People with anorexia have an obsessive desire to be thin that can lead to losing dangerous amounts of weight. Anorexia is an eating disorder that often begins around puberty, but it can begin at any age. People with this condition may have childhood trauma, emotional challenges or self-esteem issues that can make them vulnerable to developing anorexia, but it can also be related to hormones and genetics. Secrecy is a hallmark of anorexia. So how do you know if someone is struggling with this potentially life-threatening disorder? We asked experts to share the top 10 signs of anorexia: 1. Sudden Weight Loss or Interest in Dieting While weight loss that seems sudden and unexplained is one of the classic signs of anorexia, it\u2019s not always conscious or intentional. \u201cA lot of eating disorders are accidental, in the sense that someone will lose weight, get recognition for it, then continue those behaviors to an obsessive level,\u201d says Shannon, a woman in eating disorder recovery whose mission is to helps others. \u201cIf someone has made a drastic change in their life and seems to be heavily focused on their weight loss that can be a red flag.\u201d 2. Always Having an Excuse to Not Eat \u201cExcuses may include saying they already ate, they aren\u2019t hungry or they don\u2019t like the food,\u201d says Catherine Silver, LCSW, a psychotherapist who specializes in eating disorders and body image issues. They may disappear from the dinner table or simply refuse to join the family for meals. If they stay at the table, they barely eat and play with their food. 3. Overeating \u201cSafe\u201d Food Anorexia is characterized by restriction of food intake but that doesn\u2019t mean only skipping meals. \u201cThey might be restricting certain types of foods such as sugar, fats and carbs,\u201d says Silver, \u201cbut will eat other types \u2015 and sometimes even large amounts \u2015 of \u2018safe\u2019 foods.\u201d They may also drink excessive amounts of water or fluids to curb hunger. \u201cThis can be particularly confusing for people who suspect their loved one has an eating disorder,\u201d says Silver. \u201cThey know something isn\u2019t right but they still see the person eating.\u201d 4. Hiding or Disguising Food People with anorexia may hide food to make it appear like it has been eaten. This may mean stashing a roll in their pocket or removing food from the plate when no one is looking. If there\u2019s a family dog, they will feed it to the animal under the table. If hiding food is hard to pull off they may \u201cspread food out on a plate to make it appear like more was consumed,\u201d says Silver. Another sign of anorexia is overuse or inappropriate use of condiments, such as pouring on extra gravy or ketchup to make the plate seem fuller. 5. Strict Food Rules Disordered eating also often involves a long list of foods to be avoided for various reasons. \u201cThis may be based on the calorie count, carb content or exercise needed to burn all the fat in the food,\u201d says Julie Stefanski, MEd, RDN, CSSD, LDN, CDE, a nutritionist who works with patients with eating disorders. The rules of what they can and can\u2019t eat are often accompanied by rigidity about when, where and how they can eat, such as never eating in front of others, never letting food touch their mouth after a certain time of day, or eating food in a particular order, adds Silver. 6. Overinformed About Nutrition Facts Extensive knowledge of nutrition facts is not always a good thing. \u201cIt may be a sign that too much focus is being placed on restrictive eating,\u201d says Stefanski. This type of hyper-focus can be easy to hide in today's diet-obsessed culture, she says, but it is a red flag if someone who is losing weight and has other signs of anorexia suddenly becomes a nutrition expert. 7. Anxiety About Food People with eating disorders often suffer from low self-esteem, poor body image, depressed mood, irritability and general anxiety to begin with, so feeling panicked about food or getting agitated around meal times can be very disturbing to them \u2015 and it may be disconcerting to loved ones. \u201cSomeone who is struggling with anorexia will experience anxiety about \u2015 or in the presence of \u2015 food, which is related to their fear of eating certain foods or gaining weight,\u201d says Sarah Farris, LCPC, a specialist in fitness nutrition. Food can be perceived as dangerous. 8. Wearing Jackets or Layers Indoors Although some people with anorexia wear a big jacket or extra layers to hide their bodies, they are also prone to becoming very cold. \u201cI used to wear a winter jacket 24\/7,\u201d says Shannon. \u201cMy school was required to turn up the heat in my classrooms to accommodate my extremely low body fat.\u201d 9. Sudden Introversion or Withdrawing People with anorexia often want to hide. Low self-esteem may even lead them to feel they deserve to disappear and not exist in the world. \u201cThis is visually seen through thinness, but can also be seen prior to emaciation through sudden shyness,\u201d says Shannon. \u201cWhen one of my cousins also developed an eating disorder, she started by hiding behind people, being really quiet in speech and almost folding in on herself in an attempt to hide.\u201d This is often followed by withdrawal from friends and social circles. \u201cEating disorders are isolating diseases that cause those suffering to pull away from the people closest to them,\u201d she explains. 10. Physical and Health Changes In addition to obvious things such as weight loss and feeling chilly all the time, Silver points out that signs of anorexia can include the following health issues: dizziness; fatigue or tiring easily (while doing activities that weren\u2019t previously tiring like walking short distances); dry skin; osteoporosis or osteopenia; hair loss; brittle nails; and irregular period or loss of one\u2019s period. In severe cases, lanugo (when fine hairs or peach fuzz grows on other parts of the body such as the face, stomach or chest) develops. The good news is that people can recover from anorexia with proper medical, psychological and nutritional support and residential eating disorder rehab if needed. It\u2019s a process, but the healing may begin when someone notices the signs of anorexia and takes action to help the person they love.