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The hidden characteristics of anorexia nervosa

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Anorexia nervosa (AN) is one of the most widely-known types of eating disorders, but even a condition this recognizable can come with a number of hidden characteristics, or manifest in ways many people may not be aware of or be able to easily spot.

Last updated on 
April 6, 2023
In this article
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Hidden signs of anorexia nervosa

Anorexia nervosa often manifests in a very physical way, with many people, but not all, who struggle with this condition presenting as severely underweight. But the disorder is first and foremost a mental health condition, impacting people in a number of ways that may not be so readily seen.

Nearly all cases of anorexia are driven by intense psychological factors, including a deep fear of gaining weight, a fixation on body shape and size, and a distorted self-image. A majority of people with anorexia nervosa also struggle with co-occurring cases of anxiety, depression, or both.

Indeed, in many cases, anorexia nervosa arises as an attempt to exert some sense of control over one’s life—albeit through extreme and unhealthy measures. Many people who struggle with AN have experienced trauma in their past, and utilize the disorder as a stabilizing force. And people with AN may experience “perfectionist” tendencies, holding themselves to extreme standards and pushing themselves to reach those goals, even at the expense of their own health. 

The combination of conditions may make it more likely for someone to suffer from intense feelings of inferiority and self-hatred or even experience suicidal ideation, but be able to “pull it together” well enough to function in society, without raising any red flags as to the true extent of their inner anguish.

Unfortunately, these hidden personality traits of AN can also make it more difficult to determine the severity of co-occurring mental health conditions, potentially leading to many people receiving improper treatment for their eating disorder.

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Less known characteristics of anorexia nervosa

The effects of the severe caloric restriction that defines most cases of AN can also present as a number of signs and symptoms that may not be readily recognizable as part of AN on their own.

The poor nutrition that arises from AN can result in a number of compounding issues, including a weakened immune system response that can lead to the person regularly getting sick or having difficulty overcoming illnesses. (1)

Hair loss and muscle weakness are other lesser-known symptoms of AN, both of which result from restricted intake brought on by the AN, as well as the hormonal changes that often accompany extreme caloric restriction. (1)

People with AN are also more likely to experience a sensation of coldness, or may more quickly turn blue when feeling cold, due, in part, to a decreased amount of body fat and hormonal dysfunction. (1)

And the many cardiac problems brought on by AN may also be difficult to pinpoint as part of the condition. Cardiac complications seen in individuals with AN include heart palpitations or frequent episodes of fainting, which are related to a condition called syncope, when the heart beats irregularly. (1)

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Atypical anorexia nervosa

Aside from hidden or less-obvious characteristics of anorexia nervosa, many people also struggle with something called atypical anorexia nervosa (AAN) which is a subtype of other specified feeding or eating disorder (OSFED). 

This diagnosis describes cases that don’t follow the typical patterns of anorexia nervosa, most usually manifesting as someone with AN who does not present at low body weight.

Despite the absence of that physical indicator of AN, people with AAN still exhibit a number of more typical AN signs and symptoms, including skipping meals or eating smaller portions; showing extreme concern with their body weight or shape; drinking excessive amounts of water or no- or low-calorie substances; and being uncomfortable with eating in front of others.

And people with AAN also generally share a number of core characteristics with others struggling with AN, including the restrictive food intake, fear of gaining weight, and distorted self-image that are seen in nearly all cases of AN.

When to seek help for anorexia nervosa

For those exhibiting less known characteristics of anorexia nervosa or people struggling with AAN, it may be more difficult to determine whether there’s a problem. Still, it’s important for anyone struggling with any form of an eating disorder to seek help as soon as possible.

Thankfully, there are a number of treatments and therapies available for individuals who need help recovering from eating disorders —and recovery from anorexia nervosa and atypical anorexia nervosa is entirely possible.

Seeking help represents the first step, and the road it puts you on can lead to peace, hope, and a healthier—and happier—life.


of those who complete our treatment program report reduced eating disorder symptoms

The Within results

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.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.


  1. Oliver-Pyatt Centers. (2022). Hidden Signs of Anorexia Nervosa.


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