Signs and symptoms of anorexia nervosa

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Anorexia nervosa (AN) is a serious illness that may manifest in several ways. Learning the signs and symptoms of anorexia may help you or a loved one find treatment.

When discussing any illness or disease, doctors typically group any effects into two categories: signs and symptoms. The two terms sound similar and are often used as synonyms, but they actually have different meanings.

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Signs of anorexia nervosa

“Signs” of any medical condition constitute any effects that can be physically observed and recorded by an outside party, usually a doctor or nurse will discover signs of anorexia nervosa by conducting tests with measurable outcomes.

AN has a number of accompanying signs, both physical and emotional, which help doctors diagnose and assess the condition, as well as help friends and family identify a potential problem.

Physical signs of anorexia nervosa

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) Fifth Edition, which describes all known mental maladies, three primary criteria characterize anorexia nervosa: (1)

  • Restriction of food intake, relative to need
  • An intense fear of gaining weight
  • Distortion in the way one’s weight and body shape are perceived

Nearly all physical signs of anorexia relate to the first criterion: the restriction of food and all its accompanying nutrients, proteins, and calories. Without these precious resources supplying energy, the body will slowly start to breakdown, with signs that look like: (2,3)

  • Noticeable weight fluctuations
  • Dry skin
  • Brittle nails
  • Brittle or thinning hair, on head or body
  • Swelling around the salivary glands
  • Muscle weakness
  • Impaired immune system functioning
  • Insomnia or problems sleeping

Food provides the body with the energy it needs to operate, as well as with the vitamins and minerals it can’t produce on its own. (4) The absence of iron and magnesium, in particular, can wreak havoc on nearly every internal system, as the two minerals are responsible for a number of reactions that keep blood and hormone operations in line. (5,6)

Without proper iron or magnesium levels, the snowball effect can look like: (2,3)

  • Amenorrhea, or the loss of menstrual period or irregular menstrual cycles
  • Anemia, or a low iron count in the bloodstream
  • Lower thyroid or hormone levels in the blood
  • Lower blood cell counts
  • Slowed heart rate

Of course, these are not the only signs of anorexia. A patient may experience all or some of these, or other physical signs of anorexia that don’t present themselves as obviously.

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Emotional and behavioral signs of anorexia nervosa

Signs of anorexia can also show up in a patient’s emotional or behavioral responses. These types of signals stem more from the two criteria for AN that deal with the mental aspect of the condition.

The preoccupation with a patient’s body shape and size will often be at the center of their decisions and daily routines. This could lead to unusual or concerning patterns. However, anorexia nervosa can also have a potent effect on a patient’s hormone levels, which can result in more erratic behavior. (7)

Rather than doctors recording with tools and tests, friends or family often notice these signs of anorexia, as they may observe a person’s emotional state more often. Some of these effects might include: (2,3)

  • Frequent comments on weight, food, or diet
  • Frequent comments about feeling fat or too full
  • Excessive, rigid exercise regimen, despite weather, fatigue, illness, or injury
  • Refusal to eat certain foods
  • The development of certain food rituals, e.g., eating foods in certain orders, rearranging foods on the plate, or excessive chewing
  • Making excuses to avoid mealtimes or situations involving food
  • Eating in secret

Signs of anorexia are not limited to these, of course. They may present themselves as other emotional or behavioral responses, especially around food or situations that may involve eating.

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Symptoms of anorexia nervosa

Symptoms are another important part of identifying a medical condition. But they’re more difficult for others to identify.

“Symptoms” refer to any effects of an illness or medical condition that are only felt by the patient. This can be everything from physical aches and pains to mental anguish or confusion, which can only be quantified—or, indeed, known about at all—by the patient’s descriptions.

While doctors can’t take an official measure of symptoms, they’re no less important in helping a professional diagnose or assess a condition, or even recommend a course of treatment. Anorexia nervosa, in particular, is marked by a number of symptoms only the patient can feel.

Physical symptoms of anorexia nervosa

AN is categorized as a mental condition, but, unfortunately, it also takes a heavy toll on the body. Perhaps unsurprisingly, many of the physical symptoms that accompany anorexia nervosa mirror those of starvation or malnutrition. Aside from the measurable impact this may have on internal systems, it can cause the patient a great deal of discomfort.

Some primary physical symptoms of anorexia nervosa include: (2,3)

  • Gastrointestinal cramps
  • Constipation
  • Bloating
  • Acid reflux
  • Sensitivity to cold
  • Restlessness or hyperactivity

The loss of both nutrients and electrolytes found in food can also lead to imbalances in the brain and elsewhere. The body needs these minerals, which the body doesn’t produce, in large amounts to keep the body’s fluid balance line. (8)

Without the electrical charges they provide to keep things moving properly, blood pressure changes are more likely to occur, leading to symptoms like: (8)

  • Lethargy
  • Fatigue
  • Difficulty concentrating
  • Dizziness
  • Vertigo or feeling faint

To be sure, these are common physical symptoms in a number of conditions, but they could also point to someone struggling with anorexia.

Symptoms that might result from long-term anorexia

Emotional and behavioral symptoms of anorexia nervosa

Behavioral and emotional changes are one of the primary signs of anorexia. AN doesn’t exist in a vacuum. It is tied closely to food and eating, which is a central part of life. . People struggling with this condition live in and among society, family and friends. Still, many people may feel ashamed of their condition and try to hide it from others.

Many people with AN might have trouble adapting their condition to everyday life. As a result, there are a number of anorexia nervosa symptoms that show up in the person’s emotional or behavioral responses, including: (2,3,9)

  • Dressing differently—to hide the effects of AN or to stay warmer
  • Preoccupation with food, diet, exercise, and/or appearance
  • Denial of feeling hungry
  • Constantly feeling full or “fat”
  • Intense fear of gaining weight
  • Withdrawal from social activities or a sense of isolation
  • Depression
  • Anxiety, especially around social activities involving food
  • A sense of secrecy or paranoia
  • Limited social spontaneity
  • Irritability
  • Mood swings
  • Rigidity in routine—and extreme anxiety when this is disrupted

When to get help for anorexia nervosa

Certainly, if all—or even most—of these signs and symptoms of anorexia are being experienced or observed, it’s time to seek medical help. But anorexia nervosa can also be present in a number of less obvious ways.

It’s important to remember that a person can be suffering from an eating disorder without being technically underweight. Denial often plays a large role in the condition, which can make it even more difficult to spot, or make it harder to convince someone to seek help. (10)

Still, there are a number of warning signs that may indicate a person is struggling with the disorder, including: (4)

  • Dramatic or sudden weight loss
  • Avoiding eating with others
  • Lying about how much they’re eating, or how much they weigh
  • Strange behaviors around eating, e.g., cutting food into tiny pieces or eating very slowly
  • Trying to hide the true nature of their body shape through larger or baggy clothes

Medical intervention can still be helpful even if these issues are not yet full-blown. Aside from rapid weight loss, some of the earlier symptoms of anorexia tend to be emotional and behavioral. They may include: (4)

  • Irritability
  • Depression
  • Social isolation

There’s no clear-cut time, or medical recommendation for when, exactly, to seek help for anorexia nervosa. But if any of the above warning signs or early symptoms are in play, it might be time to at least start asking questions. 

Starting on a treatment plan for anorexia as early as possible can help extinguish even the most severe effects of this dangerous—but curable—condition, and hopefully help a patient get on the road to recovery.

If you or a loved one may be showing signs, or experiencing symptoms of anorexia, try to seek help as soon as possible. Within Health offers a compassionate virtual care program to help anyone struggling with an eating disorder. Our continuous care program treats eating disorders from home, through the support of our clinical care team. Call our admissions team now to learn more about how to start treatment.

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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. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Fifth edition. Arlington, Va.: American Psychiatric Association; 2013.
  2. National Eating Disorders Association. (2021). Physical Signs and Symptoms of an Eating Disorder.
  3. National Health Service. (2021, January). Symptoms - Anorexia.
  4. San Francisco Gate. (2018, December). Nutrients that Cannot Be Manufactured by the Human Body.
  5. National Institutes of Health. (2021, March). Iron: Fact Sheet.
  6. American Journal of Hypertension. (2005, June). Progestin and Potassium.
  7. Mayo Clinic. Anorexia Nervosa: Overview.
  8. https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/overview-of-electrolytes 
  9. III, J. L. L. (2021, December 16). Overview of electrolytes - hormonal and metabolic disorders. Merck Manuals Consumer Version. https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/overview-of-electrolytes 
  10. 10. National Eating Disorders Association. (2021). Emotional and Behavioral Signs of an Eating Disorder.
  11. Cone Health. (2020, February). Eating Disorders: Signs, Symptoms and When to Seek Help.

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