Symptoms and Warning Signs of Anorexia Nervosa

Physical, Behavioral, and Emotional Symptoms

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In This Article

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 pain
  • Anemic and bruises easily
  • Brittle nails
  • Cold hands and feet
  • Constipation
  • Downy hair all over the body (called lanugo), which is the body's effort to conserve heat
  • Dry and thinning hair
  • Extreme dehydration
  • Hair loss on scalp
  • Lightheadedness 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 rate
  • Muscle loss and weakness
  • Pale, dry skin
  • Sensitivity to cold
  • Significantly low body weight

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 aches
  • Cooks for others, but refuses to eat what is cooked
  • Denial of hunger
  • 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)
  • Eating unusual or odd food combinations
  • Extreme perfectionism
  • Fatigue
  • Insistence on wearing cold-weather clothing, even when it is warm outside
  • May 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 eaten
  • May hide foods in order to avoid eating them
  • May seem obsessed with cooking, cookbooks, cooking shows on television or other food-related topics
  • 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
  • Sudden and extreme changes, such as becoming a vegetarian or refusing to eat non-organic foods, even when that is all that is available
  • Talks about fears of gaining weight or being fat even when losing weight
  • Talks or thinks about food, weight, calories, and dieting so much it gets in the way of regular conversation
  • Weighs themselves often, frequently looks in the mirror, or checks the size of certain body parts
  • Withdrawal 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.

  • Anxiety
  • Depression
  • Determines self-esteem, worth, or attractiveness by appearance and weight
  • Easily irritated
  • Extremely self-critical
  • Little motivation to engage in relationships or activities
  • Strong 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.

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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.

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Article Sources
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Additional Reading