Symptoms and Warning Signs of Anorexia Nervosa

People who are experiencing anorexia nervosa may exhibit some of the following symptoms (something objectively experienced by the person) and/or signs (observable manifestations) of the disease. Sometimes family members and friends will remark after a diagnosis has been made that they didn't realize how many behaviors and changes were related to the eating disorder.

However, anorexia nervosa truly affects all areas of a person's life. While it is a disease that disproportionately affects females and most often begins in early to mid-adolescence, it also afflicts men and boys and can be diagnosed in children as well as older adults.

Anorexia nervosa is a potentially life-threatening disorder and one of the most lethal psychiatric disorders. Individuals with anorexia nervosa often do not believe they are ill and may try to mask their low weight. 

It is important to note that this is not an exhaustive list of signs and symptoms and people who do not have all of the manifestations below may still be struggling with anorexia nervosa. Also, these signs and symptoms are not always specific to anorexia and may reflect other conditions.

Physical Symptoms

Anorexia nervosa is quite literally self-starvation. The physical symptoms are a result of the body being denied essential nutrients, as the body is forced to conserve its resources in an effort to survive.

Many of these physical symptoms are only present in serious cases of anorexia nervosa. They can also be symptoms of other medical conditions so it is important to be assessed by a physician to determine a correct diagnosis and seek treatment.

• loss of menstrual period in females post-puberty (or delayed first period)

• sensitivity to cold
• cold hands and feet
• pale, dry skin
• dry and thinning hair
• hair loss on scalp
• brittle nails
• lightheadedness or loss of balance (may experience fainting)
• downy hair all over the body (called lanugo), which is the body's effort to conserve heat
• low blood pressure and heart rate
• bruises easily
• extreme weight loss
• muscle loss and weakness
• extreme dehydration
• abdominal pain
• constipation
• brittle bones (osteoporosis)

Behavioral Symptoms

These are signs that are often noticed outwardly by family members and friends of someone who is struggling with anorexia nervosa. They may be noticed somewhat earlier than some of the physical manifestations.

• talks or thinks about food, weight, calories, and dieting so much it gets in the way of regular conversation
• desperate to exercise even when inappropriate, such as running in inclement weather or missing other commitments in order to exercise (in kids might look like hyperactivity)
• talks about fears of gaining weight or being fat even when losing weight
• refusal to eat certain foods or entire groups of foods (such as carbohydrates or desserts)
• strange eating habits or food rituals, such as an insistence on using specific utensils
• eating unusual or odd food combinations

• cooks for others, but refuses to eat what is cooked
• may seem obsessed with cooking, cookbooks, cooking shows on television or other food related topics
• insistence on wearing cold-weather clothing, even when it is warm outside
• weighs themselves often, frequently looks in the mirror, or checks the size of certain body parts
• withdrawal from friends and family
• may go to great lengths to avoid eating, such as making up excuses about not joining the family for a meal or stating that they have already eaten
• sudden and extreme changes, such as becoming a vegetarian or refusing to eat non-organic foods, even when that is all that is available

• complaints of stomach aches
• denial of hunger
• fatigue
• extreme perfectionism
• may hide foods in order to avoid eating them

Emotional Symptoms

Some of these symptoms might be more difficult for someone on the outside to recognize. However, many family members and close friends would be able to assess that their loved one is experiencing some or all of these warning signs.

• determines self-esteem, worth, or attractiveness by appearance and weight
• depression
• strong need for approval
• anxiety
• little motivation to engage in relationships or activities
• easily irritated
• extremely self-critical

If you or someone you know is showing signs of anorexia nervosa, please seek professional help. Most of the symptoms and signs listed above are reversible with treatment. 

_Sources:

_{American Psychiatric Association. 2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.}

Mehler, Philip S. and Arnold Andersen, 2010.  Eating Disorders: A Guide to Medical Care and Complications. Baltimore: The John Hopkins University Press.