Anorexia nervosa is characterized by significant weight loss resulting from a restriction in calories. Some people with anorexia also suffer from body dysmorphia which means that they consider themselves to be fat, no matter how thin they get. Often people with anorexia do not recognize they are underweight and may still “feel fat” at a dangerous low body weight. In their attempts to become even thinner, people with anorexia will avoid food and taking in calories at all costs, which can result in death. An estimated 10 to 20% of people with anorexia will eventually die from complications related to it, giving anorexia nervosa the highest mortality rate of any psychiatric illness.
There has been a lot of research into anorexia in the last thirty years, and because of this treatment has been seeing much more positive results.
People with anorexia often do not believe they are ill. This is because their body and brain are sending conflicting signals, and much of this additional confusion is due to being undernourished. When a body does not have the nutrients that it needs in order to function on a daily basis, it begins to feel a great amount of stress. Sufferers can feel depressed, irritable, hopeless and moody as a result. All of these things are symptoms of malnutrition.
There are also many physical symptoms of malnutrition other than loss of weight. Damage to heart tissue and circulation are long-term effects, bad skin, brittle nails and thin hair are among the shorter term effects. Hunger is often not experienced. For this reason it is often necessary for a person with anorexia to be taken into an inpatient facility. Here they can be treated effectively through a combination of psychological, nutritional and medical care.
While it was previously thought that environmental, social or cultural aspects were the main contributors to anorexia, more recently epigenetics (a scientific field of study that looks at the interaction between environment and genes that influence a person) has led researchers to understand that anorexia is a brain based disorder. Studies with twins have also shown that it is the genetic component that is significantly influential in anorexia development and expression, more so than the environmental factors that siblings my share.
The DSM-5 (manual of mental disorders) characterizes anorexia nervosa as a pathological fear of becoming fat characterized by distorted body image and excessive dieting. DSM-5 also identifies subtypes:
- Restricting Type – where the sufferer restricts food intake and
- Binge Purge Type – where the sufferer eats but will also purge.
The following are some symptoms that might be noted; however it is important to understand that not all people with anorexia will follow the same patterns of symptoms.
- Weight loss is often but not always noted
- Becoming withdrawn
- Exercising excessively
- Feeling cold due to lack of body fat
- Muscular weakness
- Preoccupation with food, calories, recipes
- Excuses for not eating meals (ie. ate earlier, not feeling well)
- Unusual eating habits (ie. cutting food into tiny pieces, picking at food)
- Noticeable discomfort around food
- Complaining of being “too fat”, even when thin
- Cooking for others, but not eating themselves
- Restricting food choices to only diet foods
- Guilt or shame about eating
- Depression, irritability, mood swings
- Evidence of vomiting, laxative abuse, diet pills or diuretics to control weight
- Irregular menstruation
- Amenorrhea (loss of menstruation) is sometimes but not always present
- Wearing baggy clothes to hide weight loss
- Frequently checking weight on scale
- Fainting spells and dizziness
- Difficulty eating in public
- Very secretive about eating patterns
- Pale complexion (almost a pasty look)
- Fatigue and lack of energy
- Amenorrhea (loss of menstruation)
- Skin problems
- Dizziness and headaches
- Shortness of breath
- Irregular heartbeats
- Cold hands and feet
- Hair loss
- Stomach pains
- Decreased metabolic rate
- Edema (water retention)
- Lanugo (fine downy hair)
- Loss of bone mass
- Kidney and liver damage
- Electrolyte imbalances
- Cathartic colon (caused from laxative abuse)
- Low potassium (most common cause of nocturnal cardiac arrest)
- Cardiac arrest and death
Refeeding Syndrome – What refeeding syndrome is, who is at risk, prevention.
Anxiety Depression and Anorexia Symptoms – Information on the link between anxiety, depression and anorexia. Other psychological symptoms, treatment information.
Autism And Anorexia – There are many similarities between anorexia and autism, and many researchers believe they are related.
Girls With Anorexia – Additional information on how anorexia affects girls. Treatment information and resources.
Men With Anorexia – About 10% of all anorexics are men. Why men become anorexic.
Causes Of Anorexia – Causes and warning signs of anorexia. Facts, statistics, and treatment information.
Updated by Tabitha Farrar – 2014
Written By: Colleen Thompson – 1997
Twin Studies of Eating Disorders- International Journal of Eating Disorders
Genetic factors in Anorexia Nervosa- National Institutes of Health
Surviving an Eating Disorder: Perspectives and Strategies for Family and Friends by Michelle Siegel, Ph.D., Judith Brisman, Ph.D., and Margot Weinshel, Ph.D. – Harper & Row Publishers, NY, 1988
Walking A Thin Line by Pam Vredevelt and Joyce Whitman – Mullnomah Press, Oregon 1985
Eating Disorders Handout – Sudbury General Hospital Eating Disorders Clinic (information for handout obtained from NEDIC)