Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.
Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities.
Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.
To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:
- Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
1. Restricting type
People with this type of anorexia nervosa place severe restrictions on the quantity and type of food they consume.
This could include counting calories, skipping meals, restricting certain foods (such as carbohydrates) and following obsessive rules, such as only eating foods of a particular colour. These behaviours may be accompanied by excessive exercise.
2. Binge eating / purging type
People with this type of anorexia also place restrictions on the food they eat. But it’s accompanied by binge eating or purging. Binge eating involves feeling out of control and eating a large amount of food.
A person then ‘compensates’ for this eating by purging the food through vomiting, misusing laxatives, diuretics or enemas.
These behaviours are unhealthy physically and mentally, and can even be life threatening. It’s important to seek ongoing therapy and nutritional education for treatment of anorexia nervosa.
Warning Signs & Symptoms of Anorexia Nervosa
Emotional and behavioral
- Dramatic weight loss
- Dresses in layers to hide weight loss or stay warm
- Is preoccupied with weight, food, calories, fat grams, and dieting
- Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
- Makes frequent comments about feeling “fat” or overweight despite weight loss
- Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
- Denies feeling hungry
- Develops food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)
- Cooks meals for others without eating
- Consistently makes excuses to avoid mealtimes or situations involving food
- Expresses a need to “burn off” calories taken in
- Maintains an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury
- Withdraws from usual friends and activities and becomes more isolated, withdrawn, and secretive
- Seems concerned about eating in public
- Has limited social spontaneity
- Resists or is unable to maintain a body weight appropriate for their age, height, and build
- Has intense fear of weight gain or being “fat,” even though underweight
- vHas disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight
- Postpuberty female loses menstrual period
- Feels ineffective
- Has strong need for control
- Shows inflexible thinking
- Has overly restrained initiative and emotional expression
- Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
- Difficulties concentrating
- Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
- Feeling cold all the time
- Sleep problems
- Menstrual irregularities—amenorrhea, irregular periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
- Cuts and calluses across the top of finger joints (a result of inducing vomiting)
- Dental problems, such as enamel erosion, cavities, and tooth sensitivity
- Dry skin
- Dry and brittle nails
- Swelling around area of salivary glands
- Fine hair on body (lanugo)
- Thinning of hair on head, dry and brittle hair
- Cavities, or discoloration of teeth, from vomiting
- Muscle weakness
- Yellow skin (in context of eating large amounts of carrots)
- Cold, mottled hands and feet or swelling of feet
- Poor wound healing
- Impaired immune functioning
Health Consequences of Anorexia Nervosa
In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences.
The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.