Anorexia Nervosa is a psychological and potentially fatal eating disorder involving self-starvation, extremely low body weight, and an intense preoccupation with body image. Anorexia does not discriminate across genders (although females are more commonly affected) and while it tends to begin in adolescence or young adulthood, symptoms can show up earlier or later as well, and onset tends to be associated with a stressful life event. Anorexia results from the interplay of various factors, including genetic susceptibilities, environment (society or activities that value thinness), and temperament (including anxious or obsessional traits). Given the societal focus on dieting and weight loss, many individuals may appear to exhibit anorexic behaviors but are just partaking in regular dieting culture. Thus, how do you know if you or someone else potentially has anorexia and needs treatment? Here are some warning signs and symptoms:
Warning Signs and Symptoms
Restriction of energy intake. The individual with anorexia restricts the amount of energy they take in compared to bodily requirements, and does so by controlling and/or manipulating their food intake. This mainly takes place in the form of restricting food/dieting or fasting, but some individuals with anorexia also use excessive exercise or binge and/or purge behaviors (self-induced vomiting, excessive exercise, or misuse of laxatives/diuretics/medications).
Low body weight. As a result of restricting behaviors, individuals with anorexia exhibit a significantly low body weight compared to that which is “minimally normal” for someone of their age, developmental course, sex, and status of physical health, according to the DSM-5. The individual’s Body Mass Index (BMI) is used to determine whether their weight is at a healthy minimum. Moreover, there is also a diagnosis of “atypical anorexia,” which includes the behaviors of anorexia but without the low BMI. Thus, keep in mind that you may not be able to tell whether someone has anorexia just by looking at them.
Body image emphasis and distortion. Someone with anorexia experiences an intense fear of weight gain or becoming “fat,” and tends to experience high levels of body dissatisfaction. This leads to recurrent behavior that interferes with weight gain. Moreover, they engage in various behaviors of frequent “body checking” such as weighing, measuring, and looking in the mirror to evaluate one’s size or weight. Thus, weight and body shape are extremely important factors in how the individual feels about themselves. Weight gain is viewed as a failure and can drastically reduce their self-esteem, while weight loss is perceived as a huge accomplishment. Furthermore, accompanying anorexia is a disturbed/inaccurate sense of one’s body weight or shape; the individual usually feels that they are heavier than they actually are, and thereby lacks awareness of the severity of their low body weight.
Other Associated Factors
Functional impairment. Individuals with anorexia may experience functional impairment as a result of their eating disorder. The individual may isolate or avoid certain social situations and triggering environments in order to engage in their behaviors, or as a result of poor body image. They may also experience relationship issues and other interpersonal challenges, as well as poor academic or occupational performance due to physical, cognitive, and emotional decompensation.
Emotional dysregulation. The behaviors of anorexia can result as a means of coping with emotional dysregulation and stressful life circumstances. Use of behaviors may be a result of feelings of ineffectiveness, an eagerness to have control, rigidity and limited spontaneity, and restraint in emotional expression. Individuals with anorexia may also exhibit obsessive-compulsive features, both related and unrelated to food. They also tend to exhibit co-occurring mental disorders before or during the onset of their disorder; these include bipolar disorder, depression, anxiety, and OCD. Moreover, individuals with anorexia exhibit an elevated suicide risk. Such disordered behaviors are often used to help alleviate, avoid, or numb unwanted feelings temporarily.
Physical consequences. Individuals with anorexia may exhibit the following health issues: women’s menstruation absence or irregularity; abnormalities in vital signs; malnutrition and nutritional deficiencies; dental issues; fluid, electrolyte and endocrine imbalances; low bone mineral density; cold intolerance; immune system dysfunction; and cardiac abnormalities. These concerns, as well as the mental health consequences of anorexia, contribute to an overall elevated mortality risk for individuals with this eating disorder.
While reading about the symptoms and associations of anorexia, you may find that you identify with some or all of these. Regardless of the frequency and intensity of your presentation, you have the right to ask for help and seek recovery.
Bahar Moheban, M.A. is a clinical psychology doctoral candidate and registered psychological assistant in Torrance under the supervision of Dr. Nazanin Moali. She provides individual and group psychotherapy to adults and adolescents with disordered eating, negative body image, and comorbid disorders. If you believe you may be struggling with anorexia or another eating disorder, and are seeking a more peaceful relationship with food and your body, contact Bahar for a counseling appointment.