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Dave Waller

This page was medically reviewed by David Waller, (BACP, FDAP), Eating Disorder Programme Lead at Life Works.

What is anorexia?

In simple terms, anorexia nervosa is an eating disorder characterised by the intentional limitation of food intake driven by a seemingly uncontrollable desire to avoid gaining weight and to be thin. It results in the sufferer becoming emaciated and can lead to serious complications caused by malnutrition. In extreme cases, the result is death.

What are the symptoms of anorexia?

The signs, symptoms and causes of anorexia are largely focused around unhealthy eating patterns and distorted body image. People suffering from anorexia will often restrict their calorie intake and obsess over the foods they do eat. This can lead to unhealthy weight loss, a dangerously low body mass index (BMI) and a whole host of long-term problems such as osteoporosis, malnutrition, electrolyte imbalance and even death.

Anorexia can also be a very secretive disorder, with individuals going to extreme lengths to conceal their weight loss or eating habits. Not only does this have psychological consequences, but it can also mean that expert help, support and treatment may not be sought in a timely manner.

The signs and symptoms of anorexia can vary from person to person and can be categorised into psychological, physical and behavioural/social symptoms.

Psychological symptoms of anorexia:

  • Being terrified of putting on weight, and showing an unwillingness to gain weight
  • Having an obsession with the fat and calorie content of your food
  • Believing that you are fat, when other people say that you are thin. For example, thinking that certain parts of your body are too ‘fat’ even though you are underweight
  • Feeling as though you will never be thin enough
  • Being obsessed with looking a certain way and striving for a certain body shape
  • Not being able to stop thinking about food, and feeling as though this has taken over your life
  • Feeling guilty and ashamed when you eat
  • Mental health problems such as depression, anxiety, stress, panic attacks, and OCD
  • Low self-esteem
  • Suicidal thoughts
  • Finding that you get angry, irritable and impatient for no reason (mood swings)
  • Finding that you are crying more than usual and become emotional for no apparent reason
  • Finding it difficult to concentrate due a lack of energy
  • Inability to make rational decisions
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Physical symptoms of anorexia:

  • Significant weight loss over a short period of time
  • Exhaustion and extreme tiredness due to starvation
  • Loss/interruption of periods in women
  • Disrupted sleep patterns
  • Dizziness
  • Dry/yellowish skin
  • Feeling cold all the time
  • Fine hair (lanugo) on the body
  • Heart palpitations and bradycardia (abnormally low heart rate)
  • Dehydration and headaches
  • Low blood pressure
  • Constipation and abdominal pain
  • Loss of sexual urges - this could be due to a lack of body confidence

Behavioural/social symptoms of anorexia:

  • Drastically limiting the amount that you eat and drink
  • Obsessively counting calories, checking food labels and weighing out food portions
  • Having a list of foods that you won’t allow yourself to eat
  • Weighing yourself over and over again
  • Exercising excessively in an attempt to burn off calories
  • Making yourself sick after eating
  • Taking laxatives or diuretics (medication that removes fluid from the body)
  • Visiting pro-anorexia (pro-‘ana’) websites or social media platforms
  • Carrying out certain rituals when you eat such as only using certain plates/cutlery, separating food groups on your plate, chewing a certain number of times, chewing food and then spitting it out, or cutting your food into tiny pieces
  • Denying that you have a problem, both to yourself and others
  • Throwing food away and telling people that you have eaten it
  • Making excuses/lying for not eating such as “I’m not hungry”, “I don’t feel very well”, or “I’ve already eaten”
  • Telling people that you are vegetarian or wheat/lactose intolerant so that you can avoid eating more food groups and calories
  • Telling people that they are being too dramatic about your eating habits
  • Blaming your unhealthy eating habits on other people or situations in your life, such as “I don’t have time to eat at work because I’m so busy”
  • Wearing baggy clothes to conceal your thinning frame
  • Not wanting to meet with family and friends in order to avoid eating, or answering questions about your eating habits, resulting in social isolation

What are the long-term effects of anorexia nervosa?

Without timely, professional treatment, anorexia can result in a number of devastating long-term health problems, including:

  • Problems with bones, hair and teeth due to a lack of calcium and other vital nutrients within your diet
  • Heart and kidney problems - this is due to a lack of vital nutrients and low calorie intake, which puts pressure on the heart
  • Seizures
  • Infertility in women
  • Organ failure and subsequent death
  • Damage to the heart caused by irregular and low heart rates
  • Growth retardation
  • Blood problems caused by a reduced count in red and white blood cells
  • Risk of bone fractures due to osteoporosis and osteopenia

Causes of anorexia

The causes of anorexia are not fully understood. There seems to be no single trigger for the condition; a number of factors are involved:

  • Social pressure –in the Western world, great emphasis is placed on physical appearance and the media, the fashion industry and the film industry combine to create the impression that being thin is attractive. This leads to many young girls dieting to ensure that they are thin and therefore "acceptable". Some activities, like ballet and gymnastics, also require participants to have slight physiques so that those who take part feel compelled to be thin.
  • Stressful events –anorexia can be triggered by traumatic events. The death of someone close, a marriage break-up, examinations, loss of a job and even the onset of puberty can bring on anorexic episodes.
  • Genetics –research suggests that those who have a parent or sibling who is anorexic have a higher probability than others of becoming anorexic too.
  • Imbalance of chemicals in the brain –studies have found that some anorexics have an imbalance in chemicals in those parts of the brain that control appetite and digestion, emotion and risk and reward responses.
  • Environment –difficult personal relationships, living in a dysfunctional family and a history of abuse or bullying may also contribute to an individual becoming anorexic.
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