Eating Disorders Symptoms Symptoms and Warning Signs of Anorexia Nervosa Physical, Behavioral, and Emotional Symptoms By Susan Cowden, MS facebook linkedin Susan Cowden is a licensed marriage and family therapist and a member of the Academy for Eating Disorders. Learn about our editorial process Susan Cowden, MS Reviewed by Reviewed by Rachel Goldman, PhD, FTOS on August 27, 2020 facebook twitter linkedin instagram Rachel Goldman, PhD FTOS is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in weight management and eating behaviors. Learn about our Review Board Rachel Goldman, PhD, FTOS Updated on September 17, 2020 Print Andrew Brookes/Cultura/Getty Images Table of Contents View All Overview Physical Symptoms Behavioral Symptoms Emotional Symptoms 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. Eating disorders may often appear differently than the stereotyped versions of eating disorders commonly portrayed in the media. Overview 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. It is important to recognize that eating disorders can occur in people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses. Anorexia nervosa is a potentially life-threatening psychiatric disorder and is the most lethal eating disorder, with the highest mortality rate of any mental disorder. Individuals with anorexia nervosa often do not believe they are ill and may try to mask their low weight. This is not an exhaustive list of signs and symptoms and many people who have anorexia nervosa do not have all of the manifestations below. Also, these signs and symptoms are not always specific to anorexia and may reflect other conditions. Physical Symptoms Anorexia nervosa is characterized by not eating enough. 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. Abdominal painAnemic and bruises easilyBrittle nailsCold hands and feetConstipationDowny hair all over the body (called lanugo), which is the body's effort to conserve heatDry and thinning hairExtreme dehydrationHair loss on scalpLightheadedness or loss of balance (may experience fainting)Loss in bone density (osteoporosis )Loss of menstrual period in females post-puberty, or delayed the first period (This was eliminated as diagnostic criterion in the DSM-5 so males can meet the criteria for AN).Low blood pressure and heart rateMuscle loss and weaknessPale, dry skinSensitivity to coldSignificantly low body weight Eating Disorders Can Be Deadly 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. Complaints of stomach achesCooks for others, but refuses to eat what is cookedDenial of hungerDesperate 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)Eating unusual or odd food combinationsExtreme perfectionismFatigueInsistence on wearing cold-weather clothing, even when it is warm outsideMay go to great lengths to avoid eating, such as making up excuses for not joining the family for a meal or stating that they have already eatenMay hide foods in order to avoid eating themMay seem obsessed with cooking, cookbooks, cooking shows on television or other food-related topicsRefusal 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 utensilsSudden and extreme changes, such as becoming a vegetarian or refusing to eat non-organic foods, even when that is all that is availableTalks about fears of gaining weight or being fat even when losing weightTalks or thinks about food, weight, calories, and dieting so much it gets in the way of regular conversationWeighs themselves often, frequently looks in the mirror, or checks the size of certain body partsWithdrawal from friends and family 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. AnxietyDepressionDetermines self-esteem, worth, or attractiveness by appearance and weightEasily irritatedExtremely self-criticalLittle motivation to engage in relationships or activitiesStrong need for approval It is important to note that not all individuals with anorexia nervosa are emaciated. Anorexia nervosa can also be diagnosed in individuals who have recently lost a lot of weight and are what many would consider "normal weight." If you or someone you know is showing signs of anorexia nervosa, please seek help from a doctor or healthcare professional. Anorexia Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF A Word From Verywell Most of the symptoms and signs of anorexia nervosa are reversible with treatment. If you or a loved one is suffering from anorexia, it will probably take time to recover. However, speaking with a doctor and seeking support from loved ones are a couple of helpful first steps on the path toward recovery. If you or a loved one are coping with anorexia nervosa, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237. For more mental health resources, see our National Helpline Database. Anorexia in People of Higher Weights Was this page helpful? Thanks for your feedback! Learn the best ways to manage stress and negativity in your life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Eating Disorders Association. Anorexia Nervosa. National Eating Disorders Association. Eating Disorders in Men & Boys. Achamrah N, Coëffier M, Rimbert A, et al. Micronutrient Status in 153 Patients with Anorexia Nervosa. Nutrients. 2017;9(3). doi:10.3390/nu9030225 Mårild K, Størdal K, Bulik CM, et al. Celiac Disease and Anorexia Nervosa: A Nationwide Study. Pediatrics. 2017;139(5). doi:10.1542/peds.2016-4367 Mehler PS, Brown C. Anorexia nervosa - medical complications. J Eat Disord. 2015;3:11. doi:10.1186/s40337-015-0040-8 Brown JM, Mehler PS, Harris RH. Medical complications occurring in adolescents with anorexia nervosa. West J Med. 2000;172(3):189-93. doi:10.1136/ewjm.172.3.189 National Institute of Arthritis and Musculoskeletal and Skin Diseases. What People With Anorexia Nervosa Need To Know About Osteoporosis. Reviewed November 2018. Lloyd S, Yiend J, Schmidt U, Tchanturia K. Perfectionism in anorexia nervosa: novel performance based evidence. PLoS ONE. 2014;9(10):e111697. doi:10.1371/journal.pone.0111697 Swinbourne J, Hunt C, Abbott M, Russell J, St clare T, Touyz S. The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample. Aust N Z J Psychiatry. 2012;46(2):118-31. doi:10.1177/0004867411432071 Thornton LM, Welch E, Munn-chernoff MA, Lichtenstein P, Bulik CM. Anorexia Nervosa, Major Depression, and Suicide Attempts: Shared Genetic Factors. Suicide Life Threat Behav. 2016;46(5):525-534. doi:10.1111/sltb.12235 National Eating Disorders Association. Body Image & Eating Disorders. Additional Reading American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5. Washington, DC: American Psychiatric Association Publishing; 2013. Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724-31. doi:10.1001/archgenpsychiatry.2011.74 Mehler PS, Arnold A. Eating Disorders: A Guide to Medical Care and Complications, Third Edition. Baltimore, MD: Johns Hopkins University Press; 2017.