When food starts to say something else

An eating disorder doesn't start overnight. It usually starts with something that seems reasonable: eating healthier, exercising, cutting out sweets. What changes is the tone: it becomes rigid, secretive and loaded with distress.

Three ways it can show up

These can combine, and they can happen without any change in weight.

What often comes with them

• Irritability, especially around meals.
• Isolation: they stop going out when food is involved.
• Rigidity: rules, rituals, a lot of distress if something changes.
• Baggy clothes, feeling cold, tiredness.
• Denying that anything is going on, sometimes with great conviction.

Why it's not a whim

From the outside it looks like a decision: "They should just eat and that's that." From the inside it isn't. Restricting or bingeing soothes something for a while, and that makes them hard to let go of. Your teen may know it's hurting them and, at the same time, feel terrified of stopping. That's why arguing, persuading or threatening doesn't work, and why willpower alone isn't enough.

What's good to know

• No one is to blame. Comments carry weight, but no single one is enough to cause a disorder. Biology, personal history, the moment in life and the environment all play a part.
• It happens in all bodies and all genders.
• Denying it is part of what's happening to them, not a lie meant to deceive you.
• The sooner you get professional help, the better things go.

Try this: sort out what you've seen

1. 1Write down what changed and since when: meals, mood, exercise, social life.
2. 2Separate the facts from the fears.
3. 3Don't look for proof by going through their things, and don't weigh them at home.
4. 4With those notes, ask for an appointment. You don't need to wait until you're certain, or until you understand why. Understanding can wait. The appointment can't.