Anorexia nervosa is characterized by abnormal weight loss: An anorexic in the late stages of anorexia nervosa will exhibit symptoms of severe weight loss and starvation. Detecting anorexia nervosa in the early stages of the disorder, however, is more difficult. Initially, it may appear that the anorexic is just focused on losing weight, but not to excess. Symptoms of anorexia may be further masked as many anorexics are secretive about their eating habits and weight loss, and will often deny that they are losing weight.
Body Image and Anorexia
The anorexic has an unrealistic view of the ideal body: Even in the final stages of starvation, an anorexic will still perceive herself as “fat,” and take pleasure in losing weight.
The obsession with ideal body image and losing weight is not seen as abnormal by the anorexic: She may feel in control of herself when losing weight, and feel guilty when weight loss does not occur. The anorexic’s distorted view of ideal body image overpowers all other concerns. Even when in treatment and understanding the life-threatening nature of starvation-induced weight loss, anorexics are still influenced by their desire for weight loss, often to the point of resisting treatment.
Anorexic Eating Habits and Weight Loss
The eating habits of anorexics vary considerably. While some anorexics severely restrict their eating to achieve weight loss, other anorexics go through cycles of binge eating followed by purging food through self-induced vomiting or use of laxatives. Regardless, the end result is excessive weight loss.
Anorexics feel hunger intensely while losing weight, but will not eat. Any suggestion of weight gain is met with high anxiety and fear. To mask their eating habits (or lack thereof) from other people, anorexics may employ a number of strategies, including socially isolating themselves.
Eating habits common to anorexics:
- abnormal eating rituals (cuts food up small, moves food on plate but doesn’t eat it)
- cooks for others but does not eat herself
- frequent weighing to monitor weight loss
- denial of hunger
- rigid eating schedule and severe calorie restrictions
- avoids or skips meals regularly
- exhibits an obvious reduction in eating
- throws out food to avoid eating it
- exhibits fear or anxiety before eating, and guilt after eating.
An anorexic’s preoccupation with food may also include collecting recipes and storing or hoarding food. As weight loss becomes more pronounced, the anorexic may start to wear baggy clothes to hide the fact that she is still losing weight.
Mental Symptoms of Anorexia Nervosa
Certain mental symptoms are associated with anorexia nervosa. Anorexics often suffer from clinical depression, especially when weight loss is extreme and starvation results in low levels of the brain chemical serotonin. Anxiety is also a common symptom of anorexia, especially when the anorexic is confronted with eating.
Anorexics often have obsessive thoughts and/or obsessive compulsive disorders, regarding eating habits, weight loss, and other areas of their lives. Perfectionism or rigid thinking, while not symptoms of anorexia nervosa, are common personality traits of the anorexic and may contribute to her obsession with losing weight.
Denial of a weight loss problem and secrecy are common to anorexics. When asked, an anorexic is likely to deny being hungry, fatigued or thin. Due to the anorexic’s abnormal ideal body image, she does not believe she is thin, so will sincerely believe she has not lost enough weight.
The drive to lose weight often leads anorexics to exercise excessively, and to continue exercising even if exhausted or injured. Despite starvation, malnourishment and low energy levels, anorexia nervosa patients are generally physically active. The goal is not for health but for continued weight loss.
Physical Symptoms of Anorexia Nervosa
The classic physical symptom of anorexia nervosa is weight loss leading to less than 85 percent of an individual’s normal weight. Such excessive weight loss is both startling and noticeable. In addition to losing weight, anorexia nervosa symptoms may include:
- amenorrhea (ceased menstruation)
- breast atrophy
- brittle, twisted hair
- hair loss on scalp
- lack of sexual interest
- loss of body fat
- low blood pressure
- muscle atrophy
- yellow, “blotchy” skin.
Amenorrhea, or the cessation of menstruation, is a common symptom of anorexia nervosa in women. Amenorrhea is defined as a cessation of menses for at least three menstrual cycles.
Even a few months of amenorrhea have been associated with a higher risk of osteoporosis (a severe loss of bone mass). Amenorrhea during the teen years is especially serious, as amenorrhea-caused osteoporosis can hinder normal bone development and stunt growth.
Severe Weight Loss and Starvation Symptoms
In the latter stages of anorexia nervosa the anorexic exhibits signs of starvation. Weight loss has become so extreme that the anorexic has practically no body fat. Bones are clearly visible through the skin, and muscles and breasts have atrophied. At this stage of anorexia, depression is common.
Once anorexia nervosa symptoms reach this level of severity, the prognosis for the eating disorder is grim. Intense and immediate medical intervention is required to save the anorexic’s life.
American Psychiatric Association. III. Disease definition, epidemiology, and natural history. Practice Guideline for the Treatment of Patients With Eating Disorders, 2nd Edition. American Psychiatric Association, Washington, DC, 2000.