Anorexia nervosa - Symptoms 

Symptoms of anorexia 

Anorexia: Katie's story

Katie, 21, had anorexia between the ages of 14 and 19. She shares her experiences of life with anorexia and explains how she recovered.

Media last reviewed: 11/01/2013

Next review due: 11/01/2015

Spotting warning signs in others

It can often be difficult to realise a loved one or friend has developed anorexia. While they are not deliberately choosing to lie to people, the obsessive nature of anorexia can make people with the condition act in devious ways. Warning signs to look out for include:

  • losing weight
  • missing meals
  • complaining of being fat, even though they are normal or underweight
  • repeatedly weighing themselves and looking in the mirror
  • making repeated claims they have already eaten, or will shortly be going out to eat somewhere else
  • cooking big or complicated meals for others, but eating little or none of the food themselves
  • only eating certain low-calorie foods in your presence, such as lettuce or celery
  • feeling uncomfortable or refusing to eat in public places, such as a restaurant

There are also an increasing number of ‘pro-anorexia’ websites, often nicknamed ‘pro-ana’ or ‘ana’, that seek to promote anorexia as a lifestyle choice rather than a potentially fatal mental health condition.

If you are concerned someone may be using your family computer to access such sites, commercial web filters can block access to the sites and tell you someone tried to access them.

The main symptom of anorexia is losing a lot of weight deliberately.

For example, by:

  • eating as little as possible
  • making yourself vomit
  • over-exercising – burning more calories than you consume in a day

A person with anorexia will want their weight as low as possible – much less than average for their age and height. They are so afraid of gaining weight they cannot eat normally.

After eating they may try to get rid of food from their body by making themselves sick. Signs of regular vomiting could include:

  • leaving the table immediately after meals
  • dental problems such as tooth decay or bad breath caused by the acid in vomit damaging their teeth and mouth
  • hard skin on their knuckles, caused by putting their fingers down their throat

The need to obsessively burn calories usually draws people with anorexia to ‘high-impact’ activities, such as running, dancing or aerobics. Some people will use any available opportunity to burn calories, such as preferring to stand rather than sit.

They may try to make food pass through their body as quickly as possible. For example, by taking:

  • laxatives (medication that helps to empty the bowel)
  • diuretics (medication that helps remove fluid from the body)

In reality, laxatives and diuretics have little effect on calories absorbed from food.

Eating and food

Although anorexia means ‘loss of appetite’, people with anorexia nervosa do not usually lose their appetite – they like food and feel hungry.

However, they do not think about food in the same way as others. This is apparent in various ways. For example, they may:

  • tell lies about eating or what they have eaten
  • give excuses about why they are not eating
  • pretend they have eaten earlier
  • lie about how much weight they have lost
  • find it difficult to think about anything other than food
  • spend lots of time reading cookery books and recipes

Someone with anorexia nervosa strictly controls what they eat. For example, by:

  • strict dieting
  • counting the calories in food excessively
  • avoiding food they think is fattening
  • eating only low-calorie food
  • missing meals (fasting)
  • avoiding eating with other people
  • hiding food
  • cutting food into tiny pieces – to make it less obvious they have eaten little, and to make food easier to swallow
  • taking appetite suppressants, such as slimming or diet pills

They may also drink lots of fluids that contain caffeine, such as coffee, tea and low-calorie fizzy drinks, as these can provide a low-calorie, short-term burst of energy.

Some people with anorexia also use illegal stimulant drugs known to cause weight loss, such as cocaine or amphetamines.

Self-esteem, body image and feelings

People with anorexia often believe their value as a person is related to their weight and how they look. They think others will like them more if they are thinner, seeing their weight loss in a positive way.

They often have a distorted view of what they look like (their body image). For example, they think they look fat when they are not. They may try to hide how thin they are by wearing loose or baggy clothes.

Many people also practise a type of behaviour known as ‘body-checking’, which involves persistently and repeatedly:

  • weighing themselves
  • measuring themselves, such as their waist size
  • checking their body in the mirror

Anorexic people usually have low self-esteem or self-confidence. They may withdraw from relationships and become distant from family and friends.

Anorexia can also affect the person’s school work or how well they perform their job.

They may find concentration difficult, and might lose interest in their usual activities. They may have few interests, even though they seem busier than usual.

Other signs of anorexia

Eating too little for a long time can result in physical symptoms, such as:

  • fine downy hair (lanugo) growing on their body
  • more hair on their face
  • their pubic hair becoming sparse and thin

Their heartbeat may be slow or irregular, which can lead to poor circulation. They may also:

In children with anorexia, puberty and the associated growth spurt may be delayed. They may gain less weight than expected (if any) and may be smaller than other people of the same age.

Women and older girls with anorexia may stop having their periods (known as amenorrhoea or absent periods). Anorexia can also lead to infertility.

Page last reviewed: 16/05/2012

Next review due: 16/05/2014

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