Early warning signs of anorexia nervosa

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Facing an eating disorder, like anorexia nervosa (AN), in your own life or that of a loved one can be a daunting task. Current research indicates that early detection and intervention are crucial for decreasing the risk of long term illness and severe medical complications from these disorders. (5)

As there is no guaranteed way to prevent AN, early detection of warning signs of anorexia, and intervention offer the greatest opportunity to heal from this eating disorder. Educating yourself and your community about the warning signs of AN can help create supportive allies for those struggling and make sure that they know they do not need to suffer alone in silence. Community support can help reduce feelings of shame and isolation for individuals with AN and other EDs and enable earlier access to specialized treatment and support. (1,2)

According to the National Eating Disorder Association, AN warning signs can be divided into two main categories, emotional/behavioral signs and physical signs. (3) It is also important to note the impact of risk factors associated with the development of this eating disorder, and be especially aware of early signs of AN developing in individuals who are at higher risk for the illness. 

While the reasons that any individual develops AN are complex and unique, being attentive to common warning sizes in yourself and others in your life, especially children, can help facilitate early detection and intervention. The following signs and risks are common but not universal, as AN can develop in people of any body size and not every person with the disorder will exhibit every single associated behavior.

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Emotional and behavioral warning signs of anorexia

  • Dresses in layers to hide body changes or stay warm.
  • Preoccupation with weight, food, calories, fat grams, and dieting.
  • Restrictive eating.
  • Frequent self-judgment about body shape and size 
  • Denies feeling hungry.
  • Develops food rituals.
  • Cooking meals for others without eating.
  • Avoids mealtimes or situations involving food.
  • Maintains an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury. 
  • Becomes reclusive.
  • Concerned about eating in public.
  • Has limited social spontaneity.
  • Has intense fear of weight gain 
  • Has disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or inability to perceive body size accurately 
  • Feels ineffective.
  • Has a strong need for control.
  • Has overly restrained initiative and emotional expression.

Physical warning signs of anorexia 

  • Dramatic weight loss (does not always occur in AN due to variation in genetic response to energy restriction)
  • Stomach cramps and non-specific gastrointestinal ailments (constipation, acid reflux, etc).
  • Menstrual irregularities.
  • Difficulties concentrating.
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate).
  • Dizziness.
  • Fainting.
  • Feeling cold all the time.
  • Sleep problems.
  • Cuts and calluses across the top of finger joints (a result of inducing vomiting).
  • Dental problems.
  • Dry skin.
  • Dry and brittle nails.
  • Swelling around salivary glands in the mouth.
  • Thinning of hair on his or her head, dry and brittle hair (lanugo).
  • Cavities.
  • Muscle weakness.
  • Poor wound healing.
  • Impaired immune functioning.

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Risk factors for anorexia

The term “risk factor” refers to a quantifiable characteristic that precedes the onset of a disorder. According to a study specifically dedicated to risk factors of AN, they can be divided into four categories: personal vulnerability, environmental, dieting vulnerability, and age. These categories were then further specified into the following subcategories. (4)

Personal vulnerability

Childhood characteristics

  • Negative self-evaluation
  • Perfectionism
  • Extreme compliance
  • School absence through anxiety

Pre-existing psychiatric disorders

  • Major depression
  • Drug abuse
  • Alcohol abuse

Behavioral problems

  • Marked conduct problems
  • School absence
  • Deliberate self-harm

Parental psychiatric disorder

  • Parental depression
  • Parental alcoholism
  • Parental drug abuse

Environmental

Parental problems

  • Low parental contact
  • Separation from parents
  • Parental arguments, criticism, high expectations, over involvement, under-involvement, minimal affection

Disruptive events

  • Parental death
  • Change of parent figure
  • Parental chronic illness
  • Frequent house moves
  • Severe personal health problems

Parental psychiatric disorder

  • Parental depression
  • Parental alcoholism
  • Parental drug abuse

Teasing and bullying

  • Sexual and physical abuse

Dieting vulnerability

Dieting risk

  • Family member dieting
  • Critical comments by family about shape, weight, or eating
  • Teasing about shape, weight, eating, or appearance
  • Parental history of AN or Bulimia Nervosa
  • Having parents who are in higher weight bodies Being in a higher weight body as a child or prior to the disorder
  • Parental Eating Disorder

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When to seek help

Anorexia nervosa is a serious illness which can have significant psychological, physical, and social impacts on individuals who are struggling as well as their families and communities. It can result in long term medical complications and even death. Early detection and intervention is linked to better treatment outcomes and reduced chances of long-term illness of AN left. While there is no guaranteed way to prevent AN, awareness of risk factors, attentiveness to early warning signs, and access to immediate and supportive care are important ways to facilitate the best possible outcome. If you think you or someone you know may be struggling with anorexia nervosa, learning more and reaching out for advice and support are important steps towards healing.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Kalindjian, N., Hirot, F., Stona, A. C., Huas, C., & Godart, N. (2022). Early detection of eating disorders: a scoping review. Eating and weight disorders : EWD, 27(1), 21–68. https://doi.org/10.1007/s40519-021-01164-x
  2. Weeda-Mannak, W. L. (1983). Aspects of Early Detection of Anorexia Nervosa. SpringerLink. Retrieved July 12, 2022, from https://link.springer.com/chapter/10.1007/978-1-4684-4496-4_14
  3. National Eating Disorders Association. (2017, February 26). Warning Signs and Symptoms. Retrieved July 12, 2022, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia/warning-signs-symptoms
  4. Fairburn, G. D. C. M. (1999, May 1). Risk Factors for Anorexia Nervosa: Three Integrated Case-Control Comparisons. Obesity | JAMA Psychiatry | JAMA Network. Retrieved July 13, 2022, from https://jamanetwork.com/journals/jamapsychiatry/article-abstract/205036
  5. Why early intervention for eating disorders is essential. National Eating Disorders Association. (2019, September 3). Retrieved August 31, 2022, from https://www.nationaleatingdisorders.org/blog/why-early-intervention-eating-disorders-essential

FAQs

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