Young people go to great lengths to deny and conceal their painful struggles with food. Here are some signs that may help you recognize an eating disorder in someone you know.

• Excessive weight loss. Anorexia is diagnosed when the teenager is 15 percent below expected weight (whether due to loss or failure to gain with growth).
• Frequent weight fluctuations. Although the bulimic usually maintains near normal body weight, his/her roller coaster dieting may show up in erratic weight gains and losses.
• Unusual eating habits, like taking tiny bites to stretch out eating time or compulsively arranging food on the plate.
• Stops eating meals with the family; i.e., too busy or eating elsewhere.
• Secretive behavior, especially with respect to eating and bathroom use. A teenager who habitually runs water, plays the radio or flushes the toilet repeatedly while using the bathroom may be masking the sounds of vomiting.
• Use of laxatives or diet pills.
• Food disappearing on a regular basis.
• Excessive and often obsessive exercise.
• Dull hair and hair loss, splitting or softening nails.
• An absence of menstrual periods related to loss of body fat.
• Dental cavities and gum disease, caused by malnutrition and vomiting.
• Extreme sensitivity to cold, due to loss of fat and muscle.
• Fine body hair on arms and legs. This is the body's attempt to keep warm.
• Low self-esteem.
• Distorted body image. No matter how thin she/he gets, the anorexic still believes she/he is too fat.
• Irritability, depression or talk of suicide.
• Drug or alcohol abuse. Sometimes, teenagers with eating disorders will turn to substance abuse to relieve feelings of fear, shame and depression.