range from hours at the gym, increased physical activity and exercising in the bedroom. Change of behaviour; saying that they would walk when previously they would have asked to be driven. Agitated and aggravated behaviour if their exercise regime is interrupted.

Physical – Being cold all the time, tired, hair falling out, nails breaking easily, fatigue, low blood pressure, shaking due to loss of potassium, fainting, rapid weight loss and loss of menstrual cycle, changing the style of clothing to conceal weight loss. Excess hair growth, particularly around the face and arms, swollen cheeks and glands from excessive purging, marks on the back of knuckles from purging.

Binging – large quantities of food going missing from the cupboards, increased amount of junk food- particularly high sugar foods and carbohydrates. Hoarding and excessive spending. Eating in secret, often in their rooms, eating everyone’s left overs from the plate as well as what is ever left over from the meal.

Purging – marks on the back of the hands, swollen cheeks and glands, shaking due to drop in electrolytes, going to the toilet straight after meal times, spending a long time in the bathroom, running water, splash marks around the rim of the toilet and up the wall, toilet roll going down quickly where it has been used to cushion the sound of purging and to clean the toilet.

Psychological – Social isolation, depression, mood-swings, constantly looking in the mirror and grabbing at any excess skin, also known as body pinching.

Frequently checking weight and using the bathroom scales. An Intense fear of gaining weight; lack of self-esteem and self-confidence; body dysmorphia – (seeing yourself differently than you are in reality) Obsession with body shape and appearance; negative attitude to appearance and body image.

Feeling ashamed, guilty and irritable. There is a degree of self-loathing and most are argumentative; particularly to those closest.

In addition, individuals come across as defiant, deceptive and selfish. They feel out of control and there is a heightened anxiety.Sensitive to comments made- ‘you’re looking well’ can be perceived as ‘you look fat’, or ‘why can’t you just eat’. (It isn’t as simple as that).

A fascination with celebrities; what they look like, their weight loss, dieting tips, magazines, stories, the latest diet fad.

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