Behaviors of anorexia

Anorexia nervosa - Symptoms and causes


Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.

To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.

Anorexia isn't really about food. It's an extremely unhealthy and sometimes life-threatening way to try to cope with emotional problems. When you have anorexia, you often equate thinness with self-worth.

Anorexia, like other eating disorders, can take over your life and can be very difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia's serious complications.

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The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioral issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight is different for each person, and some individuals may not appear extremely thin. Also, people with anorexia often disguise their thinness, eating habits or physical problems.

Physical symptoms

Physical signs and symptoms of anorexia may include:

  • Extreme weight loss or not making expected developmental weight gains
  • Thin appearance
  • Abnormal blood counts
  • Fatigue
  • Insomnia
  • Dizziness or fainting
  • Bluish discoloration of the fingers
  • Hair that thins, breaks or falls out
  • Soft, downy hair covering the body
  • Absence of menstruation
  • Constipation and abdominal pain
  • Dry or yellowish skin
  • Intolerance of cold
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Swelling of arms or legs
  • Eroded teeth and calluses on the knuckles from induced vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia. But people with anorexia generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by:

  • Severely restricting food intake through dieting or fasting
  • Exercising excessively
  • Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products

Emotional and behavioral signs and symptoms may include:

  • Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them
  • Frequently skipping meals or refusing to eat
  • Denial of hunger or making excuses for not eating
  • Eating only a few certain "safe" foods, usually those low in fat and calories
  • Adopting rigid meal or eating rituals, such as spitting food out after chewing
  • Not wanting to eat in public
  • Lying about how much food has been eaten
  • Fear of gaining weight that may include repeated weighing or measuring the body
  • Frequent checking in the mirror for perceived flaws
  • Complaining about being fat or having parts of the body that are fat
  • Covering up in layers of clothing
  • Flat mood (lack of emotion)
  • Social withdrawal
  • Irritability
  • Insomnia
  • Reduced interest in sex

When to see a doctor

Unfortunately, many people with anorexia don't want treatment, at least initially. Their desire to remain thin overrides concerns about their health. If you have a loved one you're worried about, urge her or him to talk to a doctor.

If you're experiencing any of the problems listed above, or if you think you may have an eating disorder, get help. If you're hiding your anorexia from loved ones, try to find a person you trust to talk to about what's going on.

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The exact cause of anorexia is unknown. As with many diseases, it's probably a combination of biological, psychological and environmental factors.

  • Biological. Although it's not yet clear which genes are involved, there may be genetic changes that make some people at higher risk of developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity and perseverance — all traits associated with anorexia.
  • Psychological. Some people with anorexia may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which causes them to think they're never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.
  • Environmental. Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.

Risk factors

Anorexia is more common in girls and women. However, boys and men have increasingly developed eating disorders, possibly related to growing social pressures.

Anorexia is also more common among teenagers. Still, people of any age can develop this eating disorder, though it's rare in those over 40. Teens may be more at risk because of all the changes their bodies go through during puberty. They may also face increased peer pressure and be more sensitive to criticism or even casual comments about weight or body shape.

Certain factors increase the risk of anorexia, including:

  • Genetics. Changes in specific genes may put certain people at higher risk of anorexia. Those with a first-degree relative — a parent, sibling or child — who had the disorder have a much higher risk of anorexia.
  • Dieting and starvation. Dieting is a risk factor for developing an eating disorder. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.
  • Transitions. Whether it's a new school, home or job; a relationship breakup; or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia.


Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur suddenly — even when someone is not severely underweight. This may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.

Other complications of anorexia include:

  • Anemia
  • Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure
  • Bone loss (osteoporosis), increasing the risk of fractures
  • Loss of muscle
  • In females, absence of a period
  • In males, decreased testosterone
  • Gastrointestinal problems, such as constipation, bloating or nausea
  • Electrolyte abnormalities, such as low blood potassium, sodium and chloride
  • Kidney problems

If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.

In addition to the host of physical complications, people with anorexia also commonly have other mental health disorders as well. They may include:

  • Depression, anxiety and other mood disorders
  • Personality disorders
  • Obsessive-compulsive disorders
  • Alcohol and substance misuse
  • Self-injury, suicidal thoughts or suicide attempts


There's no guaranteed way to prevent anorexia nervosa. Primary care physicians (pediatricians, family physicians and internists) may be in a good position to identify early indicators of anorexia and prevent the development of full-blown illness. For instance, they can ask questions about eating habits and satisfaction with appearance during routine medical appointments.

If you notice that a family member or friend has low self-esteem, severe dieting habits and dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, you can talk about healthier behavior or treatment options.

By Mayo Clinic Staff


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9 Symptoms of Anorexia Nervosa

Anorexia nervosa, commonly called anorexia, is a serious eating disorder in which a person adopts unhealthy and extreme methods to lose weight or avoid gaining weight.

There are two types of the disorder: restrictive type and binge eating/purging type.

Those with restrictive anorexia control their weight by restricting their food intake, while those with binge eating/purging anorexia expel what they have eaten through vomiting or the use of medications like laxatives and diuretics.

A complex variety of factors influence the development of anorexia. Reasons for developing anorexia can be different for each person and may include genetics, past trauma, other mental health conditions such as anxiety and depression.

People at the highest risk of developing anorexia include females in their teenage and young adult years, although men and older women are also at risk (1, 2).

Anorexia is usually not quickly diagnosed because people with the eating disorder don’t typically know they’re experiencing it, so they may not ask for help (3).

It’s also common for people with anorexia to be reserved and not discuss their thoughts about food or body image, making it difficult for others to notice symptoms.

No single test can identify the disorder, as many factors need to be considered to make a formal diagnosis.

Here are 9 common signs and symptoms of anorexia.

Purging is a common characteristic of anorexia. Purging behaviors include self-induced vomiting and the over use of certain medications like laxatives or diuretics. It can also include the use of enemas.

The binge eating/purging type of anorexia is characterized by episodes of excessive eating followed by self-induced vomiting.

Using large amounts of laxatives is another form of purging. These medications are taken in an attempt to decrease food absorption and speed up the emptying of the stomach and intestines.

Similarly, diuretics are often used to increase urination and reduce body water as a means to lower body weight.

A study exploring the prevalence of purging in eating disorder patients found that up to 86% used self-induced vomiting, up to 56% abused laxatives and up to 49% abused diuretics (4).

Purging can lead to many serious health complications (4).


Purging is the practice of self-induced vomiting or the use of certain medications to reduce calories, avoid food absorption and lose weight.

Constant worry about food and the close monitoring of calorie intake are common characteristics of anorexia.

People with anorexia might record every food item they consume, including water. Sometimes, they even memorize the calorie content of foods.

Worry over gaining weight contributes to obsessions with food. Those with anorexia may decrease their calorie intake dramatically and practice extreme diets. Some may eliminate certain foods or entire food groups from, such as carbohydrates or fats, from their diet.

If someone restricts food intake for a long period, it can lead to severe malnutrition and nutrient deficiencies, which can alter mood and increase obsessive behavior about food (5, 6).

Decreased food intake can also affect appetite-regulating hormones, like insulin and leptin. This can lead to other health problems such as bone-mass loss, as well as reproductive, mental and growth issues (7, 8).


Excessive concern about food is a hallmark of anorexia. Practices may include logging food intake and eliminating certain food groups due to the belief that those foods may increase weight.

People who are diagnosed with anorexia often have symptoms of other conditions as well, including depression, anxiety, hyperactivity, perfectionism and impulsivity (9).

These symptoms can cause those with anorexia to not find pleasure in activities that are usually enjoyable for others (9 [15]).

Extreme self-control is also common in anorexia. This characteristic is manifested by restricting food intake to achieve weight loss (10, 11).

Also, individuals with anorexia might become highly sensitive to criticism, failure and mistakes (12).

Imbalances in some hormones, such as serotonin, dopamine, oxytocin, cortisol and leptin, can explain some of these characteristics in those with anorexia (13, 14).

Since these hormones regulate mood, appetite, motivation and behavior, abnormal levels could lead to mood swings, irregular appetite, impulsive behavior, anxiety and depression (8, 15, 16, 17).

In addition, reducing food intake can lead to a deficiency of nutrients involved in mood regulation (18).


Mood swings and symptoms of anxiety, depression, perfectionism and impulsivity are commonly found in people with anorexia. These characteristics may be caused by hormonal imbalances or nutrient deficiencies.

Body shape and attractiveness are critical concerns for people with anorexia (19).

The concept of body image involves a person’s perception of their body size and how they feel about their body (20).

Anorexia is characterized by having a negative body image and negative feelings toward the physical self (21).

In one study, participants showed misconceptions about their body shape and appearance. They also exhibited a high drive for thinness (22).

A classic characteristic of anorexia involves body-size overestimation, or a person thinking they are bigger than they actually are (23 [29], 24 [30]).

One study investigated this concept in 25 people with anorexia by having them judge whether they were too big to pass through a door-like opening.

Those with anorexia significantly overestimated their body size, compared to the control group (25).

Repeated body checking is another characteristic of anorexia. Examples of this behavior include looking at yourself in a mirror, checking body measurements and pinching the fat on certain parts of your body (26).

Body checking can increase body dissatisfaction and anxiety, as well as promote food restriction in people with anorexia (26, 27).

Additionally, evidence shows that sports in which weight and aesthetics are a focus can increase the risk of anorexia in vulnerable people (28 [34], 29 [35]).


Anorexia involves an altered perception of the body and overestimation of body size. Additionally, the practice of body checking increases body dissatisfaction and promotes food-restrictive behaviors.

Those with anorexia, especially those with the restrictive type, often exercise excessively to lose weight (30).

In fact, one study in 165 participants showed that 45% of those with eating disorders also exercised an excessive amount.

Among this group, it found that excessive exercising was most common in those with restrictive (80%) and binge eating/purging (43%) types of anorexia (31).

In teenagers with eating disorders, excessive exercise seems to be more common among women than men (32).

Some people with anorexia also experience a feeling of intense guilt when a workout is missed (33, 34).

Walking, standing and fidgeting more frequently are other types of physical activity commonly seen in anorexia (35).

Excessive exercise is often present in combination with high levels of anxiety, depression and obsessional personalities and behaviors (35, 36).

Lastly, it seems that low levels of leptin found in people with anorexia might increase hyperactivity and restlessness (37, 38).


Excessive exercise is a common symptom of anorexia, and people with anorexia may feel intense guilt if they miss a workout.

Irregular eating patterns and low appetite levels are important signs of anorexia.

The restrictive type of anorexia is characterized by a constant denial of hunger and refusal to eat.

A number of factors may contribute to this behavior.

First, hormonal imbalances can provoke people with anorexia to maintain a constant fear of gaining weight, resulting in a refusal to eat.

Estrogen and oxytocin are two hormones involved in fear control.

Low levels of these hormones typically found in people with anorexia can make it hard to overcome the constant fear of food and fat (39, 40, 41 ).

Irregularities in hunger and fullness hormones, such as cortisol and peptide YY, can contribute to the avoidance of eating (42, 43).

People with anorexia can find weight loss more gratifying than eating, which can make them want to continue restricting food intake (12, 39, 44).


A constant fear of gaining weight can cause people with anorexia to refuse food and deny hunger. Also, the low reward value of food can lead them to further decrease their food intake.

Obsessive behavior about food and weight often triggers control-oriented eating habits (45).

Engaging in such rituals can ease anxiety, bring comfort and generate a sense of control (47).

Some of the most common food rituals seen in anorexia include:

  • Eating foods in a certain order
  • Eating slowly and excessive chewing
  • Arranging food on a plate in a certain way
  • Eating meals at the same times every day
  • Cutting food into small pieces
  • Weighing, measuring and checking portion sizes of food
  • Counting calories before eating the food
  • Only eating meals in specific places

People with anorexia can view deviation from these rituals as a failure and loss of self-control (46).


Anorexia can lead to various eating habits that can bring a sense of control and reduce anxiety often caused by food.

In some cases, anorexia can lead to the chronic use of alcohol, certain medications and diet pills.

Alcohol may be used to suppress appetite and cope with anxiety and stress.

Those engaged in binge eating/purging are about 18 times more likely to abuse alcohol and drugs than the restricting type (48, 49, 50).

For some, alcohol abuse might also be followed by drastic reductions in food intake to compensate for the calories consumed through drinking (51).

The abuse of other drugs, including amphetamines, caffeine or ephedrine, are common in the restrictive type, as these substances can suppress appetite, increase metabolism and promote rapid weight loss (52).

Food restriction and rapid weight loss can affect the brain in ways that may further increase the desire for drugs (53, 54).

Long-term substance abuse combined with reduced food intake can cause malnutrition and trigger other health problems.


Anorexia can lead to the abuse of alcohol and certain drugs to help decrease food intake or calm anxiety and fear towards food.

Excessive weight loss is a main sign of anorexia. It’s also one of the most concerning.

The severity of anorexia depends on the extent to which a person suppresses their weight. Weight suppression is the difference between a person’s highest past weight and their current weight (55).

One study showed that weight suppression had significant links to weight, body concerns, excessive exercise, food restriction and the use of weight control medication (56).

Guidelines for the diagnosis of anorexia consider weight loss to be relevant if the current body weight is 15% below the expected weight of a person of that age and height, or if the body mass index (BMI) is 17.5 or less (57).

However, weight changes in a person can be difficult to notice and may not be enough to diagnose anorexia. Therefore, all other signs and symptoms need to be considered to make an accurate determination.


Extreme weight loss is a significant sign of anorexia, such as when body weight drops below 15% of the expected weight for a person of that age and height, or their BMI is less than 17. 5.

The symptoms listed above may be the first and most obvious indications of anorexia.

In those with more severe anorexia, body organs can be affected and trigger other symptoms, including:

  • Fatigue, sluggishness and lethargy
  • Cavity formation from vomiting
  • Dry and yellowish skin
  • Dizziness
  • Thinning of bones
  • Growth of fine, soft hair covering the body
  • Brittle hair and nails
  • Muscle loss and muscle weakness
  • Low blood pressure and pulse
  • Severe constipation
  • Feeling cold all the time due to a drop in internal temperature

Because the likelihood of full recovery is higher with early treatment, it’s important to seek help as soon as symptoms are noticed.


The progression of anorexia can cause many changes and affect virtually all body organs. Symptoms may include fatigue, constipation, feeling cold, brittle hair and dry skin.

Anorexia nervosa is an eating disorder characterized by weight loss, body image distortion and the practice of extreme weight loss methods like food purging and compulsive exercising.

Here are some resources and ways to seek help:

  • National Eating Disorders Association (NEDA)
  • National Institute of Mental Health
  • National Association of Anorexia Nervosa and Associated Disorders

If you believe that you or a friend or family member may have anorexia, know that it is possible to recover and help is available.

Editor’s note: This piece was originally reported on April 1, 2018. Its current publication date reflects an update, which includes a medical review by Timothy J. Legg, PhD, PsyD.

Anorexia | Tervisliku toitumise informatsioon

Anorexia ( anorexia nervosa ) is an eating disorder in which a person tries to achieve the lowest possible body weight. Despite dangerously low weight, a person feels fat and is afraid to gain weight.

The disorder manifests itself in malnutrition and associated mental and physical complications. As a result of this disease, a person eats low-calorie, often monotonous foods to avoid weight gain. The focus is on weight, appearance, nutrition. Often this becomes the main activity, negatively affecting all other important areas of a person’s life. Violated close relationships, deteriorating ability to learn and work. nine0005

Anorexia usually develops in early adolescence. Most often, young girls get sick. Anorexia occurs in 1% of women and 0.1% of men. The genetic predisposition for anorexia is higher than for other eating disorders. The influence of heredity on this disease is estimated at 40-60%. The presence of a close relative with anorexia increases the risk of the disease by 11 times. As with all eating disorders, biological factors and the environment play an important role. nine0005

Symptoms of anorexia:
  • underweight - significantly lower than should be for age, sex and height diarrhoea, abuse of appetite suppressants or laxatives
  • distorted body image, perception of being larger than one actually is. nine0014
  • fear of weight gain, very strict weight restrictions
  • concomitant hormonal, metabolic, physical complications
  • normal physical development is disturbed in children and adolescents, developmental delay occurs
Complications of anorexia:
  • , osteoporosis)
  • amenorrhea or absence of menstrual bleeding
  • damage to the cardiovascular system, arrhythmias, palpitations, decreased performance
  • kidney, liver and pancreas dysfunction
  • gastrointestinal disorders which may be associated with constipation or diarrhoea, bloating, abdominal pain
  • damage to nails and skin, thinning hair
  • chronic fatigue, weakness and loss of strength, decreased exercise tolerance, dizziness, shortness of breath, fainting
  • difficulty concentrating, memory problems
  • Anorexia is often associated with affective and anxiety disorders, sleep disorders
Anorexia treatment options

Treatment of anorexia is often time consuming and complex. People with anorexia often lack a meaningful desire for treatment, as well as an understanding of the disease. Because of the strong resistance to weight gain, treatment is delayed. Thus, awareness of the disease is a prerequisite for treatment, which is facilitated by a trusting relationship between the patient and the treatment team. The main goal of treatment is to restore a regular and varied diet and thereby increase body weight. Also important are physical monitoring and treatment, psychotherapy, treatment of comorbid mental disorders, involvement of family members in patient support. Medications are not always prescribed for anorexia, but sometimes they are needed. Treatment is often started on an outpatient basis, and in more severe cases, inpatient treatment is required. nine0005

Diagnosis and treatment of an eating disorder usually starts with your family doctor, so if you notice any signs of anorexia, see your family doctor first.

Anorexia: what it is, symptoms, causes, types, how to treat it

Together with an RBC expert Stil tells what are its causes and consequences, and how the disease can be cured.

  • What is
  • Species
  • Stages
  • Symptoms
  • Causes
  • Consequences
  • How to treat
  • Expert commentary

The material was checked and commented by Elmira Gereeva, psychologist, consultant in weight management and eating behavior, nutritionist, head of the educational department of the School of Emotional Intelligence

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What is anorexia

Many people strive to normalize weight, watch their diet, go on diets and limit harmful foods on the menu. But sometimes these processes turn into an obsessive state. Anorexia nervosa is an eating disorder that can lead to severe weight loss. A person with this disease is preoccupied with what and how much he eats, often keeps a strict calorie count, adheres to an extremely meager diet. The decreasing number on the scales is the main aspiration and the only achievement that brings joy. Often, a reduction in food intake is complemented by increased training. nine0005

Anorexia is most common in girls between the ages of 14 and 25, but it is also diagnosed in older women and men. At different times, she was moved by Angelina Jolie, Demi Moore, Victoria Beckham, Mary-Kate Olsen, Yulia Lipnitskaya. At the same time, it is almost impossible to determine anorexia only by external signs.

Types of anorexia

Anorexia is not necessarily a psychological illness. It may be temporary, independent of the patient's desire to normalize weight and pass as soon as possible (for example, the recovery period after poisoning). nine0005

© Shutterstock

In clinical practice, there are several types of eating disorder:

  1. Primary anorexia. It often occurs against the background of other health pathologies, expressed in a lack of appetite, disorders of the gastrointestinal tract.
  2. Neuropsychiatric anorexia. It is typical to refuse any food for no apparent reason, but against the background of mental problems, such as paranoia or depression.
  3. Mental morbid anorexia. Complete loss of the need for food with relatively normal physical and mental well-being. nine0014
  4. Drug anorexia. Occurs as a side effect of taking drugs designed to solve other health problems, such as antidepressants or stimulants.
  5. Anorexia nervosa. A conscious refusal to eat due to the all-consuming idea of ​​getting rid of excess weight.

Stages of anorexia

Only a doctor can diagnose anorexia. Do not rush to labeling and diagnosing if you met with an old friend and think that she has lost a lot of weight. This may be due to another illness or prolonged stress. Or maybe - the result of proper nutrition and sports in accordance with the doctor's recommendations. To make a diagnosis, many criteria are taken into account, including heart rate, tests, and a conversation with a psychotherapist. nine0005

Gereeva Elmira:

The stages of development of anorexia nervosa can be divided into several stages:

The first stage. A person decides to lose weight. This stage is characterized by pronounced dysmorphophobia - delusional or overvalued ideas of dissatisfaction with one's own appearance, which trigger mechanisms to prevent this shortcoming. Now the number of diagnosed cases of anorexia nervosa has significantly decreased, but the age threshold is also lowering. Children and teenagers are at risk. nine0005

In today's society, the boundaries of a healthy lifestyle have been erased. Due to the lack of knowledge, it is very difficult for people to determine whether now their loved one has simply begun to monitor their diet or is developing an eating disorder. Therefore, most often the first stage of the development of the disease is skipped. After all, improving nutrition and exercising is great. Only no one says what is hidden behind this "idea fix".

Second stage. Characterized by deliberate actions. And it ends at the moment when the weight is reduced by 20-50% of the initial indicators. It all starts with a reduction in daily calorie content, restrictions in a particular food group, or excessive physical activity. nine0005

Further ways to reduce weight depend only on its subjective "severity". Induction of vomiting and use of diuretics or laxatives entail secondary somatoendocrine disorders. This happens about 1-2 years after the person started to lose weight. For example, girls begin amenorrhea.

At this point, the idea of ​​weight loss absorbs a person completely, he thinks only about food and indicators on the scales. The fear of gaining weight back causes disturbing thoughts about every bite eaten. The lower the numbers, the more pronounced somatic disorders: from prolapse of organs, constipation, pain in the stomach to cachexia - an extreme degree of exhaustion of the body. nine0005

Third stage. The resulting pathologies become more pronounced. Thermoregulation is disturbed, hair falls out, teeth are destroyed, the level of physical activity decreases. In addition, a person does not notice objective problems and a decrease in the quality of life. He still continues to go to the "ideal" because of the disturbed perception of his own body. Even at this stage, it is possible to correct the consequences. But the risk of recurrence of the condition, which requires hospital observation, remains for another two years. nine0005

Symptoms of anorexia

People with anorexia nervosa constantly lose weight and appear emaciated. In addition to external manifestations, there are a number of symptoms in the patient's health and lifestyle:

  • inability to maintain optimal weight;
  • fatigue and insomnia;
  • yellowish skin tone, dark or pale patches;
  • thinning and hair loss;
  • absence of menstruation for several cycles; nine0014
  • dry skin;
  • low pressure;
  • problems with the gastrointestinal tract, lack of stool.

If you notice the following symptoms in your loved ones, they most likely need specialist help.

Constantly cold

Anorexia affects the production of thyroid hormones, which regulate metabolic processes and are responsible for the normal functioning of the immune system. One of the consequences of such an imbalance is a violation of the temperature regime of the body. Due to poor microcirculation and a drop in internal temperature, patients with anorexia are constantly cold [1]. They are given out by multi-layered baggy clothes, which they are forced to wear even in the warm season. nine0005

For the same reason, the body begins to be covered with a layer of thin fluffy hairs - this is how the body tries to keep warm. In addition, due to a weakened immune system, people with this eating disorder are more likely to get colds than others. For example, a common runny nose can easily turn into chronic sinusitis or tonsillitis.

Begins to get involved in cooking

Passion for cooking and the desire to feed everyone around is one of the main symptoms of anorexia. You can recognize the disease by a sudden desire to watch cooking shows, talk a lot about food, collect recipes, read cookbooks and cook sumptuous meals for the family. True, the patient himself is unlikely to touch the prepared dishes. Food begins to occupy all thoughts, but it is no longer associated with what can be taken orally. nine0005

Some people think that interest in cooking is an attempt by the brain to remind the body to eat. Others are sure that anorexics get indirect joy and pleasure by watching how others eat. If you notice that a friend is giving her lunch to a pet, throwing away food, or shifting it to other people's plates, this is cause for concern.

Often sad and easily pissed off

Extreme diets lead to nutritional deficiencies [2] and imbalances in certain hormones: serotonin, dopamine, oxytocin, leptin, and cortisol, the stress hormone [3]. Therefore, in patients with anorexia, there are sharp mood swings, and obsessive behavior in relation to food intensifies. For example, some of them begin to wash their hands after each contact with food. nine0005

In addition, endocrine changes cause increased feelings of anxiety and prolonged depression, according to the staff of the Harvard Medical School [4]. The fact is that estrogen and oxytocin help fight fear, reduce stress and anxiety. And the low level of these hormones, which is typical for people with anorexia, makes it difficult to overcome the fear of food. At the same time, pressure from relatives only increases anxiety.

© Shutterstock

Tired quickly

Lack of proper nutrition and poor appetite lead to increased fatigue. Since protein-energy deficiency occurs with anorexia, this negatively affects the work of all organs and systems of the body. To maintain life, he is forced to use internal resources, which are far from unlimited. nine0005

As a result, anorexic patients experience a decrease in muscle strength. They begin to tire faster, experience weakness, drowsiness and frequent dizziness [5]. In addition, fainting and malfunctions of the heart (weak pulse, arrhythmia) are possible. The faster the girl loses weight, the more pronounced the unpleasant consequences.

Abruptly loses weight and is afraid to gain weight

The mere thought of the possibility of gaining weight causes a panic attack in patients with anorexia. At the same time, it is almost impossible to feed them. To keep the number of calories consumed to a minimum, not all girls refuse food. nine0005

They use different methods to reduce body weight. According to a study by American psychologists [6], 86% of people with eating disorders artificially induce vomiting, 56% abuse laxatives, and another 49% use diuretics.

In addition to changes in behavior, over time, external signs of the disease begin to appear. Among them are a sharp weight loss, sunken cheeks and stomach, blue bags under the eyes, protruding collarbones, pointed knees and elbows. At the same time, the skin becomes dry and pale, and the hair becomes brittle and dull. nine0005

Becomes withdrawn and unsociable

When the desire to lose weight becomes an obsession, the circle of interests narrows. A patient with anorexia becomes withdrawn and uncommunicative, gradually losing contact with relatives and friends. Since at this moment a person is left alone with his problem, he begins to seek support in the circle of like-minded people who are losing weight.

As a rule, people with anorexia find each other in special communities that promote the disease. There they share daily reports and life hacks that help them on their way to the “perfect body”. System administrators do not keep track of such malicious content, so these groups continue to exist [7]. According to Canadian researchers [8], social media is one of the main catalysts for the development of eating disorders. nine0005

Constantly counting calories

Strict calorie counting is another rule that anorexics follow. They register every food they eat. As a rule, such girls reduce the calorie intake to 400–700 per day [9].

At the same time, many keep so-called "food diaries". They are published in social networks using the hashtag #anorexiadnevnik. For some, the disease begins with a harmless rejection of sweets and starchy foods, while others decide to give up meat or become a vegan. From the outside, it may seem that everything happens within the framework of the concept of a healthy diet, so relatives perceive these restrictions as a teenage whim. But soon the diet is reduced to a few “safe” low-fat foods, and mood begins to depend on the number on the scale. nine0005

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Exercising and walking a lot

Extreme dieting is often accompanied by exhausting workouts in anorexics. In this way, patients punish themselves for eating and burn calories that have entered the body. According to the results of a study [10] conducted by Italian doctors, 45% of patients with eating disorders resorted to heavy physical exertion.

This phenomenon is more common in women than in men, according to scientists from La Trobe University in Australia [11]. With anorexia, thoughts about training become obsessive: when, for some reason, patients miss classes, they experience a strong sense of guilt [12]. nine0005

If a friend starts walking a lot and torturing herself with prolonged physical activity, she most likely needs help, psychiatrists warn [13].

Complains of menstrual irregularities

Reducing portion size and number of meals negatively affects the synthesis of leptin and insulin, hormones that regulate appetite. Their deficiency leads to various metabolic and neuroendocrine disorders. For example, the patient's bones become looser and more fragile, and therefore the risk of fractures increases significantly. nine0005

In addition, with anorexia, the production of sex hormones decreases, due to which sexual growth slows down, the reproductive function of the body is disturbed and sexual desire disappears. As a rule, along with the loss of kilograms in patients with anorexia, the menstrual cycle is interrupted.

And with a lack of leptin, the brain ceases to control the process of losing weight. As a result, the body begins to quickly lose weight and reject incoming food at the cellular level.

Considers himself fat

Anorexics cannot objectively assess their figure. They spend a lot of time in front of the mirror and consider themselves fat [14], even when everyone around them says that they are exhausted. This is a feature of the disease: the perception of the body is distorted [15], so the ideal weight for such girls is unattainable.

French researchers conducted an interesting experiment [16]. They invited 50 participants, half of whom suffered from anorexia. The girls were asked to visually assess whether they could pass through a narrow doorway. nine0005

The results of the study showed that participants with eating disorders overestimate body size. They feel bigger than they really are. Scientists believe this is due to disorders of the central nervous system. Girls saw themselves the same as they were before anorexia.

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Causes of anorexia

The exact cause of the diagnosis is unknown. People who develop anorexia may suffer from perfectionism and constantly strive for an unattainable ideal or be characterized by excessive anxiety and look for ways to control their lives. Doctors identify several main factors prone to eating disorders:

  1. Biological. Genetics and hormones can lead to the development of anorexia nervosa. It is especially associated with low levels of serotonin.
  2. Social. Intrusive images of thin people broadcast in magazines, social networks and videos can affect how a person perceives himself. We inevitably compare ourselves with others, especially if they are beautiful and successful.
  3. Psychological. People with obsessive-compulsive disorder (OCD) tend to diet and exercise rigorously due to obsessions and compulsions. nine0014

Consequences of anorexia

Eating disorders cause many serious complications. Sometimes they lead to death, and often suddenly, without prior excessive weight loss. This is due to an abnormal heart rhythm or an imbalance of electrolytes—vital minerals—sodium, calcium, and potassium.

Other complications of anorexia can be cardiovascular problems such as mitral valve prolapse and heart failure. Often, the disease is accompanied by loss of muscle and bone mass, leading to an increased risk of fractures. Anorexia leads to hormonal disorders and diseases of the stomach, chronic renal failure. nine0005

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How to Treat Anorexia

One of the biggest challenges in treating anorexic patients is their lack of desire to change. Sometimes a person does not agree to the help of a doctor, even when it becomes obvious that the quality of life is suffering. Lack of energy and strength, physical and nervous exhaustion, depression, inability to eat for a long time are already the extreme stages of an eating disorder. The main goal of treatment is to return the body to normal weight and develop proper eating habits without strict restrictions and hunger strikes. Therefore, a nutritionist works together with a therapist and a psychiatrist, who will help to create a menu and gradually return the patient to the joy of eating. Comprehensive treatment includes:

  1. Individual therapy. Cognitive-behavioral methods help to change the vector of thinking, learn to cope with strong emotions and increase self-esteem.
  2. Family therapy. It is good if not only anorexia sufferer participates in therapeutic sessions with a psychiatrist, but also his relatives and friends. To create a favorable atmosphere for all participants in the process, it is important to learn how to resolve conflicts, as well as adhere to a healthy lifestyle.
  3. Group therapy. These sessions allow people with identical problems to communicate with each other. All conversations are held with the participation and under the supervision of a doctor, otherwise they can turn into competitions between those who want to lose weight even more. nine0014
  4. Medical treatment. There is currently no cure for anorexia, but doctors can prescribe pills to combat the disease's symptoms of depression and anxiety.
  5. Hospitalization. Depending on the degree of weight loss, the patient can be treated as an outpatient or inpatient. In some cases, a feeding tube and droppers are indicated to keep the body alive, especially with severe dehydration.

Many people cope with anorexia and return to a full life. However, there are patients who cannot be saved. This usually happens due to untimely access to specialists, when the body is exhausted to such an extent that there are irreversible malfunctions in the work of internal organs. Some people require lifelong support from a psychologist and work with groups of patients suffering from eating disorders.

There is no proven way to prevent anorexia nervosa, it can occur unpredictably as a result of severe psychological shocks. But observing the symptoms of the disorder helps in rapid diagnosis, subsequent treatment, and recovery. Do not hesitate to seek professional help from doctors if you suspect violations in yourself and your loved ones. nine0005

Expert comment

Elmira Gereeva. Psychologist, consultant in weight management and eating behavior, nutritionist, head of the educational department of the School of Emotional Intelligence

Anorexia nervosa is one of the most terrible mental disorders. It is diagnosed based on a low BMI (body mass index). This line is outlined in the diagnostic criteria (according to ICD-10 below 17.5). In people with ED, the highest risk of death is observed precisely in connection with this disease [17]. Anorexia nervosa is characterized by a deliberate reduction in body weight, which (which is very important) is caused by the person himself. Conventionally, there are two types of anorexia nervosa: purgative and restrictive. nine0005

Restrictive anorexia nervosa proceeds without episodes of body cleansing. And catastrophic weight loss is due to hunger strikes and excessive physical exertion. Cleansing anorexia nervosa is characterized by episodes of inducing vomiting after an attack of overeating, as well as the use of medications (laxatives, diuretics).

Dehydration in anorexia is due to a general tendency to starvation. At some point, in order to reduce the feeling of hunger, a person can increase the consumption of zero-calorie liquids. It is in this case that the risk of mortality increases. Recovery from anorexia is a very complex process. A good indicator is when a person has returned to his optimal BMI. The disease is often corrected in the hospital.

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