Signs and symptoms of anorexia

People with anorexia often hide their condition, so the warning signs are not always easy to spot. Furthermore, anorexics will typically try to explain away their disordered eating behaviors when confronted. But as anorexia progresses, the signs and symptoms become increasingly obvious and difficult to deny.

Eating and food behavior signs and symptoms

• Dieting despite being thin – Follows a severely restricted diet. Eats only certain low-calorie foods. Bans “bad” foods such as carbohydrates and fats.
• Obsession with calories, fat grams, and nutrition – Reads food labels, measures and weighs portions, keeps a food diary, reads diet books.
• Pretending to eat or lying about eating – Hides, plays with, or throws away food to avoid eating. Makes excuses to get out of meals (“I had a huge lunch” or “My stomach isn’t feeling good.”).
• Preoccupation with food – Eats very little, but constantly thinks about food. May cook for others, collect recipes, read food magazines, or make meal plans.
• Strange or secretive food rituals – Often refuses to eat around others or in public places. May eat in rigid, ritualistic ways (e.g. cutting food “just so”, chewing food and spitting it out, using a specific plate).

Appearance and body image signs and symptoms

• Dramatic weight loss – Rapid, drastic weight loss with no medical cause.
• Feeling fat, despite being underweight – May complain about being overweight in general or just “too fat” in certain places such as the stomach, hips, or thighs.
• Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight.
• Harshly critical of appearance – Spends a lot of time in front of the mirror checking for flaws. There’s always something to criticize. They’re never thin enough.
• Denies being too thin – Refuses to believe that his or her low body weight is a problem, but may try to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).

Purging signs and symptoms

• Using diet pills, laxatives, or diuretics – Abuses water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.
• Throwing up after eating – Frequently disappears after meals or goes to the bathroom. May run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.
• Compulsive exercising – Follows a punishing exercise regimen aimed at burning calories. Will exercise through injuries, illness, and bad weather. Works out extra hard after bingeing or eating something “bad.” 

Anorexia causes and risk factors

What sets someone on a course toward self-starvation? It’s easy to blame a culture that equates slenderness with beauty and success and portrays stick-thin women as the physical ideal, but eating disorders have been around for centuries.
Although our culture’s idealization of thinness plays a powerful role in the development of anorexia, there are other contributing factors, including genetics, individual personality traits, and family environment.

Biological causes of anorexia

Research suggests that a genetic predisposition to anorexia may run in families. If a girl has a sibling with anorexia, she is 10 to 20 times more likely than the general population to develop anorexia herself. Brain chemistry also appears to play a significant role. People with anorexia tend to have high levels of cortisol, the brain hormone most related to stress, and decreased levels of serotonin and norepinephrine, which are associated with feelings of well-being.

Major risk factors for anorexia nervosa

• Body dissatisfaction
• Dieting
• Low self-esteem
• Perfectionism
• Childhood sexual abuse
• Family history of eating disorders

Psychological causes of anorexia

People with anorexia are often perfectionists and overachievers. They’re the “good” daughters and sons who do what they’re told, excel in everything they do, and focus on pleasing others. But while anorexics may appear to have it all together on the surface, inside they feel helpless, inadequate, and worthless. They view themselves through a harshly critical lens. If they’re not perfect, they’re a total failure.

Family and social pressures

In addition to the cultural pressure to be thin, there are other family and social pressures that can contribute to anorexia. This includes participation in an activity that demands slenderness, such as ballet, gymnastics, or modeling. It also includes having parents who are overly controlling, put a lot of emphasis on looks, diet themselves, or criticize their children’s bodies and appearance. Stressful life events—such as the onset of puberty, a breakup, or going away to school—can also trigger anorexia.

Effects of anorexia

The severe calorie restriction of anorexia has dire physical effects. When the body doesn’t get the fuel it needs to function normally, it goes into starvation mode. It slows down to conserve energy and turns in on itself for essential nutrients. In essence, the body begins to consume itself. As the self-starvation continues and more body fat is lost, the medical complications pile up.

The first physical signs and effects of anorexia are:

Loss of menstrual periods Lack of energy and weakness Feeling cold all the time Dry, yellowish skin

Constipation and abdominal pain Restlessness and insomnia Dizziness, fainting, and headaches Growth of fine hair all over the body and face

Source: WomensHealth.gov
If anorexia continues unchecked, the health problems only get worse. Over time, anorexia causes hair loss, infertility, stunted growth, osteoporosis, heart problems, kidney failure, and death. Other effects of anorexia include tooth decay and gum damage from malnutrition and vomiting, and damage to the esophagus and larynx from acid reflux. Anorexia can also lead to depression, severe mood swings, and thoughts of suicide.

Maria’s Story

Seventeen-year-old Maria has been on one diet or another since she was in junior high. She recently lost 10 pounds from an already slender frame after becoming a strict vegetarian. Her parents are concerned about the weight loss, but Maria insists that she’s just under stress at school. Meanwhile, her vegetarian diet is becoming stricter by the day.
Maria obsessively counts calories, measures food portions, and weighs herself at least twice a day. She refuses to eat at restaurants, in the school cafeteria, or anywhere else in public, and she lives on salad dressed with vinegar, rice cakes, and sugar-free Jell-O. Maria also has a large stash of fat-free candy in her room. She allows herself to indulge as long as she goes for a run right afterwards.