Five Key Signs Of Anorexia

Anorexia nervosa (commonly known as anorexia) is an eating disorder characterized by a person taking extreme measures to lose weight. It’s a psychological disorder, not a choice, and its symptoms can be life-threatening. If you’ve noticed symptoms of anorexia in yourself or a loved one, it’s recommended that you seek professional support or talk to your healthcare provider right away, as early interventions for anorexia can be life-saving and may improve the chances of positive outcomes long term. See below for some of the most common warning signs of anorexia nervosa so you can be prepared to recognize and address them with the help of a healthcare provider. First, we’ll begin with an overview of the condition, symptoms, and its potential health effects.

What is anorexia?

Many people with anorexia have a distorted body image (often related to perceived body fat), and it’s very common for them to experience another comorbid, or co-occurring, mental health disorder, such as a mood disorder, anxiety disorder, substance use disorder, or post-traumatic stress disorder. Those experiencing anorexia may also be more likely to think about or engage in self-harm or suicide, which is another reason that seeking treatment for anorexia as soon as possible can be so important. 

Who is at risk for anorexia?

Anorexia can affect anyone of any age, gender, race, or sexual orientation. While women seem to be more at risk for anorexia, it could be that men are simply underdiagnosed due to gendered cultural expectations related to eating disorders or weight. Note also that individuals belonging to some groups may be more likely to develop an eating disorder like anorexia and/or less likely to receive diagnosis or treatment. For example, the National Association of Anorexia Nervosa and Associated Disorders (ANAD) reports that:

• Black individuals are less likely to be diagnosed with anorexia than white people and are likely to experience the condition for a longer period
• Black, Indigenous, and people of color (BIPOC) are less likely to be asked about eating disorder symptoms by their doctor than white individuals
• 20% of women with anorexia also display high levels of autistic traits, and may also benefit least from current treatment models
• Transgender college students report experiencing disordered eating at around four times the rate of cisgender college students
• Women who have a physical disability are more likely to develop an eating disorder

Potential health effects and symptoms of anorexia

Anorexia is a mental health condition, but the lack of nutrition a person living with anorexia usually experiences can have a significant and even life-threatening impact on their physical health as well. 

Below are the potential consequences of this mental health condition on each major body system over time.

The cardiovascular system and blood pressure

When the body does not receive enough protein or other nutrients to sustain itself with anorexia, it begins to break down muscle tissue to get energy. The heart is one of the muscles that can be impacted by this process. Over time, this can cause one’s heart rate and blood pressure to drop, potentially leading to problems like heart failure and lack of blood flow to vital organs. In addition to lower blood pressure, a lack of electrolytes from food can cause irregular heartbeats (possibly from changes in the heart’s electrical activity), which could eventually be fatal. If the heart beats differently (an abnormal heart rhythm), a person may experience heart palpitations. If the heart stops beating, a person can experience cardiac arrest. 

The gastrointestinal system

Purging or starving from anorexia can cause issues such as severe constipation, muscle loss in the intestinal tract, bacterial infections, stomach pain, nausea, and blocked intestines (which may rupture, a situation that can be life-threatening). 

The nervous system

One reason it can be hard to help someone with anorexia is that the brain can be significantly affected by a lack of food as well, which may make it hard for them to think clearly. Without adequate calories and nutrition to sustain brain function, a person may experience side effects such as difficulty focusing and concentrating, trouble sleeping, numbness in the hands, feet, and extremities, seizures, muscle cramps, dizziness, and sleep apnea.

The endocrine system

Healthy hormone production relies on nutrients from food, so the starvation often associated with anorexia can result in lower testosterone and estrogen levels (which can result in the absence of periods), brittle bones and bone loss, a reduced metabolism (resulting in lower body temperatures and potential hypothermia), and the risk of the body resisting insulin, which can cause type-2 diabetes.

Full body effects

Other effects of anorexia on the whole body can include dry skin, brittle nails and hair (which can lead to hair loss), the growth of lanugo hair to conserve heat, kidney failure, a reduction of white blood cells, and anemia.

As the list above illustrates, the potential health complications of anorexia can be many. In one study of 35 patients who had severe anorexia in life, this disorder was listed as the cause of death for almost 70% of them. If you’re experiencing signs of anorexia, know that help is available.

If you or a loved one is experiencing an eating disorder, you can contact the National Eating Disorder Association Helpline for support and resources at 1-800-931-2237 (M–Th from 9AM–9PM EST and Fri 9AM–5PM EST).

Five key symptoms of anorexia to watch for

Although it can affect anyone at virtually any stage of life, the average age of onset for anorexia is between 12 and 25. That means parents, teachers, and others who regularly engage with young people, in particular, may want to familiarize themselves with the most common symptoms of anorexia so they can seek help if they notice them in a loved one or a student. Anorexia can be deadly, so getting treatment as soon as possible is usually imperative. Here are five key signs of anorexia to watch out for.

1. Extreme weight loss

One of the most well-known signs of anorexia nervosa is extreme weight loss, usually achieved by severely restricting food, counting calories, avoiding certain foods altogether, purging, and/or exercising excessively. While this may result in extreme thinness in some individuals, note that it may not in others. Larger-bodied people can also have clinical anorexia. As expert Andrea Garber, PhD, RD, and chief nutritionist at the University of San Francisco puts it, “Our study suggests that patients with large, rapid, or long duration of weight loss are more severely ill, regardless of their current weight.” In fact, people who have anorexia and are in larger bodies may carry an even “heavier psychological burden,” the article reports, because of added negative feelings about body size, shape, or weight.

2. Symptoms of an unhealthy relationship with food

People living with anorexia generally do not have a healthy relationship with food, which can manifest in a variety of different ways that may be noticeable to others. For example, they may:

• Avoid eating in front of others
• Have secrecy around food and eating
• Cook for others without eating themselves
• Insist they’re not hungry
• Eat foods only in certain orders or after specific rearranging on the plate
• Refuse to eat certain categories of food (carbohydrates, desserts, etc.)
• Be overly preoccupied with nutrition or calorie counting
• Be overly preoccupied with body size, shape, or weight
• Feel the need to engage in exercise to “compensate” for food eaten

3. Impaired physical functioning

A person who severely restricts their food intake like someone with anorexia is likely to experience a significant decline in physical functioning as time goes on. This can manifest in all sorts of ways that may be noticeable to family or friends. For instance, a person with anorexia might be cold all the time, wounds may be slow to heal, they may be dizzy, faint, or have muscle weakness or fatigue, they may have trouble sleeping, and/or they may be prone to stomach cramps and other GI complaints.

4. A strong need for control

A person with anorexia may feel that rigidly restricting their food intake offers them a measure of control when life may otherwise feel out of control or hard to manage. As a result, they’re likely to stick to their unhealthy dietary and exercise regimens with intense regularity and devotion. For example, they might never or may very rarely give in to the temptation of eating food they’ve sworn not to eat, or they might engage in excessive exercise even when they’re sick or exhausted. Spontaneity and changes in routine that could affect their food or exercise habits, such as going on vacation, could cause them significant distress. 

5. Social withdrawal

It’s not uncommon for people experiencing anorexia to withdraw socially. They may avoid social outings that could involve food or drink because they don’t want to have to answer for their habits or feel pressured into eating something they don’t want to eat. Since being secretive about food intake is a potential symptom, they may not want to get too close to anyone who could notice what’s going on. They could also have low energy as a result of lack of food, making it hard to engage socially at all.

Seeking help for anorexia

Getting professional treatment is crucial when it comes to anorexia. If you or someone you know is experiencing symptoms of anorexia, it’s recommended that you seek out medical and psychological help immediately. The National Eating Disorders Association (NEDA) offers a free screening tool on its website that can help you decide whether the symptoms you’re experiencing or observing may necessitate seeking professional support. 

There isn't currently a cure for anorexia and recovery can be a long and difficult process, but it is possible with the right support. Some of the challenges that usually need to be overcome at the start of treatment for anorexia include addressing any medical problems from malnutrition, learning to cultivate healthy eating habits and a healthy relationship with food, and engaging in therapy to address the psychological aspects of anorexia. Remember, eating disorders are not a choice or a matter of willpower, and simply urging someone to develop healthier habits will generally not be helpful and may push them away. Seeking the support of a trained professional is typically best.

How online therapy can help

When you reach out for help with anorexia, you’ll likely be supported in building a care team of health professionals who can help you in the recovery process. One of these will likely be a trained therapist who has experience working with individuals with eating disorders. In some cases, this part of the treatment can be done from the comfort of home through online therapy. 

Research suggests that online therapy may help improve symptoms of anorexia in some cases and in tandem with other forms of support, so this format may be worth considering if it’s more convenient for you. With a platform like BetterHelp, you can connect with a licensed therapist who you can speak with via phone, video call, and/or in-app messaging to address your concerns.