Early signs of an eating disorder in a teenager — what to notice before it gets bad

“I did see that something was wrong. I just thought it was a phase.”

That was said to me by a mother holding a tissue and not crying. She was angry with herself, and that is the most unfair part of this subject: parents almost always notice something, they just do not know that what they noticed was a sign. Because the signs of an eating disorder are not dramatic. They are small, understandable and, taken one at a time, entirely innocent.

This piece is about what to notice earlier. I will not list behaviours and I will give no numbers of any kind — that sort of content is harmful to a young person who reads it. Instead I will describe the shifts in language, in relationships and in mood that a parent can actually see.

Why time is the single most important factor in adolescence

In eating disorders, how long the difficulties have lasted is one of the strongest predictors of the course. The shorter the period in which the pattern has been hardening, the better the outcome. This is precisely what early intervention programmes are built on, and over the past decade they have shown that shortening the wait for help improves results in itself.

With a young person there is a further reason. Their body and brain are in a period of rapid development, so a stretch of poor nutrition places a heavier burden than it would on an adult. And a third reason: in adolescence the pattern is still being established, so it is still soft enough to shift.

In short — waiting is not neutral. It is not true that you lose nothing by it.

Why it is so hard to recognise

The first reason is that much of this overlaps with ordinary growing up. Teenagers change their tastes, shut themselves in their rooms, get moody, form convictions. Any single change may be normal.

The second reason is that in a young person the disorder first looks like an improvement. The child becomes more disciplined, more focused, more organised. Marks often improve. A parent has the feeling that their child has finally “found themselves” — and so praises exactly the thing that should have been noticed.

The third reason is the most painful: very often the young person does not know this is a disorder. They hide it not out of dishonesty but because it is the only thing currently holding them upright. I have written separately about how a symptom is saying something.

Signs in language and thinking

The earliest signs are almost always in language. A child starts speaking about food in categories that are not their own — in terms of correctness, of deserving, of making up for something. Words appear about having “earned” something or needing to “compensate”.

The second linguistic sign is rigidity. What used to be a matter of taste becomes a rule, and the rule will not be negotiated. If you suggest a change of plan, the answer is not “can’t be bothered” but something more taut.

The third sign is excessive interest in content about food, exercise and the body — long hours, a narrow range, a lot of comparing. And the fourth: talking about oneself in an accusing tone that is no longer ordinary teenage dissatisfaction but something closer to a verdict. In adults I treat that voice as the inner critic; in a teenager it sounds even more direct.

Signs in relationships and daily life

Eating disorders are seen most reliably in how the calendar shrinks. A child begins to decline things they used to love. Birthdays, outings, lunch at their grandmother’s, sleepovers — each time the reason is different and each one is plausible on its own. Added together, they show a direction.

The second sign is withdrawal from shared meals. Not as a one-off but as a pattern that keeps acquiring new justifications. The third is a change in how much control over the day’s plan the child needs — an unexpected change of schedule becomes disproportionately hard.

And the fourth, which parents often only describe in hindsight: the child becomes more alone. Not necessarily lonely on the outside, but less reachable. Conversations get shorter, answers get tidier, as though prepared in advance.

Signs in mood and in the body

Mood signs are often the ones that really alarm a parent — irritability that was not there before, sudden outbursts over small changes, crying with no visible cause, withdrawal. Anxiety often joins in, showing up as a need for everything to be known in advance.

Physical signs worth attention include tiredness that sleep does not lift, feeling cold, poorer concentration, dizziness on standing, disturbed sleep, and in girls changes in the menstrual cycle. None of these on its own means a disorder. All of them together are a reason to see the GP, not to search online.

What is happening to you meanwhile

Too little is written about this, although it matters a great deal for how things go. When a parent starts to suspect, a mixture of fear and guilt almost always takes over. Fear says something must be done immediately. Guilt says this is your fault. Together they lead to the things people later regret — checking, negotiating, conversations that turn into a row in the middle of the kitchen.

So I always tell parents two things. First: eating disorders are not a result of how you parented. That explanation was in circulation for a long time, is not supported by evidence, and did a great deal of damage. Second: your own distress is understandable and needs a place of its own — with a partner, a friend or a professional, not with your child. A child cannot carry your fear on top of their own.

In practice this means taking a moment before a conversation to ask yourself whether you are going into it for information or for reassurance. If you go for reassurance, the conversation will turn into an interrogation. If you go for contact, it will stay a conversation.

What the school may notice

Often it is school that notices first, not home — because they see the child in another setting and among other people. A form teacher or the school counselling service may notice withdrawal from company, a change during breaks, a drop in concentration, missed PE lessons, or unusual performance tension before every test.

If you have a good relationship with the school, the question “how does he seem to you lately” is entirely legitimate and does not mean betraying your child’s trust. It means you are assembling a picture before deciding. The school is not there to make diagnoses, but it can tell you whether the shift is visible outside the home too.

What is not a sign

Because lists of signs are dangerous in their own way, let me say this too. It is not a sign if a teenager becomes vegetarian on ethical grounds and eats normally, sees friends and keeps their flexibility. It is not a sign if they take up a sport and enjoy it. It is not a sign if they have low periods or dislike being photographed.

The difference is always the same: is life wider alongside this, or narrower. If the calendar has been filling and the child is still reachable, things are probably fine. If the calendar has been emptying, they are not.

The second distinguishing question is whether the child can talk about it. A teenager for whom vegetarianism is a value will talk about it gladly and will tolerate disagreement. A teenager with fear underneath will dodge the conversation or become disproportionately upset. It is not about the content of the conviction, but about how much room around it they can bear.

What to do, in order

When a parent suspects something, one of two things usually happens: they freeze and wait, or they mobilise and start controlling. Both end badly. The path in between is duller and more effective.

The first step is observing without acting. A fortnight is long enough for a pattern to show and short enough not to waste time. Write down what changed and when it started — not as evidence, but because you will need it at the doctor’s. Under stress, memory shrinks to the past week.

The second step is a conversation that does not go through food. If you start with food you will get defence, because food is exactly the ground your child is defending. If you start with how they are feeling — with tiredness, pressure, the fact that they seem less cheerful to you — you leave a door open. I will write in more detail about how to hold such a conversation separately; here what matters is mainly that the conversation happens at all.

Where this list fails

Now the part that unsettles my own piece, and please read it to the end before you start counting anything.

First: these signs are not specific. The same picture can be produced by depression, an anxiety disorder, bullying, a hard experience, pressure at school, or an entirely ordinary stretch of growing up. A list of signs does not make a diagnosis and cannot.

Second: lists trigger surveillance. That is the most counterproductive reaction I know of in eating disorders. A child who senses they are being watched does not open up — they only hide better. Surveillance also reinforces the very axis the disorder stands on: who has control over whom.

Third: an absence of signs is not proof that everything is fine. Eating disorders can go on for a long time without visible changes, and that is exactly why conversation matters more than observation.

And fourth, worth saying plainly: as a parent you cannot solve this alone, and it is not your job to make the assessment. Your job is to stay in the relationship and to get your child to someone who can. That is less than you would want, and it is at the same time what counts most.

When not to wait

Some things are not for monitoring. Fainting, dizziness on standing, a pounding heart, marked weakness, rapid deterioration in general condition or loss of menstruation mean a doctor’s appointment that same week, not at the next opportunity.

The same applies if your child says they are harming themselves or that they no longer want to be alive. That is a medical priority, not a family matter. I have written about when a doctor is the first step in a separate piece, and I map out the routes to help in Slovenia in the piece on referrals and waiting lists.

What to remember

The early signs of an eating disorder in a teenager are not dramatic. They show as rigidity where taste used to be, as a calendar that keeps emptying, and as talk about themselves that has grown harsher. No single sign means anything; together they show a direction.

Time counts. The shorter it lasts, the better the outcome — which is exactly why it is worth asking too early and being wrong rather than asking too late and being right.

If you are unsure, start with the GP. And if you are afraid of offending your child by asking: a question put with curiosity and without accusation spoils nothing. Silence can.