Anorexia nervosa is a serious eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight, and a distorted perception of body weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly compromise their health. While anorexia nervosa primarily affects teenage girls and young women, the disorder can impact people of all genders, ages, and backgrounds.
Catching the signs of anorexia early is crucial, as the disorder can lead to severe medical complications and even become life-threatening if left untreated. But because people with anorexia often try hard to hide their disordered behaviors, it can be challenging for loved ones to recognize the problem. Being aware of some of the most common warning signs is key to getting someone the help they need before the illness progresses further.
1. Rapid, significant weight loss
One of the hallmark signs of anorexia nervosa is when someone loses a substantial amount of weight very quickly, seemingly for no reason. This unexplained weight loss is often the most obvious outward sign of the disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), most people with anorexia lose at least 15% of their body weight, dropping below what is considered minimally normal for their age and height. However, the weight loss can be much more dramatic than that in severe cases.
Losing weight quickly through increased exercise and strict dieting may seem innocuous or even admirable at first. But when the weight loss becomes extreme through severely limiting food intake, it is cause for concern. The individual may claim they “feel fat” despite becoming very underweight objectively. Preoccupation with calories, fat grams, and other aspects of food intake is common. They may exhibit strange food behaviors like cutting food into tiny pieces, eating very slowly, or avoiding eating around others.
Typical weight loss behaviors
– Severely restricting calorie intake well below daily needs
– Fasting for long periods
– Eliminating entire food groups like fat or carbs
– Over-exercising beyond a healthy level
– Using diet pills, laxatives, or diuretics
Physical signs of low body weight
– Visibly thin appearance, especially sunken cheeks
– Protruding bones visible under skin
– Thin limbs and digits
– Lanugo hair growing on body
– Hair thinning or loss on scalp
– Muscle wasting
2. Intense fear of gaining weight or being “fat”
In addition to radical weight loss, an intense fear of weight gain is also one of the key diagnostic criteria for anorexia. Despite being alarmingly underweight, the person may still view themselves as overweight or “too fat.” They have a distorted, inaccurate view of their body size and shape. Even just a few pounds of weight gain or perfectly normal fluctuations in weight can trigger enormous fear, anxiety, and efforts to quickly lose weight again.
This excessive preoccupation with weight generally comes along with severely limiting food intake and other behaviors aimed at losing (or avoiding gaining) weight. The desire to lose weight stems from an emotional, psychological problem rather than a simple desire to improve physical health or fitness. The person places an unreasonably high importance on weight and shape in determining their self-worth.
While it is normal to want to maintain a certain weight, people with anorexia take it to an unhealthy extreme. Minor weight gain leads to extreme emotional distress. They may frequently weigh themselves, scrutinize themselves in the mirror, and compare their bodies to others obsessively. Clothing size, calories, pounds, and other aspects related to their weight consume their thoughts. This obsession leaves little room for normal interests, relationships, or activities.
Fear of weight gain behaviors
– Weighing self excessively throughout the day
– Constantly comparing own weight/shape to others
– Severely limiting “safe foods” believed to not cause weight gain
– Developing food rituals to avoid perceived weight gain
– Continuing fasting, restriction despite being underweight
Fear of weight gain thought patterns
– Preoccupied with food/weight the majority of the time
– Experiencing anxiety or disgust at the sight of normal-weight body parts
– Viewing oneself as “too fat” despite underweight status
– Feeling the need to lose 5-10 lbs even when underweight
– Wanting to see specific numbers on the scale before feeling “okay”
3. Body image disturbance
A distorted body image involves seeing yourself as larger than you really are. People with anorexia do not see their body accurately and may perceive themselves as “fat” even when underweight. Even as their weight drops well below normal levels, they still feel a need and desire to lose weight. They may develop unusual rituals around mirrors, avoid seeing themselves, and wear baggy clothing to hide their body shape.
Some signs that someone has a distorted body image include:
– Claiming parts of the body like the stomach, hips, or thighs are “too fat” despite leanness
– Expressing fear of developing fat on certain body parts
– Pinching or measuring body parts frequently
– Asking for reassurance about appearance often
– Defining self-worth based on weight and shape
– Feeling “too big” to wear certain clothing sizes
A distorted body image comes from the mind’s inability to see the body accurately. People with anorexia develop an inner representation of their outer appearance that does not match reality. Altered brain pathways may play a role. The distortion may be worse at times of stress.
Professionals use perceptual testing to diagnose body image distortion. This involves computer alteration of photographs to determine what a person recognizes as their current body size compared to their actual measurements. People with anorexia often do not recognize their true thin state.
Working with a therapist can help foster awareness of when negative body thoughts occur. Some therapies aim to directly improve body image accuracy and satisfaction. Medications are sometimes used to treat concurrent conditions like obsessive thoughts or depression that may contribute to distorted thinking.
Other common warning signs
In addition to the three major hallmarks described already, some other common warning signs that may indicate anorexia include:
Food-related signs
– Obsession with food, recipes, and cooking for others but not eating themselves
– Excuses to avoid eating with others
– Adherence to strict dietary rules and avoidance of entire food groups
– Denial of hunger despite not eating
– Taking tiny portions or eating very slowly
– Disappearing immediately after eating to purge in secret
Emotional and behavioral signs
– Moodiness, depression, or irritability
– Perfectionism traits
– Withdrawal from friends and activities
– Compulsive behaviors like counting calories or exercise reps
– Frequently feeling cold due to poor circulation
– Lethargy and fatigue
– Insomnia
– Dizziness or fainting
Physical signs
– Constipation from inadequate nutrition
– Abdominal pain or bloating
– Loss of menstrual cycle in females
– Dry skin and brittle nails
– Growth of fine hair all over body
– Poor circulation or swollen feet
– Low heart rate and low blood pressure
What to do if someone shows signs of anorexia
If someone is exhibiting several disordered behaviors or physical signs related to anorexia, it is crucial to address the issue sensitively but directly. Eating disorders thrive on secrecy, so opening the lines of communication is a critical first step. Avoiding the subject can allow the illness to progress further, while early intervention leads to better recovery outlooks.
Here are some tips for approaching someone who may be suffering from anorexia:
– Choose a private moment to initiate a caring, open conversation where the person feels listened to
– Avoid accusations and expressions of alarm, which may cause defensiveness
– Explain specific, observable signs that are concerning without judgment
– Acknowledge the person’s distress rather than debating their behaviors
– Explore options together to seek professional help and support
– Offer to assist in the recovery process, as it is challenging to overcome alone
– Understand relapse may occur on the road to healthier patterns
– Provide a source of hope that full recovery is possible, despite difficulty
Recovering from an eating disorder is frightening and uncomfortable at times. With compassionate support from loved ones, and help from mental health and medical professionals, those suffering can get better and go on to live healthy, fulfilling lives in recovery. The sooner someone gets appropriate treatment tailored to their needs, the higher the chances they can overcome anorexia for good.
Professional treatment options for anorexia
Since anorexia nervosa is a serious and complex condition, professional treatment is always recommended. The major treatment approaches include:
Medical care and monitoring
Because anorexia can lead to dangerous physical effects like malnutrition, physicians monitor vital signs, nutrition levels, and organ function. Hospitalization may be needed to medically stabilize someone whose weight drops dangerously low. Weight restoration through carefully planned meals is a priority.
Individual psychotherapy
Seeing a psychologist or therapist can help uncover the root psychological and emotional issues driving disordered eating. The therapist provides a safe, non-judgmental environment for open discussion. Cognitive behavioral therapy (CBT) is commonly used to help modify distorted thoughts about food and self-image.
Nutritional counseling
Dietitians help those with anorexia overcome fears around food and regain healthy eating habits. Meal planning, exposure therapy, and education are often part of nutritional therapy. The goal is to reduce food restriction and rituals.
Family therapy
Eating disorders affect the whole family, so including loved ones in therapy sessions can be very beneficial. Parents and partners learn how to best support recovery without accidentally enabling disordered behaviors further.
Group therapy
In group therapy, peers recovering from eating disorders can share their struggles and successes. It helps reduce isolation and provides inspiration to keep making progress.
Medications
Antidepressants may improve mood and treat co-occurring disorders like depression. Osteoporosis drugs help strengthen bones weakened by poor nutrition. Other supplements or injections aim to support medical stability.
The most effective programs utilize a comprehensive, multidisciplinary approach combining medical, psychological, and nutritional care. With early treatment matched to specific needs, the prognosis for recovering from anorexia is good. Ongoing aftercare helps prevent relapse and maintain remission long-term.
Conclusion
Anorexia nervosa is a complicated illness that ravages the mind and body. But armed with greater awareness of the common warning signs, friends and family can help their loved one get life-saving treatment sooner. Dramatic weight loss, intense fear of weight gain, and distorted body image perceptions are major red flags of the disorder. Approaching the topic with compassion and providing professional support can aid recovery. With proper treatment, many people with anorexia are able to regain their physical and mental health, and go on to live a meaningful life in recovery. There are always reasons for hope.
