Anorexia nervosa, commonly called anorexia, is a serious eating disorder in which a person adopts unhealthy and extreme methods to lose weight or avoid gaining weight.
There are two types of the disorder: restrictive type and binge eating/purging type.
Those with restrictive anorexia control their weight by restricting their food intake, while those with binge eating/purging anorexia expel what they have eaten through vomiting or the use of medications like laxatives and diuretics.
A complex variety of factors influence the development of anorexia. Reasons for developing anorexia can be different for each person and may include genetics, past trauma, other mental health conditions such as anxiety and depression.
Anorexia is usually not quickly diagnosed because people with the eating disorder don’t typically know they’re experiencing it, so they may not ask for help (
It’s also common for people with anorexia to be reserved and not discuss their thoughts about food or body image, making it difficult for others to notice symptoms.
No single test can identify the disorder, as many factors need to be considered to make a formal diagnosis.
Here are 9 common signs and symptoms of anorexia.
Purging is a common characteristic of anorexia. Purging behaviors include self-induced vomiting and the over use of certain medications like laxatives or diuretics. It can also include the use of enemas.
The binge eating/purging type of anorexia is characterized by episodes of excessive eating followed by self-induced vomiting.
Using large amounts of laxatives is another form of purging. These medications are taken in an attempt to decrease food absorption and speed up the emptying of the stomach and intestines.
Similarly, diuretics are often used to increase urination and reduce body water as a means to lower body weight.
A study exploring the prevalence of purging in eating disorder patients found that up to 86% used self-induced vomiting, up to 56% abused laxatives and up to 49% abused diuretics (
Purging can lead to many serious health complications (
Summary Purging is the practice of self-induced vomiting or the use of certain medications to reduce calories, avoid food absorption and lose weight.
Constant worry about food and the close monitoring of calorie intake are common characteristics of anorexia.
People with anorexia might record every food item they consume, including water. Sometimes, they even memorize the calorie content of foods.
Worry over gaining weight contributes to obsessions with food. Those with anorexia may decrease their calorie intake dramatically and practice extreme diets. Some may eliminate certain foods or entire food groups from, such as carbohydrates or fats, from their diet.
Decreased food intake can also affect appetite-regulating hormones, like insulin and leptin. This can lead to other health problems such as bone-mass loss, as well as reproductive, mental and growth issues (
Summary Excessive concern about food is a hallmark of anorexia. Practices may include logging food intake and eliminating certain food groups due to the belief that those foods may increase weight.
People who are diagnosed with anorexia often have symptoms of other conditions as well, including depression, anxiety, hyperactivity, perfectionism and impulsivity (
These symptoms can cause those with anorexia to not find pleasure in activities that are usually enjoyable for others (
Also, individuals with anorexia might become highly sensitive to criticism, failure and mistakes (
In addition, reducing food intake can lead to a deficiency of nutrients involved in mood regulation (
Summary Mood swings and symptoms of anxiety, depression, perfectionism and impulsivity are commonly found in people with anorexia. These characteristics may be caused by hormonal imbalances or nutrient deficiencies.
Body shape and attractiveness are critical concerns for people with anorexia (
The concept of body image involves a person’s perception of their body size and how they feel about their body (
Anorexia is characterized by having a negative body image and negative feelings toward the physical self (
In one study, participants showed misconceptions about their body shape and appearance. They also exhibited a high drive for thinness (
One study investigated this concept in 25 people with anorexia by having them judge whether they were too big to pass through a door-like opening.
Those with anorexia significantly overestimated their body size, compared to the control group (
Repeated body checking is another characteristic of anorexia. Examples of this behavior include looking at yourself in a mirror, checking body measurements and pinching the fat on certain parts of your body (
Summary Anorexia involves an altered perception of the body and overestimation of body size. Additionally, the practice of body checking increases body dissatisfaction and promotes food-restrictive behaviors.
Those with anorexia, especially those with the restrictive type, often exercise excessively to lose weight (
In fact, one study in 165 participants showed that 45% of those with eating disorders also exercised an excessive amount.
Among this group, it found that excessive exercising was most common in those with restrictive (80%) and binge eating/purging (43%) types of anorexia (
In teenagers with eating disorders, excessive exercise seems to be more common among women than men (
Walking, standing and fidgeting more frequently are other types of physical activity commonly seen in anorexia (
Summary Excessive exercise is a common symptom of anorexia, and people with anorexia may feel intense guilt if they miss a workout.
Irregular eating patterns and low appetite levels are important signs of anorexia.
The restrictive type of anorexia is characterized by a constant denial of hunger and refusal to eat.
A number of factors may contribute to this behavior.
First, hormonal imbalances can provoke people with anorexia to maintain a constant fear of gaining weight, resulting in a refusal to eat.
Estrogen and oxytocin are two hormones involved in fear control.
Summary A constant fear of gaining weight can cause people with anorexia to refuse food and deny hunger. Also, the low reward value of food can lead them to further decrease their food intake.
Obsessive behavior about food and weight often triggers control-oriented eating habits (
Engaging in such rituals can ease anxiety, bring comfort and generate a sense of control (
Some of the most common food rituals seen in anorexia include:
- Eating foods in a certain order
- Eating slowly and excessive chewing
- Arranging food on a plate in a certain way
- Eating meals at the same times every day
- Cutting food into small pieces
- Weighing, measuring and checking portion sizes of food
- Counting calories before eating the food
- Only eating meals in specific places
People with anorexia can view deviation from these rituals as a failure and loss of self-control (
Summary Anorexia can lead to various eating habits that can bring a sense of control and reduce anxiety often caused by food.
In some cases, anorexia can lead to the chronic use of alcohol, certain medications and diet pills.
Alcohol may be used to suppress appetite and cope with anxiety and stress.
For some, alcohol abuse might also be followed by drastic reductions in food intake to compensate for the calories consumed through drinking (
The abuse of other drugs, including amphetamines, caffeine or ephedrine, are common in the restrictive type, as these substances can suppress appetite, increase metabolism and promote rapid weight loss (
Long-term substance abuse combined with reduced food intake can cause malnutrition and trigger other health problems.
Summary Anorexia can lead to the abuse of alcohol and certain drugs to help decrease food intake or calm anxiety and fear towards food.
Excessive weight loss is a main sign of anorexia. It’s also one of the most concerning.
The severity of anorexia depends on the extent to which a person suppresses their weight. Weight suppression is the difference between a person’s highest past weight and their current weight (
One study showed that weight suppression had significant links to weight, body concerns, excessive exercise, food restriction and the use of weight control medication (
Guidelines for the diagnosis of anorexia consider weight loss to be relevant if the current body weight is 15% below the expected weight of a person of that age and height, or if the body mass index (BMI) is 17.5 or less (
However, weight changes in a person can be difficult to notice and may not be enough to diagnose anorexia. Therefore, all other signs and symptoms need to be considered to make an accurate determination.
Summary Extreme weight loss is a significant sign of anorexia, such as when body weight drops below 15% of the expected weight for a person of that age and height, or their BMI is less than 17.5.
The symptoms listed above may be the first and most obvious indications of anorexia.
In those with more severe anorexia, body organs can be affected and trigger other symptoms, including:
- Fatigue, sluggishness and lethargy
- Cavity formation from vomiting
- Dry and yellowish skin
- Thinning of bones
- Growth of fine, soft hair covering the body
- Brittle hair and nails
- Muscle loss and muscle weakness
- Low blood pressure and pulse
- Severe constipation
- Feeling cold all the time due to a drop in internal temperature
Because the likelihood of full recovery is higher with early treatment, it’s important to seek help as soon as symptoms are noticed.
Summary The progression of anorexia can cause many changes and affect virtually all body organs. Symptoms may include fatigue, constipation, feeling cold, brittle hair and dry skin.
Anorexia nervosa is an eating disorder characterized by weight loss, body image distortion and the practice of extreme weight loss methods like food purging and compulsive exercising.
Here are some resources and ways to seek help:
- National Eating Disorders Association (NEDA)
- National Institute of Mental Health
- National Association of Anorexia Nervosa and Associated Disorders
If you believe that you or a friend or family member may have anorexia, know that it is possible to recover and help is available.
Editor’s note: This piece was originally reported on April 1, 2018. Its current publication date reflects an update, which includes a medical review by Timothy J. Legg, PhD, PsyD.