Anorexia nervosa may be mild and transient or severe and persistent.
The first indications of the impending disorder may be a subtle increased concern with diet and body weight.
Such concerns seem out of place because most individuals who develop anorexia nervosa are not significantly overweight when the disorder begins.
Preoccupation and anxiety about weight intensify as people become thinner. Even when emaciated, individuals may claim to feel fat, deny that anything is wrong, not complain about weight loss, and usually resist treatment.
They continue to try to lose weight even when friends and family members reassure them that they are thin or warn them that they are getting too thin.
Individuals with anorexia nervosa view any weight gain as an unacceptable failure of self-control.
Anorexia literally means lack of appetite, but most individuals who have anorexia nervosa are actually hungry. Many do not lose their appetite until they are very emaciated.
Also, individuals with this disorder are preoccupied with food. For example, they may do the following:
- Rather than eat, they study diets and count calories.
- They hoard, conceal, or throw away food.
- They may collect recipes.
- They may prepare elaborate meals for other people.
About 30 to 50% of individuals who have anorexia nervosa binge and/or purge by vomiting or taking laxatives. The others simply restrict the amount of food they eat.
They also frequently lie about how much they have eaten and conceal their vomiting and their peculiar dietary habits.
Some individuals also take diuretics (drugs that cause the kidneys to excrete more water) to reduce perceived bloating and to try to lose weight.
Many women with anorexia nervosa stop having menstrual periods, sometimes before losing much weight. Women and men with anorexia nervosa may lose interest in sex.
Typically, individuals with anorexia nervosa have a low heart rate, low blood pressure, a low body temperature, and may develop fine soft hair on their body, or excess body and facial hair. Tissues swell because fluid accumulates (called oedema). Individuals commonly report bloating, abdominal distress, and constipation.
Self-induced vomiting can erode tooth enamel, enlarge the salivary glands in the cheeks (parotid glands), and cause the esophagus to become inflamed.
Depression is common.
Even when individuals become very thin, they tend to remain active, often exercising excessively to control their weight. Until they become emaciated, they have few symptoms of nutritional deficiencies.
Hormonal changes resulting from anorexia nervosa include markedly reduced levels of oestrogen (in women), testosterone (in men), and thyroid hormone and increased levels of cortisol.
If individuals become severely malnourished, every major organ system in the body is likely to be affected. Bone density may decrease, increasing the risk of osteoporosis.
Rapid or severe weight loss can cause life-threatening problems. Problems with the heart and with fluids and electrolytes (such as sodium, potassium, and chloride) are the most dangerous:
- The heart gets weaker and pumps less blood through the body.
- Heart rhythm may become abnormal.
- Individuals may become dehydrated and prone to fainting.
- The blood may become alkaline (a condition called metabolic alkalosis).
- Potassium and sodium levels in the blood may decrease.
Vomiting and taking laxatives and diuretics can worsen the situation. Sudden death, probably due to abnormal heart rhythms, may occur.
Recognising Anorexia Nervosa
Individuals who have anorexia nervosa usually deny they have a problem and try to conceal their unusual eating habits rather than seek help.
Because many individuals who have anorexia nervosa are meticulous, compulsive, and intelligent, with very high standards for achievement and success, they are often able to conceal the disorder.
Thus, family members and friends may be unaware of the disorder until it has become severe.
Because anorexia nervosa has serious, sometimes life-threatening complications, family members and friends of someone who often diets or is excessively concerned about weight need to know how to recognise the disorder.
Individuals with anorexia nervosa often do the following:
- Complain about being fat although they are very thin;
- Deny being thin;
- Think about food all the time;
- Measure their food;
- Hoard, conceal, or throw away food;
- Prepare elaborate meals for others;
- Skip meals;
- Pretend to eat or lie about how much they have eaten;
- Exercise compulsively;
- Dress in bulky clothing or many layers;
- Weigh themselves several times a day; and/or
- Base their self-esteem on how thin they are.