Anorexia Symptoms and Signs: Am I Really Anorexic?
It is notoriously hard for people with anorexia to recognize the disease. It can distort the way you think about both your body and the world around you, and that can make self-diagnosis really difficult. But, in general, if you find that you have a pathological fear of gaining weight, and you prioritize almost everything you do in order to avoid weight gain, anorexia could be an issue for you.
Anorexia nervosa, known as anorexia, is a diagnosable mental health disorder that is characterized by efforts to maintain a low weight through diet manipulation and/or excessive exercise.
As anorexia is a clinical mental health disorder, it is included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Health Disorders – 5 (DSM-5) in the chapter entitled “Feeding and Eating Disorders.”
According to DSM-5, the following criteria are used to diagnose anorexia:
- Ongoing restriction of caloric intake that leads to a considerable low body weight as compared to the healthy weight in the individual’s peer group
- An intense and persistent fear of becoming overweight to a point where these thoughts influence the individual’s ability to gain weight or achieve a healthy weight
- Any of the following forms of distorted thinking: (1) not having a realistic interpretation of one’s shape or weight, (2) undue focus on self-evaluation of one’s weight or body shape, or (3) an ongoing inability to accurately view one’s present low body weight
These criteria can take place during the earliest phase of anorexia and throughout the life of the disorder. In the initial stage, individuals may hear their internal voice prodding them to lose weight and/or being overly critical about body image, and respond with diet restrictions. After the weight loss begins, individuals may feel more comfortable with their inner voices and even believe they are being guided to take the right action in view of the results. In the latter stages of the disorder, weight loss begins to affect people’s mood and daily behaviors.
Rather than eating to live, individuals in the more advanced stages of anorexia are usually living to lose weight.
Although this destructive way of life can seem illogical to outsiders, it makes sense within the mindset of a person who is experiencing anorexia.
As distorted thinking, including body dysmorphia, is a hallmark of this disorder, it is particularly difficult for an individual suffering from anorexia to be able to identify it. Even if individuals afflicted with anorexia recognize they need treatment, this disorder can prevent them from seeking help because they believe treatment will conflict with their low-weight maintenance goals.
As individuals suffering from anorexia have a pathological fear of being overweight or obese, receiving treatment can feel like opening the door wide to their most acute fears. This resistance to treatment is not a permanent bar to getting help. Once treatment is initiated, over time, recovery efforts can take root and lead to healthy outcomes. Oftentimes, friends or family members need to intervene on behalf of their loved one, to illustrate the need for treatment.
Signs and Symptoms
Anorexia is associated with physical, psychological, and behavioral symptoms.
For onlookers, the symptoms may at first overlap so closely with general weight loss that it is difficult to know the person is actually in the early phase of anorexia. Individuals who engage in anorexic practices may initially feel in control of the process, as if they are engaging in a reasonable weight loss plan. But over time, they will lose their grip over their behaviors. For this reason, it is critical to be aware of the possible symptoms that can manifest. Physical symptoms include but are not limited to:
- Weight loss that is extreme
- An abnormal blood count
- Constipation and dehydration
- Cessation of menstruation (in women)
- Insomnia and fatigue
- Bluish fingers
- Fainting or dizziness
- Thinning hair (it may break or fall out)
- Irregular heart rhythms
- Development of soft hairs on body
- Swollen arms and/or legs
- Dry skin or yellowing skin
- Feeling intolerant of cold weather
- Low blood pressure
There are numerous psychological symptoms that can arise when individuals are facing anorexia. These symptoms may be new or may be a more extreme expression of existing feelings, such as low self-esteem (chronic or episodic). Psychological signs include but are not limited to:
- Withdrawal from social relationships
- Depressed mood
- Not feeling hungry
- Fear of weight gain
- Preoccupation with food
- Lying about food intake
- Lack of emotion or feeling flat
- Reduced interest in intimacy
- Suicidal thoughts
Behavioral signs may be tied directly into anorexic behaviors or associated behaviors, such as efforts to hide the disorder. The following behavioral signs reflect some of the possible range of activities that may be visible:
- Calorie counting (in a diary or otherwise)
- Denying hunger or appetite
- Writing down calories burned during exercise
- Rigid practices around meals, such as chewing then spitting out food
- Fasting or inducing vomiting
- Excessive exercise
- Complaining about being “fat” or overweight
- Buying and using laxatives, enemas, diet aids, and/or herbal supplements
- Avoiding or refusing to eat in public
- Constantly weighing oneself
The root causes of anorexia can be difficult to identify; however, research shows that individuals who have developed anorexia may have experienced certain psychological stresses, such as lifelong low self-esteem, sexual abuse, growing up repressed or not being able to express oneself, using food as a coping mechanism in the face of negative emotions, or a tendency to think rigidly in black-and-white terms (e.g., being overweight is bad and being thin is good).
Due to these underlying emotions, individuals who are experiencing anorexia may likely incorporate media and print magazine portrayals of beauty into their thinking.
Trying to meet this unrealistic standard of “beauty” fuels the anorexic behavior.
There are also biological factors involved in the development of anorexia. Some individuals may be genetically disposed to eating disorders or related disorders like depression or anxiety. Certain personality types may increase the likelihood of developing anorexia (e.g., individuals who meet the diagnostic criteria for obsessive-compulsive disorder).
Anorexia may have a neurological basis, such as a deficient or excessive amount of certain neurochemicals in the brain, especially serotonin. The neurochemicals involved in anorexia may also be the basis of co-occurring mental health conditions. When individuals experience anorexia with at least one co-occurring mental health disorder, they are considered to have a dual diagnosis. In these cases, a treatment center that is equipped to accommodate dual diagnoses is necessary.
Anorexia may have a strong visual component, especially as this disorder progresses, but individuals often try to hide the behavior in order to protect it. For this reason, those who are experiencing anorexia may look to the Internet for guidance and even a self-test. It is always advisable to seek a professional assessment from a medical doctor or mental health professional.
However, if an individual chooses to take an online assessment, the best practice is to choice a reputable source, such as a government agency or well-established nonprofit organization.
The National Eating Disorders Association (NEDA) is a nonprofit that provides information to individuals who are facing eating disorders. NEDA offers an online screening tool for eating disorders for the public. The tool is free, anonymous, and easily navigable, and it only takes a few minutes to take the test. Screening questions, like self-exam tools in general, are reflective of the criteria discussed above but couched in a helpful question format. Provided the responses are accurate, the self-screening tool will indicate if it is advisable to seek professional help.
Psych Central provides an online Eating Attitudes Test. A sample of the key elements of the questions can provide further insight into the type of diagnostic questions that a mental health professional will ask during a consultation. For instance:
- Do you avoid eating when you’re hungry?
- Do you know the calories of all the foods you eat?
- Do you focus on eating “diet foods”?
- Do you feel extremely guilty after eating?
- Do you like your stomach to be empty?
- When you exercise, do you think about burning calories?
- Do you hear comments that you’re too thin or that you should eat more?
- Do you avoid foods that contain fat? Sugar? Carbohydrates?
Again, it is important to note that any self-screening or online advisement cannot approach the accuracy of a one-on-one assessment with a qualified healthcare professional. As anorexia is a progressive disorder, seeking help at any point can be beneficial to address existing healthcare issues and prevent the onset of even worse conditions. Further, an accurate diagnosis is always the starting point of treatment. When a trained professional works with a client with anorexia to gauge the stage of this disorder as well as the appropriate treatment plan, the healing process can begin.
AAC facilities do not treat anorexia; however, comprehensive care can be found at various treatment facilities across the US.