Anorexia nervosa (AN) is a serious and potentially life-threatening eating disorder which affects millions of people around the world. According to the National Eating Disorders Association, between 0.3-0.4% of young women and 0.1% of young men will suffer from this condition at some point. [1]

Still, early intervention can vastly improve the chances for a full recovery. So it’s crucial to know the common signs and symptoms of anorexia nervosa, to help you or a loved one recognize a potential issue, and seek proper treatment.

What is Anorexia Nervosa?

Anorexia nervosa is both an eating disorder and mental health condition. It manifests as an extreme focus on body weight, shape, and size and a strong fear of gaining weight.

The condition is characterized by a distorted body image and often accompanies other mental health concerns, such as low self-esteem, depression, or any number of anxiety disorders. When combined with the focus on body shape and weight, these factors often lead to restrictive eating patterns and extreme weight loss.

Anorexia nervosa can affect people differently, and there are several types of this disorder. Atypical AN may look like someone in a larger body experiencing the signs and symptoms of anorexia nervosa, or like someone with AN who presents at a healthy weight, despite employing disordered eating habits.

Signs and Symptoms of Anorexia Nervosa

Anorexia nervosa is characterized by various physical, emotional, and behavioral symptoms.

In general, when someone is struggling with AN, they deliberately limit their food intake, and often place great importance on controlling their body weight and shape.

Strict calorie counts, portion control, and excessive exercise are common strategies employed to lose weight, though for someone with AN, these measures generally become drastic, to the point of disrupting their daily life. [1]

Yet, many individuals struggling with this condition attempt to conceal the truth of their experience, whether by hiding their body in oversized clothes, or by socially isolating, to hide their eating and physical habits.

But there are some cardinal signs that may help you recognize the traits of anorexia nervosa in yourself or a loved one.

Physical Signs of Anorexia

The physical signs of anorexia nervosa can cause serious health consequences if left untreated. Some of the most common include:

Weight Loss

People struggling with AN may have a body weight significantly below the normal range for their age, sex, and height.

Studies show that this weight suppression is often linked to body image concerns, and the excessive exercise and food restriction they tend to support. [2]

Muscle Wasting

Anorexia nervosa may result in loss of muscle mass, which can make one appear—or become—physically weak. [3]

When the body does not receive the proper amount of energy it needs to survive through food consumption, it will turn to other sources for reserves. Muscle wasting results when the body begins breaking down muscle tissue to make up this energy.

Dry, Thinning Hair

People with AN may experience hair loss, often caused by a lack of protein, essential fatty acids, vitamins, minerals and other nutrients in the diet. Hair is particularly dependent on nutrients that must be obtained outside the body, or through diet, for growth and luminance.

When the body is not getting enough of these nutrients, it may divert resources away from hair growth and towards more essential functions, leading to hair loss.

Cold Intolerance

Cold intolerance in people with anorexia nervosa frequently occurs due to low body fat. While people with the condition generally attempt to eliminate it, body fat is necessary to retain body heat.

People with AN also often experience slow metabolism, due to a combination of malnutrition and generally using their digestive system less. Among the cascade of ill effects this can cause in the body is decreased body temperature regulation, which will also lead to cold intolerance.

Fatigue and Low Energy Levels

People with anorexia nervosa severely limit the amount of food they consume, which works to slow down the body’s metabolism, leading to overall feelings of sluggishness. They also regularly engage in excessive exercise, which can lead to a significant depletion of energy stores in the body.

As a result, someone may feel constantly tired and lack the energy for everyday activities. Anorexia nervosa can also lead to a depletion of essential nutrients and electrolytes, further contributing to fatigue and low energy levels. [4]

Behavioral Signs of Anorexia Nervosa

Anorexia nervosa isn’t just a physical issue. The condition starts, and is rooted, in the mind, and may also lead to some telltale behaviors.

Fixation on Food

A constant focus on food is a common sign of AN.

People with this condition often monitor their caloric intake closely. They may sometimes record every food item they consume, memorize the calorie content of certain foods, or eliminate entire food groups all together.

And it’s not just their own diet people with AN may be concerned with. This focus could potentially extend to comments, concerns, or a general fixation on the foods other people are eating, as well.

Fixation on Body Weight, Shape, or Size

Like their focus on food, people struggling with anorexia nervosa also often fixate on the concepts of body weight, shape, or size.

Again, this fixation doesn’t have to be personal. While it often presents as someone making frequent comments about their own appearance, the obsession with body shape, weight, and size can also extend out to others.

Someone struggling with AN may revere someone they think has the “perfect” body, or comment on how they wished their body looked like someone else’s.

Irregular Eating Patterns

Irregular eating patterns, such as a constant denial of hunger and refusal to eat, are also common behavioral signs of anorexia nervosa.

Hormonal imbalances—specifically low levels of estrogen and oxytocin—may contribute to this behavior by helping to develop and maintain the constant fear of gaining weight. [5, 6] And these types of hormonal imbalances are also more likely to occur the longer someone participates in disordered eating patterns.

Purging

While most people struggling with AN will go to extreme measures to control their body weight, some people with the condition utilize purging methods to achieve this.

Purging-type anorexia nervosa will involve purging behaviors such as self-induced vomiting or the misuse of laxatives. [7] Not everyone with AN experiences these behaviors, but a subset of people who struggle with AN are diagnosed with this specific type of the condition.

Mood Swings

Anorexia nervosa can affect a person’s mood in a number of ways.

The disordered eating patterns involved in the condition leads to nutritional fluctuation, which can contribute to hormonal fluctuation, resulting in noticeable mood swings.

A majority of people with anorexia nervosa are also simultaneously struggling with at least one other type of mental health disorder. Commonly, people with AN have a co-occurring diagnosis of a depressive disorder or anxiety disorder, and these, too, can be exacerbated by the irregular eating patterns involved with AN.

Alternatively, someone with AN may exhibit extreme self-control, often manifested through restrictive eating habits. [8]

Health Complications Associated with Anorexia

Anorexia nervosa can lead to a number of serious health complications, both in the short and long term. The appearance of these issues may also help someone recognize the presence of anorexia nervosa, in themselves or a loved one.

Some of the most common health complications connected to AN include:

Electrolyte imbalances
Dehydration
Anemia
Osteoporosis
Heart problems

Aside from its effect on the physical body, anorexia nervosa also has a significant impact on mental health. This often manifests as a number of depressive or anxiety disorders and, sadly, an increased risk of suicidal ideation or suicide attempts. [15]

Unfortunately, if not promptly treated, some of these issues can eventually lead to death. In fact, eating disorders are generally considered the deadliest type of mental health condition, and among them, AN is often considered the deadliest type of eating disorder. [16]

But help is still available for those who need it, and the earlier an intervention takes place, the higher the likelihood of a successful recovery.

Anorexia Nervosa Risk Factors

It is very likely that there is no one cause of AN. Rather, various factors often combine to develop and maintain the condition.

Still, among these factors, some patterns have been discovered, pointing to a higher likelihood of someone developing the condition.

Biological Risk Factors

While it was once thought that AN was primarily driven by social forces, science has discovered an increasing number of biological risk factors for developing the condition.

Studies have suggested that certain genetic variations may increase a person’s risk of developing anorexia, including the ways the react to stress, which can be biologically influenced. [9] This is thought to be one reason why AN commonly runs in families.

An imbalance of certain chemicals in the brain, such as serotonin, may also contribute to the development of anorexia. [10] And this, too, can be a genetically inherited trait, making someone with these genes more vulnerable to developing AN.

Environmental Risk Factors

The recent exploration of biological risk factors for AN doesn’t mean there’s no credence to the influence someone’s environment may have on them. There are still a number of recognized social or environmental risk factors for developing anorexia nervosa.

Family issues, such as overprotectiveness, criticism, or lack of emotional support may contribute to the development of the condition. And emotional trauma, such as physical, emotional, or sexual abuse, has sadly been linked to a large number of AN cases. [11][12]

Other Risk Factors

The causes of anorexia nervosa are not fully understood, and no single cause applies to all cases. However, various other factors can increase someone’s risk of developing AN, including:

Past criticism about their eating habits or weight
Societal pressure to be slim
Low self-esteem
A personality that tends toward obsession or perfectionism
A history of dieting

How is Anorexia Nervosa Diagnosed?

Anorexia nervosa is diagnosed based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), or the official record of all recognized mental health disorders.

The criteria for AN include: [13, 14]

Significantly low body weight due to restriction or energy intake
Intense fear of gaining weight
Disturbance in how 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.
Menstrual dysfunction, or absence of at least three consecutive menstrual cycles in biological females.

A healthcare professional, such as a physician or a mental health professional, uses these criteria to help determine whether someone may be struggling with AN. The evaluation may also include a physical examination, lab tests, and a psychological assessment.

Finding Help for Anorexia Nervosa

Living with anorexia nervosa can be a challenging experience. Those struggling with the condition need to seek professional help, including therapy and medical treatment. These often include:

Cognitive behavioral therapy (CBT)
Family-based therapy (FBT)
Medications, such as antidepressants

Nutrition education and support are also crucial in the recovery process. A registered dietitian can work with the individual to develop a healthy meal plan and provide guidance on safe weight restoration.

In addition to professional help, there are also several things that friends and family can do to support a loved one with anorexia nervosa.

Patience and understanding are always helpful, particularly for conditions that can be this lengthy and complex. Avoiding criticizing or commenting on someone’s body or food choices can go a long way.

Focusing on the person’s strengths and positive qualities is another way to help. This will shift the perspective from the things that are wrong, difficult, or need to change, to the things that are worth changing for, or just things that help a person feel happy.

Self-care and self-compassion are another great focus. People with anorexia nervosa often have a negative self-image and low self-esteem, so encouraging them to practice self-compassion can help restore some positive experiences for them.

If you or a loved one are struggling with anorexia nervosa, it is important to seek out help. You can reach out to your primary care physician or mental health therapist for advice on how to get started.

Recovery from anorexia nervosa takes time and effort. However, with the right treatment, support, and self-compassion, individuals with anorexia nervosa can regain their health and improve their quality of life.

Resources

1. Keyes A, Woerwag-Mehta S, Bartholdy S, Koskina A, Middleton B, Connan F, Webster, P, Schmidt U, Campbell IC. (2015). Physical Activity and the Drive to Exercise in Anorexia Nervosa. The International Journal of Eating Disorders; 48(1):46-54.
2. Lavender JM, Shaw JA, Crosby RD, Feig EH, Mitchell JE, Crow SJ, Hill L, Le Grange D, Powers P, Lowe MR. (2015). Associations between weight suppression and dimensions of eating disorder psychopathology in a multisite sample. Journal of Psychiatric Research; 69:87–93.
3. Rosa-Caldwell ME, Eddy KT, Rutkove SB, & Breithaupt L. (2022). Anorexia nervosa and muscle health: A systematic review of our current understanding and future recommendations for study. The International Journal of Eating Disorders, 10.
4. Winston AP. (2012). The clinical biochemistry of anorexia nervosa. Annals of Clinical Biochemistry; 49(Pt 2):132–143.
5. Demitrack MA, Lesem MD, Listwak SJ, Brandt HA., Jimerson DC, & Gold PW. (1990). CSF oxytocin in anorexia nervosa and bulimia nervosa: clinical and pathophysiologic considerations. The American Journal of Psychiatry; 147(7):882-886.
6. Lawson EA, Donoho DA, Blum JI, Meenaghan EM, Misra M, Herzog DB, Sluss PM., Miller KK, & Klibanski A. (2011). Decreased nocturnal oxytocin levels in anorexia nervosa are associated with low bone mineral density and fat mass. The Journal of Clinical Psychiatry; 72(11):1546-1551.
7. Forney KJ, Buchman-Schmitt, JM, Keel PK, & Frank GK. (2016). The medical complications associated with purging. The International Journal of Eating Disorders; 49(3):249–259.
8. Steinglass JE, Figner B, Berkowitz S, Simpson HB, Weber EU, & Walsh BT. (2012). Increased capacity to delay reward in anorexia nervosa. Journal of the International Neuropsychological Society; 18(4): 773-780.
9. Berrettini W. (2004). The genetics of eating disorders. Psychiatry; 1(3):18-25.
10. Haleem DJ. (2012). Serotonin neurotransmission in anorexia nervosa. Behavioural pharmacology; 23(5-6):478-495.
11. Groth T, Hilsenroth M, Boccio D, & Gold J. (2019). Relationship between Trauma History and Eating Disorders in Adolescents. Journal of Child & Adolescent Trauma; 13(4):443-453.
12. Schmidt U, Tiller J, Blanchard M, Andrews B, & Treasure J. (1997). Is there a specific trauma precipitating anorexia nervosa? Psychological medicine; 27(3):523-530.
13. DSM-5 Changes: Implications for Child Serious Emotional Disturbance. National Library of Medicine. Accessed January 2023.
14. Kreipe, R. E., Strauss, J., Hodgman, C. H., & Ryan, R. M. (1989). Menstrual cycle abnormalities and subclinical eating disorders: a preliminary report. Psychosomatic Medicine; 51(1):81-86.
15. Lian Q, Zuo X, Mao Y, Luo S, ZhangS, TuX, Lou C, & Zhou W. (2017). Anorexia nervosa, depression and suicidal thoughts among Chinese adolescents: a national school-based cross-sectional study. Environmental Health and Preventive Medicine; 22(1):30.
16. van Hoeken D, & Hoek HW. (2020). Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Current Opinion in Psychiatry; 33(6):521-527.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Edited on March 31, 2023
Published on EatingDisorderHope.com, Eating Disorder Help

Common Signs and Symptoms of Anorexia Nervosa