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  • Writer's picturemichellepugle

3 Signs of Anorexia and Anorexia Relapse That Should Never Be Ignored

With self-reflection comes a new level of honesty. With a new level of honesty comes fresh space to grow.

So here we are. It's February 12, 2023. I have been living with and in recovery from anorexia for two decades. Here's what I want you to know about the signs of anorexia and signs of anorexia relapse that should never be ignored.

Advocacy disclaimer

We still live in a society fixated on female thinness and a society that believes the beauty myth. This is a major roadblock for people in anorexia recovery.*** Why? Because when we try to approach the subject to share how our eating disorder is affecting us, it is all too often met with: "ME TOO" and a relief that someone has finally called attention to something they wanted to discuss.

Now, of course as I continue to speak more candidly about my experiences, the narrative shifts ever so slightly to:

  • "I don't even have an eating disorder, and I experience that!"

  • "I totally get it. Not the eating disorder part. But everything else."

  • "I know, [insert semi-related experience that ignores anorexia's seriousness here]."

Don't get me wrong: I love having these conversations and shedding light and adding new layers of understanding but sometimes, just sometimes, I don't want to be explaining or shaping narratives. I want someone else to help me understand or, at the very least, just listen.

I'm writing this because after this past Eating Disorder Awareness Week, I found myself in deep reflection of the ways in which we talk and respond to signs of disordered eating or body images challenges in our communities. It's become strikingly clear to me how many stereotypes and half-truths still plague this conversation and prevent people from truly being able to support those, like myself, with a history of anorexia. With the rise of copywriting AI, too, I fear the conversations will become evermore watered down and removed from reality than what we already see. So I've decided to keep adding to the conversation.

Anorexia is a deadly disease. It has the highest mortality rate of any mental illness. This means someone with anorexia is more likely to die from health complications than people living with other mental illnesses.

I have found that ignoring signs of sickness and signs of relapse makes them shine brighter, trying to get my attention as they should. Signs are not meant solely to scare you; they're meant to signal it's time to seek support.

Signs of Anorexia and Signs of Anorexia Relapse

These are not the neatly-defined signs and symptoms of anorexia you'll find on clinical lists. To learn about the commonly cited signs and symptoms of anorexia, and how diagnosis is determined, you can read any of the several articles I've written on anorexia.

Read more from Michelle Pugle:

The following signs of anorexia or anorexia relapse come from my lived experience and personal observations. They are not clinical signs and symptoms. However, I would suggest paying close attention to any of the following if they are relatable or if you start noticing them in your life.

If these signs are causing distress, please consider reaching out for support. Recommendations including speaking with an eating disorder specialist or trauma-informed therapist. More information can be found at the National Eating Disorder Information Centre (CAN).

Lesser Known Signs of Anorexia and Anorexia Relapse

Please know conditions like anorexia ebb-and-flow with external stressors so while these can be clear signs of anorexia and relapse, they are not always present. When they arise, though, this is when we need to pay close attention because healing can happen in the moments we make space to grow in.

A Nagging Pulling to Step on the Scale

I haven't owned a body weight scale since I was in undergraduate school. Not owning a scale is part of my recovery. This is not because the scale taunts me or makes me feel less than when it's above a certain number (both also true) but it's because the scale is a gateway to and tool for obsessing about numbers.

Now, this doesn't mean I don't search for scales in every new space I enter... Especially if I am experiencing signs of anorexia and relapse, and I visit a new space (spa, doctor's office, residential home, home store, gym or fitness center), it's one of the first things I consider.

How likely is it that if I go searching I'll find a scale?


After all, we are a culture obsessed with body weight.

Scale-based thoughts centered on secrecy (a factor in maintaining an eating disorder) include:

  • Can I weigh myself without anyone hearing me: moving the scale, or stepping on the scale, or stepping off the scale?

  • Can I weigh myself quickly enough that no one will notice extra time spent in the bathroom?

  • What happens if the scale says I'm above my, "I'm comfortable being uncomfortable at this weight" weight?

  • What if I break down crying on the scale?

  • What if I can't pull myself together afterwards?

  • I don't want to know.

  • I NEED to know.

  • I want to smash the scale.

  • I want to steal the scale.

  • You should just buy your own scale so this never happens again.

  • You know you shouldn't step on the scale, but everyone does it. You're the only person coddling yourself about this. Find out the truth. What did recovery cost you?

  • Can you trust the scale, though? How do you know how old it is, how accurate it is, and whether or not it will give you consistent readings across time? You will need to begin developing a baseline with this scale. A relationship.

Exposure therapy with scales is not what the goal is. You see, it's not the case that I have anxiety about the scale- it's not about the scale at all. Seeing more scales, spending time with scales, and even using scales will never be a part of treatment. The scale offers an avenue to explore body control through body modification. It is paraphernalia.

Old or New Fixation on a Certain Body Part

I can go days, weeks, and at times even months without fixating on my appearance in any way, shape, or form.

And then there are the times where a glimpse of something to be assessed is imprinted on my mind and it's like a switch has gone off. I wrote about this mind chatter in Ana, Mia & Me and have since then learned how to control thoughts fueled by anorexia. It doesn't mean I'll never have these thoughts, again, though...

It goes something like this: I see light refracting off my clavicle or the bones in my hand and I'm overwhelmed with a sense of "okayness." Ana says if I can still make out the full shape of my clavicle bone and finger bones, I must still be categorically thin (and Ana tells me this is the core of what matters). The bones become my scale, my measure of how close to or how far from the current beauty myth ideal I am. I examine the bones in comparison to the soft flesh under my belly button. How can such sharp angles live on such a soft canvas, I ask and ask and ask.

And then there are the parts that do not provide an "okayness." There is the fleshiness of my cheeks, the softness of my belly, the jiggle in my thighs and arms, the blemishes that crop up and tell me I'm eating too much of this and that. Every blackhead, every pimple, is a slap in the face to the perfectionist looking for signs she's doing recovery just well enough to look healthy but not well enough to actually let go of restrictive eating and compensatory behaviours that may result in "too much" weight restoration. The dangerous games we play.

But we aren't simply "vain." If this was the case, education would go a lot further in the recovery process than it does.

And I know it can seem like I'm fixated on my looks, but it's what these looks say to me about myself that matters most: it's not the pimple; it's the messaging around what it means to be healthy, beautiful, "pure" and clean, and worthy of praise and adoration.

It's what we have all been told the blemish signals: something to be hidden, fixed, figured out, and finally, removed. So when I start picking apart my face, fixating on tiny blemishes, and berating myself for what I've been eating and not eating because I feel it SHOWS, I know something deeper is actually going on inside me. Because truth be told: a pimple is not just a pimple for someone with an eating disorder.

The Compensation Station is Lit

The compensation station is the place in the mind of someone with anorexia where we go to make deals with ourselves in attempt to compensate for incredibly normal behaviours that for whatever reason we have been made to feel horrible about or for disordered eating behaviours we've been led to understand are not okay to continue with.

The compensation station exists as a space of negotiation with a psychiatric disorder. It is not a safe space to stay. Trust me when I say Ana will never been satisfied with the types of trades you're making. Ana will always ask for more (or less). This is why anorexia is so deadly.

When signs of anorexia or relapse are present, the compensation station is never closed. It offers a space to learn about ourselves, our beliefs, and to challenge myths.

What does your compensation station look like?

Your compensation station will be very different from mine, yes, even if we both have anorexia. Why? Because anorexia is always more than the clinical signs. It is dipped in our family history, our culture, our religion, our experience of this world. This is why I don't think sharing my exact compensation station list is helpful or appropriate. I actually feel like sharing it could be triggering in a really unhelpful way (yes, I believe some triggers can be helpful when the right tools are available).

Rather, I'd encourage you to become familiar with the deals you make with your eating disorder, start recognizing compensatory behaviours, and, yeah, start calling yourself out on them. Remember, there is no winning with anorexia. While these compensations can and do feel incredibly soothing in the moment, they are not healthy and they are not the path to recovery. Compensation stations keep up sick under the guise of being in control.

What to do now

The best thing you can do is be honest with yourself. This is the beginning step of any recovery process. While you may not want to be sick anymore, you may also want to consider the ways in which hanging onto disordered eating behaviours is harming you now and in the future.

Feeling hopeless, lost, or unsafe? Talk Suicide Canada can help.

If you're struggling to see a future, please tell someone. Suicidal depression and anorexia are often found together and not being able to look ahead is a sign you need more support than you're receiving right now.

***I write about anorexia because that is the eating disorder I have personal experience with. This is not meant exclusionary, it's actually meant to elevate the conversation. We have too many sites conflating "eating disorders" when, really, having anorexia is vastly different from having binge eating disorder or bulimia. Are there overlaps? Absolutely! But there are also overlaps between dieting, disordered eating, and anorexia, and, well, there are overlaps all over the mental illness spectrum. Talking about them all is if they are the same? AI bots can do that. I'm here to add nuance to the discussion on anorexia. If you live with another eating disorder and feel left out of the conversation, please know, this is not intentional. Anorexia is a spectrum, too, and zooming out too far to include all eating disorders is an erasure of what we experience and keep stigmas and stereotypes alive.

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