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Anorexia Nervosa

What Are The Warning Signs And Symptoms?

Last modified: 
16/03/2012 - 14:59

Contributing Author: Guy Slowik FRCS

The main criteria necessary for the diagnosis of anorexia nervosa are:

  • Excessive weight loss or lack of normal weight gain, often to the point of starvation
  • Intense fear of gaining weight or becoming fat
  • Distorted image of body weight or shape
  • Absence of at least three menstrual periods in a row in females

The following are common behaviors that occur in anorexia nervosa:

  • Significant reduction of the amount of food eaten
  • Avoiding eating; skipping meals
  • Intense focusing on food, eating, and body weight and shape
  • Repeatedly weighing oneself
  • Denial of hunger
  • Rigid eating patterns, such as extreme controlling of calories and fat even when underweight
  • Unusual rituals at mealtimes, such as cutting food into tiny pieces, moving food around the plate, and throwing out food so it does not have to be eaten
  • Storing or hoarding food
  • Collecting recipes and cooking for others while finding excuses to avoid eating
  • Wearing baggy clothes to hide the amount of weight lost
  • Obvious fear or anxiety before eating and guilt after eating
  • Complaining of bloating and unusual fullness after eating only small amounts of food
  • Excessive or compulsive exercising

In addition to extreme dieting, many people with anorexia nervosa use excessive exercising to burn off calories and keep their weight very low. If unable to exercise for some reason, they may experience extreme guilt or even panic. Thus, they may continue to exercise despite injury and exhaustion.

Binge Eating And Purging

About half of the people with anorexia nervosa also regularly engage in binge eating and then purging to keep their weight low.

Binge eating means eating an abnormally large amount of food within a certain amount of time, usually accompanied by a feeling of lack of control over eating.

  • Binge eating means eating an abnormally large amount of food within a certain amount of time, usually accompanied by a feeling of lack of control over eating.
  • Purging means ridding the body of food by self-induced vomiting or misuse of laxatives, diuretics, or enemas.

Binge eating is usually very distressing to people with anorexia nervosa because of their fear of weight gain. It often causes greater obstacles to recovery.

Purging usually begins because it appears to be a solution to cravings for food on the one hand and terror about gaining weight on the other. Purging can actually lead to episodes of overeating since it allows the person to give in to food cravings and then feel that s/he can "get rid of the food" without gaining weight. Although purging usually starts gradually, it typically escalates over time, and the person eventually feels completely out of control.

Changes In Emotions And Relationships

Anorexia nervosa is associated with significant emotional changes and often with marked changes in relationships with family members and friends. In the early stages of weight loss the person may feel better about herself or himself, seem excessively cheerful, show a burst of self-confidence, and be more outgoing.

Depression, anxiety, irritability, anger, and rapid mood shifts usually follow and may become severe as starvation progresses. Sometimes mood seems dull or flat, and the person may appear extremely withdrawn and aloof. Binge eating, dieting, exercising, and purging may become ways to escape from unpleasant feelings.

Deterioration in relationships may occur, especially as others express concern about the person's condition. However, sometimes a person with anorexia nervosa becomes more dependent on certain family members as the disorder progresses and may even express fears that parents will stop taking care of her or him if recovery occurs.

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Anorexia Nervosa

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.