Anorexia nervosa, often simply referred to as anorexia, encompasses a wide range of physical and emotional symptoms that can manifest differently in each individual. If you are worried about a friend or family member, it’s important to know that support and assistance are available. This serious eating disorder compels individuals to engage in unhealthy and extreme behaviors to lose weight or prevent weight gain.

There are two primary forms of this disorder: the restrictive type and the binge eating/purging type. Individuals with restrictive anorexia manage their weight through severe food intake limitation, whereas those with the binge eating/purging type may expel consumed food by vomiting or using medications such as laxatives and diuretics.

The onset of anorexia is influenced by a complex interplay of factors, which vary significantly from person to person. Contributing elements may include genetic predispositions, previous traumatic experiences, and other mental health disorders like anxiety and depression. Interestingly, the population most at risk for developing anorexia consists mainly of females during their teenage and early adult years, although men and older women also face significant risk.

Diagnosing anorexia is often a prolonged process, as those affected may be unaware that they have the disorder and might not seek help. Furthermore, it is common for individuals with anorexia to be reticent about discussing their feelings regarding food or body image, making it challenging for others to recognize potential symptoms. Because there is no single test that can definitively diagnose anorexia, a comprehensive evaluation of various factors is essential for an accurate diagnosis. Here are nine prevalent signs and symptoms associated with anorexia.

1. Understanding Purging as a Weight Control Strategy

Purging is a prevalent behavior often associated with anorexia nervosa, encompassing actions such as self-induced vomiting and the excessive use of specific medications like laxatives or diuretics. In addition, enemas may be utilized as a form of purging.

The binge eating/purging subtype of anorexia is marked by cycles of uncontrollable eating, which are subsequently followed by self-induced vomiting. This cycle can severely impact both physical and mental health. Administering large quantities of laxatives is yet another method of purging, where individuals seek to minimize food absorption and hasten the process of gastric and intestinal emptying. This practice is particularly concerning due to the potential for dependency on these medications. Likewise, diuretics are frequently employed to promote urination, thereby diminishing body water to achieve weight loss. However, this method can lead to dehydration and electrolyte imbalances.

Research has revealed alarming statistics regarding purging behaviors among individuals with eating disorders, indicating that as many as 86% engage in self-induced vomiting, 56% misuse laxatives, and 49% resort to diuretic abuse. Such practices can result in severe health complications. In essence, purging involves the act of self-induced vomiting or the administration of certain medications to curtail caloric intake, inhibit food absorption, and facilitate weight loss, highlighting the pressing need for awareness and intervention.

2. The Preoccupation with Food, Calories, and Dieting

A persistent concern regarding food and meticulous tracking of calorie intake are prevalent traits associated with anorexia. Individuals grappling with this disorder often feel compelled to document every morsel they ingest, even including water. In some cases, they may go as far as to memorize the caloric values of various foods.

Fear of weight gain significantly fuels their obsession with food. Those suffering from anorexia may drastically cut back on their calorie consumption and engage in extreme dieting practices. This can manifest in the elimination of specific foods or even entire food categories, such as carbohydrates (carbohidratos) or fats (grasas), from their meals.

Long-term restriction of food intake can lead to severe malnutrition and nutrient deficiencies that may adversely affect mood and exacerbate obsessive behaviors surrounding food. Additionally, reduced food consumption can interfere with appetite-regulating hormones, such as insulin and leptin, leading to serious health complications like bone mass loss, as well as reproductive, psychological, and developmental issues. A profound concern over food choices is a defining feature of anorexia. Common behaviors include meticulously logging daily food intake and avoiding certain food groups based on the misguided belief that these foods could contribute to weight gain.

3. Changes in Mood and Emotional State

Individuals diagnosed with anorexia often exhibit symptoms of co-occurring mental health conditions, including depression, anxiety, hyperactivity, perfectionism, and impulsivity. These overlapping symptoms can diminish the ability of those affected by anorexia to derive joy from activities that typically bring pleasure to others ( [15]). Furthermore, a hallmark of anorexia is an extreme level of self-control, which often manifests as a strict restriction of food intake aimed at achieving weight loss.

Additionally, individuals suffering from anorexia may develop an acute sensitivity to criticism, perceived failure, and mistakes. Hormonal imbalances involving key neurotransmitters such as serotonin, dopamine, oxytocin, cortisol, and leptin could elucidate some of these emotional patterns observed in those with anorexia. These hormones play a crucial role in regulating mood, appetite, motivation, and behavior, thus abnormal levels may lead to mood swings, irregular appetite, impulsivity, anxiety, and depression.

Moreover, the act of significantly limiting food intake can result in a deficiency of essential nutrients that are vital for mood regulation. Consequently, the interplay of mood swings, anxiety, depression, perfectionism, and impulsivity is frequently encountered in individuals with anorexia. Such characteristics may stem from both hormonal imbalances and nutrient deficiencies.

4. Distorted Body Image

The perception of body shape and attractiveness is a significant concern for individuals grappling with anorexia. The term 'body image' refers to how a person perceives their body size and their emotional response to it. Anorexia is marked by a predominantly negative body image and adverse feelings regarding one's physical appearance. Research has revealed that individuals suffering from this disorder often possess significant misconceptions about their body shape and appearance, coupled with a pronounced drive for thinness.

A hallmark of anorexia is the tendency to overestimate one's body size, leading individuals to believe they are larger than they are in reality. For example, one study involving 25 individuals with anorexia assessed their ability to determine if they were too large to pass through a doorway. The results showed that those with anorexia consistently overestimated their body size when compared to a control group.

Another common behavior associated with anorexia is repeated body checking, which may involve scrutinizing oneself in the mirror, measuring different body parts, or pinching fat on specific areas. Such behaviors can exacerbate feelings of body dissatisfaction and anxiety, further encouraging food restriction among those affected by anorexia. Moreover, it has been noted that participation in sports that emphasize weight and aesthetics can elevate the risk of developing anorexia in susceptible individuals. Overall, anorexia is characterized by a skewed perception of body size, and the practice of body checking not only heightens body dissatisfaction but also reinforces restrictive eating behaviors.

5. Excessive Exercise

Individuals diagnosed with anorexia, particularly those exhibiting the restrictive subtype, frequently engage in excessive physical activity as a means to reduce body weight. One notable study involving 165 participants revealed that 45% of those with eating disorders reported a tendency to exercise excessively. Among these individuals, excessive physical activity was predominantly observed in those with the restrictive type (80%) and the binge eating/purging type (43%) of anorexia. In adolescent populations suffering from eating disorders, the prevalence of excessive exercise appears to be higher in females compared to their male counterparts. Furthermore, many individuals with anorexia often grapple with profound feelings of guilt when they are unable to complete their workout sessions. Other forms of physical activity, such as increased walking, standing, and fidgeting, are also commonly observed among this group. Excessive exercise frequently coexists with elevated anxiety levels, depression, and obsessive traits and behaviors. Additionally, research suggests that the low levels of leptin found in those with anorexia may contribute to heightened hyperactivity and restlessness. In summary, excessive exercise is a prevalent characteristic of anorexia, and individuals affected may experience significant guilt for missing their workout routines.

6. Denial of Hunger and Refusal to Eat

Irregular eating habits and diminished appetite are critical indicators of anorexia nervosa. This condition, particularly the restrictive type, is marked by a persistent denial of hunger and an outright refusal to consume food. Several factors can contribute to this troubling behavior. Firstly, hormonal imbalances play a significant role, provoking individuals with anorexia to experience an overwhelming fear of weight gain, which leads to their refusal to eat. Hormones such as estrogen and oxytocin are crucial in managing fear responses.

Individuals suffering from anorexia often exhibit lower levels of these hormones, making it increasingly challenging to overcome their persistent fear of food and body fat. Additionally, irregularities in hormones that regulate hunger and satiety, like cortisol and peptide YY, can further exacerbate the avoidance of meals.

For many with anorexia, the feeling of weight loss may provide a sense of gratification that is greater than the desire to eat, reinforcing their behavior of food restriction. The ongoing anxiety about gaining weight can compel those affected to shun food and deny their hunger signals. Moreover, when food loses its perceived reward value, it can lead to an even further decline in their food intake.

7. The Significance of Food Rituals

Obsessive tendencies related to food and body weight frequently lead to control-oriented eating behaviors. Engaging in specific rituals surrounding food can help alleviate feelings of anxiety, provide comfort, and foster a sense of control over one's life. Individuals coping with anorexia often exhibit a variety of food-related rituals, which may include:

• Consuming foods in a particular sequence
• Eating at a deliberate pace and chewing excessively
• Carefully arranging food items on a plate
• Maintaining consistent meal times daily
• Slicing food into tiny pieces
• Measuring, weighing, and assessing portion sizes
• Counting calories prior to consumption
• Restricting meals to designated locations

For those affected by anorexia, any deviation from these established rituals can be perceived as a failure and a significant loss of self-control. Such compulsive eating habits often arise as a coping mechanism to manage anxiety surrounding food.

8. Alcohol or Drug Abuse

In certain instances, anorexia can result in the prolonged use of alcohol, specific medications, and diet pills. Individuals may resort to alcohol as a means to suppress their appetite and manage feelings of anxiety and stress. Research indicates that those who engage in binge eating and purging behaviors are approximately 18 times more likely to abuse alcohol and other drugs compared to those who primarily restrict their food intake. For some individuals, the misuse of alcohol might be followed by significant reductions in food consumption as a strategy to offset the calories ingested through drinking.

Moreover, the abuse of various drugs, such as amphetamines, caffeine, or ephedrine, is frequently observed among individuals with restrictive eating patterns, as these substances can effectively suppress appetite, boost metabolism, and encourage rapid weight loss. The combination of food restriction and quick weight loss can alter brain chemistry in ways that may intensify the craving for drugs. Over time, substance abuse, coupled with diminished food intake, can lead to malnutrition and provoke a host of other health complications. Essentially, anorexia can drive individuals towards the abuse of alcohol and specific drugs as a means to reduce food intake or alleviate anxiety and fear surrounding food.

9. Severe Weight Loss

A dramatic decrease in weight is a critical indicator of anorexia nervosa, and it stands out as one of the most alarming symptoms associated with this eating disorder. The intensity of anorexia nervosa greatly correlates with the degree to which an individual restricts their weight. This phenomenon, referred to as weight suppression, is calculated by the difference between a person's highest recorded weight and their current weight. Research indicates that weight suppression is closely linked to various factors, including weight, body image issues, excessive physical activity, dietary restrictions, and the use of medications aimed at controlling weight.

According to diagnostic criteria for anorexia, weight loss is deemed significant if an individual's current weight is 15% lower than the expected weight for their age and height, or if their body mass index (BMI) is at or below 17.5. Nonetheless, observing weight fluctuations can be challenging, and such changes may not be sufficient for an accurate diagnosis of anorexia. It is essential to evaluate all accompanying signs and symptoms to ensure a thorough assessment is made. Extreme weight loss serves as a major warning sign of anorexia, particularly when body weight falls below 15% of the expected weight for one's age and height, or when the BMI dips below 17.5.

Physical Symptoms That May Emerge Over Time

The symptoms detailed above can often serve as the initial and most apparent signs of anorexia.

In individuals experiencing more advanced stages of anorexia, various body organs may be compromised, leading to additional symptoms such as:

• Fatigue, sluggishness, and a general sense of lethargy
• Cavity formation resulting from frequent vomiting
• Dry, yellowish skin that may appear unhealthy
• Dizziness and lightheadedness
• Thinning of bones, contributing to increased fracture risk
• Development of fine, soft hair, known as lanugo, covering the body
• Brittle hair and nails that break easily
• Loss of muscle mass and associated weakness
• Low blood pressure and a decreased pulse rate
• Severe constipation that may require medical attention
• Persistent feelings of being cold, attributed to a drop in internal body temperature

Due to the increased chances of a complete recovery with early intervention, it is crucial to seek assistance as soon as any symptoms become apparent. The progression of anorexia can lead to numerous physiological changes, impacting nearly every organ in the body. Symptoms may encompass fatigue, constipation, a constant sensation of coldness, brittle hair, and dry skin.

The Conclusion

Anorexia nervosa is a severe eating disorder marked by significant weight loss, a distorted body image, and the adoption of extreme methods for weight loss, such as food purging and compulsive exercise.

Here are some valuable resources and avenues to seek assistance:

• National Eating Disorders Association (NEDA)
• National Association of Anorexia Nervosa and Associated Disorders

If you suspect that you or someone close to you may be struggling with anorexia, it’s important to remember that recovery is attainable and support is accessible.