Common Signs and Symptoms of Anorexia Nervosa

Anorexia nervosa (AN) is a serious and potentially life-threatening eating disorder, affecting roughly 0.9% of women and 0.3% of men by some counts and impacting people around the world of every age, gender, race, and sexuality.¹

Still, early intervention can vastly improve the chances of a full recovery. Learning more about the common signs and symptoms of anorexia nervosa can help you or a loved one recognize a potential issue and seek out proper treatment.

What is Anorexia Nervosa?

Anorexia nervosa is a mental health condition that affects a person’s relationship with eating and food. It manifests as an extreme focus on body weight, shape, and size and an intense 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, including:^17,18

• Restricting type: Severely restricted food intake is the primary method used to lose/control weight.
• Binge-purge type: Food intake is restricted, but binge eating and purging episodes also occur.
• Atypical anorexia nervosa (ANN): Involves all the same signs and symptoms of anorexia nervosa except extreme low body weight.

Signs and Symptoms of Anorexia Nervosa

When someone is struggling with anorexia nervosa, they often limit their food intake and place great importance on controlling their body weight and shape. Strict calorie counts, portion control, and excessive exercise are common strategies used to achieve these goals.

For someone with AN, these measures generally become drastic, disrupting their daily life. Yet many individuals struggling with this condition attempt to conceal the truth of their experience, whether by hiding their bodies in oversized clothes or through social isolation. Many others may be in denial of a problem or fail to recognize how serious the issue is.

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:

• Fatigue and low energy levels
• Weight loss
• Muscle wasting
• Dry, thinning hair
• Cold intolerance

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 their diet.¹⁹ 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.¹⁹

Cold Intolerance 

Cold intolerance in people with anorexia nervosa can happen for several reasons. Low body weight and rapid weight loss can lead to this feeling due to their effect on body fat, which is needed to help insulate the body and keep it warm.¹⁴

People with AN also often experience a low basal metabolic rate due to a combination of malnutrition and generally using their digestive system less. This can lead to the sensation of often feeling cold, particularly feeling cold hands.²⁰ 

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. 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 record every food item they consume, memorize the calorie content of certain foods, or eliminate entire food groups. 

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

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 manifests as frequent comments about one’s appearance, the obsession with body shape, weight, and size can also extend to others.

Someone struggling with AN may revere someone they think has the “perfect” body or comment on how they wish their own 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. 

Similarly, someone with AN may participate in strange food rituals, such as cutting food into tiny pieces, excessive chewing, or eating food in a specific order.¹³

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 lead 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

However, help is still available for those who need it, and the earlier an intervention is initiated, the greater the likelihood of a successful recovery.

Anorexia Nervosa Risk Factors

The development of anorexia nervosa is often complex. Rather than a single cause, various factors often combine to develop and maintain the condition.

Still, research has uncovered certain risk factors that may make it more likely for someone to experience anorexia nervosa.

Biological Risk Factors

As scientific tools have become more sophisticated and research on AN has continued, an increasing number of biological risk factors for the condition have been discovered.

Studies have suggested that certain genetic variations may increase a person’s risk of developing anorexia, including the ways they 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 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. 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:^5,6

• Bullying around weight or appearance
• Low self-esteem
• A history of sexual abuse or other trauma
• Perfectionist tendencies
• Gastrointestinal issues in childhood
• 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:¹⁸

• Restriction of energy intake relative to what is appropriate for age, sex, physical health, and developmental trajectory 
• Intense fear of gaining weight 
• Persistent interference in gaining weight
• Disturbance in how one’s body weight or shape is experienced
• Undue influence of body weight or shape on self-evaluation
• Denial of the seriousness of the current low body weight

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 help an individual 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.

Another way to help is to focus on the person’s strengths and positive qualities. 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 make a person 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 help. You can contact your primary care physician or mental health therapist for advice on getting started.Recovering from anorexia nervosa takes time and effort. However, with the proper treatment, support, and self-compassion, individuals with anorexia nervosa can regain their health and improve their quality of life.