Anorexia can be difficult to identify. If you’re concerned you or a loved one is struggling with anorexia, this page outlines the warning signs, symptoms, and causes of this disorder.
What are the Signs and Symptoms of Anorexia?
The earliest warning signs of anorexia (anorexia nervosa) can be very difficult to distinguish from normal eating or dieting behavior. Anorexia symptoms may also be concealed, attributed to other health conditions or dismissed as side effects of prescription drugs.
However, eating disorder treatment professionals can distinguish symptoms of anorexia from other medical conditions by identifying physical signs such as:
- extreme weight loss
- thin appearance
- abnormal blood counts
- elevated liver enzymes
- dizziness or fainting
- brittle nails
- hair that thins, breaks or falls out
- absence of menstruation (amenorrhea)
- development of fine hair on the extremities (lanugo)
- dry skin
- intolerance of cold
- irregular heart rhythms
- low blood pressure
- osteoporosis, the loss of bone calcium, which may result in broken bones
What Are the Warning Signs of Anorexia Nervosa?
Most early signs of anorexia center on preoccupation with food or dieting. Behavior may appear obsessive or compulsive, and begin to consume more time. Eventually, disordered eating patterns will become more noticeable to others and potentially disrupt schooling, career, and relationships with family and friends.
If you’re concerned that you or someone you love may have an eating disorder, watch for these early warning signs of anorexia:
- refusal to eat
- denial of hunger, even when starving
- difficulty concentrating
- obsession with body size and shape
- skipping meals
- making excuses for not eating
- eating only a few certain foods considered safe, usually those low in fat and calories
- adopting meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing
- weighing food
- cooking elaborate meals for others but refusing to eat
In men or women with an abnormal preoccupation with food, several other behaviors should also be recognized as clear warning signs of anorexia nervosa, or possibly other eating or body image disorders:
- excessive exercise
- flat mood, or lack of emotion
- repeated weighing of themselves
- frequent checking in the mirror for perceived flaws
- wearing baggy or layered clothing
- complaining about being fat
What is Anorexia?
Anorexia nervosa is an eating disorder in which a person is obsessed with weight, body shape and food intake to the point of self-imposed starvation. Anorexia symptoms frequently develop over a period of years in women and men with certain genetic, emotional or life-experience predispositions. Anorexia most often develops in young women during the teenage years, but increasing reports cite symptoms of anorexia and other eating disorders in pre-teen girls and boys.
Anorexia nervosa symptoms appear in two inter-related patterns:
- Conscious refusal to maintain a body weight that’s healthy for a man or woman’s age and height
- Severely distorted self-image, and obsession with the perception that he or she is overweight, even when severely underweight
To prevent weight gain or to continue losing weight, a person with anorexia nervosa will severely restrict food intake or exercise excessively, and resist efforts to change behavior. Some anorexics purge after eating regular meals or engage in binge eating followed by purging. Without proper eating disorder treatment, anorexia can reduce a person to a point where he or she is skeletally thin but still perceives that they are overweight.
Anorexia nervosa causes are much more serious than excessive dieting, an unhealthy view of food or an obsession with body image. Although anorexia is most distinguished by disordered eating behaviors and rituals, the disease process involves much more than food. Anorexia symptoms are ultimately attempts to cope with seemingly unmanageable emotions by achieving perfectionism and control. For a man or woman with anorexia nervosa, recognition of self-worth often centers on ability to reach a goal of thinness or maintain control over the body and appetite.
What Causes Anorexia?
Much work remains to be done to understand the causes of anorexia nervosa. As with bulimia, other eating disorders, and addiction, anorexia involves complicated interaction among biological, psychological and social factors.
Doctors, therapists and staff at anorexia treatment centers have more recently acknowledged that genetics play a part in the development of anorexia. A young woman with a biological sibling or parent with an eating disorder is at higher risk, suggesting a possible genetic link. However, it’s not clear specifically how genetics may interact with other contributing factors. It may be that some people have a genetic tendency toward perfectionism, sensitivity and rigidity, all traits associated with anorexia nervosa.
Psychological and emotional characteristics may also leave some people more susceptible to seeking emotional relief through self-starvation. Common examples observed in anorexics are:
- Low self-esteem, which may stem from unresolved experiences of neglect or abuse during childhood
- Obsessive or compulsive personality traits, which make it easier to adhere to strict diets and resist hunger
- Perfectionism, when centered on the body leads to thought distortions such as “I’m never thin enough.”
- Low levels of serotonin, one of the brain chemicals involved in depression
Cultural influences can also contribute to the development of anorexia nervosa. Our society sends a constant stream of media reinforcing thinness as an ideal, especially for young women. Television, magazines, and billboards are filled with images of unrealistically thin models, athletes and actresses / actors. Success and worth are often equated with being thin. Peer pressure may fuel the desire to be thin, particularly among teen girls, who over time view anorexic symptoms as normal, even positive traits.
What are the Effects of Anorexia Nervosa?
Anorexia’s effects vary depending on the severity of the disease. They tend to worsen as thoughts about food crowd out more and more of an anorexic’s thoughts.
- Forced withdrawal from school or college
- Loss of connection to faith or religion
- Career disruption
- Isolation from friends and family
The physical effects of starvation are often irreversible, and reflect the extremely high rate of deaths associated with anorexia nervosa:
- Shutdown of major body systems
- Brain damage
- Heart attacks
What Other Signs or Symptoms Should I Look For?
Anorexia nervosa is a complicated disease that affects each man or woman differently. There are several patterns of anorexia signs and symptoms that eating disorders treatment specialists know to look for:
Adolescent women with anorexia show a dramatically greater incidence of alcoholism than the rest of their peer group. This can occur when efforts to numb feelings of inadequacy by restricting food intake fail to bring the control and emotional relief a woman with anorexia seeks. College-aged women in particular are much more likely to show symptoms of co-occurring alcohol addiction along with anorexia nervosa.
Abuse of Stimulants
Many over the counter energy boosters, dietary supplements and prescription stimulants, such as medication for ADHD, have appetite suppressing side effects. Because of the ready availability of these drugs in schools and on college campuses, adolescents with anorexia are particularly susceptible to the temptation to misuse them to suppress appetite.
Anorexia nervosa often co-exists with major depression, anxiety disorders, or obsessive compulsive disorder (OCD).These are called co-occurring disorders, and they are difficult for many treatment providers to diagnose accurately and treat effectively in conjunction with an eating disorder. Patients whose anorexia nervosa treatment fails to address co-occurring disorders will face a vastly more difficult treatment path and more complex challenges in recovery.
Purging Behaviors with Starvation
Many with symptoms of anorexia show signs of a separate variation, the binge-purge type. Persons with this type of anorexia disorder will not only self-starve, but also take other actions to reduce their weight. This may include exercising obsessively, or abusing laxatives, diuretics / water pills, or other diet drugs.
Pro Anorexia (“Pro Ana”) and Pro Eating Disorder Websites
Numerous internet websites and communities center around the dangerous culture of pro-anorexia / pro ana, eating disorders, and “thinspiration.” This trend can have deadly implications for persons at risk for anorexia, bulimia, and other eating disorders.
Pro ana websites contain pictures of people dangerously thin with eating disorders, as well as photos of celebrities and others to whose appearance they aspire. These sites also contain anorexia tips to accelerate weight loss, to hide the effects of starvation, and even to deceive eating disorder treatment professionals. Some pro ana sites even actively promote an anorexic “lifestyle.”
Similar “pro mia” sites have developed for those with bulimia symptoms or bulimic behaviors. Anorexics who begin to purge may also visit these pro bulimia sites.
Loved ones should consider evidence that a person has regularly visited pro eating disorder websites as a very strong indication of the need to seek treatment of anorexia or bulimia nervosa.
Anorexia nervosa is a very serious eating disorder, particularly if it is accompanied by co-occurring psychiatric and addictive disorders. Like bulimia nervosa and other eating disorders, anorexia is a medical disease that can result in irreversible health complications, including death.
Find out more about residential anorexia treatment for adolescent girls and adult women (ages 12 to 65+) at Timberline Knolls Treatment Center.