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Appendix C SIGNS OF AN EATING DISORDER & HOW TO HELP A FRIEND People struggling with disordered eating may exhibit some of the following signs and symptoms, depending on the type of eating disorder: • Preoccupation with weight, food, calories, fat grams and dieting • Frequent comments about feeling “fat” or overweight • Dramatic weight loss or rapid fluctuations in weight • Creating schedules or rituals to make time for binge sessions • Dressing in layers or baggy clothes to hide weight loss or body shape • Distorted view of body weight or shape • Over–emphasis of weight or shape on self–evaluation • Refusing to eat certain foods, or restricting whole categories of food (e.g. no fat, etc.) • Complaints about constipation, abdominal pain, cold intolerance, lethargy or excess energy • Growth of a fine, downy hair, called lanugo, on face, arms or legs • Denying feeling hungry, skipping meals or taking small portions at meals • Food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging  food on plate) • Cooking meals for others without eating any, or secretly binging on it later • Consistently making excuses to avoid meals or situations involving food or concern  about eating in public • Excessive, rigid exercise regimen—despite weather, fatigue, illness, or injury; the need to “burn off” calories taken in • Withdrawing from friends and becoming more isolated and secretive • Loss of menstrual period in post–puberty females • Feelings of being ineffective, need for control, inflexible thinking or overly restrained initiative and emotional expression • Evidence of binge eating, including disappearance of large amounts of food in short  periods of time or lots of empty wrappers and containers • Stealing or hoarding food • Periods of uncontrolled eating beyond the point of feeling comfortably full • Engaging in sporadic fasting or repetitive dieting • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, packages of laxatives • Drinks excessive amounts of water, or uses excessive amounts of mouthwash,  mints and gum 41