Anorexia nervosa (often simply called anorexia) is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives. In many cases anorexia is being caused by the ‘perfect picture’ women seen on social media, TV and movies. Often in combination with a psychological disorder.

In this article we explain what anorexia nervosa is, how to recognise anorexia, what causes anorexia and what you can do if you have anorexia.

What happens when you have anorexia?

To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.

Anorexia isn’t really about food. It’s an extremely unhealthy and sometimes life-threatening way to try to cope with emotional problems. When you have anorexia, you often equate thinness with self-worth.

Anorexia, like other eating disorders, can take over your life and can be very difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia’s serious complications.

Health risks and consequences of anorexia

Anorexia nervosa is a serious medical condition that can affect every organ system of the body. The most serious health risk of anorexia is increased mortality. Other health risks associated with anorexia are also very serious and may require treatment to achieve lasting recovery. Anorexia can lead to several short-term and long-term effects. Short-term health risks include weight loss, gastrointestinal complaints, fatigue, dehydration, and hair loss, among others.

• Weight loss: is the most common health risk associated with anorexia nervosa. Severe weight loss can set off a series of other serious health risks that can become life threatening.
• Gastrointestinal complaints: someone suffering from anorexia may experience nausea, stomach pain, bloating, vomiting, constipation, and dizziness.
• Fatigue: is often seen in people with anorexia as a result of decreased intake of food and nutritional deficiencies. After a while this can lead to extreme exhaustion.
• Hair loss: is another health risk associated with anorexia. When people with anorexia don’t get proper nutrition, their hair becomes thinner.
• Dehydration: individuals with anorexia may experience dehydration associated with restrictive eating– even if they are drinking water. This occurs because a large percentage of dietary water comes from food. Dehydration can become a serious health risk if not treated.

Symptoms and physical signs of anorexia nervosa

The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioral issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight is different for each person, and some individuals may not appear extremely thin. Also, people with anorexia often disguise their thinness, eating habits or physical problems.

Physical signs and symptoms of anorexia may include:

• Extreme weight loss or not making expected developmental weight gains.
• Thin appearance.
• Abnormal blood counts.
• Fatigue.
• Insomnia.
• Dizziness or fainting.
• Bluish discoloration of the fingers.
• Hair that thins, breaks or falls out.
• Soft, downy hair covering the body.
• Absence of menstruation.
• Constipation and abdominal pain.
• Dry or yellowish skin.
• Intolerance of cold.
• Irregular heart rhythms.
• Low blood pressure.
• Dehydration.
• Swelling of arms or legs.
• Eroded teeth and calluses on the knuckles from induced vomiting.

Some people who have anorexia binge and purge, similar to individuals who have bulimia. But people with anorexia nervosa generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.

Emotional and behavioral symptoms of anorexia

Behavioral symptoms of anorexia may include attempts to lose weight by:

• Severely restricting food intake through dieting or fasting.
• Exercising excessively.
• Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products.

Emotional and behavioral signs and symptoms of anorexia may include:

• Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them.
• Frequently skipping meals or refusing to eat.
• Denial of hunger or making excuses for not eating.
• Eating only a few certain “safe” foods, usually those low in fat and calories.
• Adopting rigid meal or eating rituals, such as spitting food out after chewing.
• Not wanting to eat in public.
• Lying about how much food has been eaten.
• Fear of gaining weight that may include repeated weighing or measuring the body.
• Frequent checking in the mirror for perceived flaws.
• Complaining about being fat or having parts of the body that are fat.
• Covering up in layers of clothing.
• Flat mood (lack of emotion).
• Social withdrawal.
• Irritability.
• Insomnia.
• Reduced interest in sex.

What are the most common symptoms of anorexia?

Here are the nine of the most common signs and symptoms of anorexia.

1. Purging for weight control.
2. Obsession with food, calories and dieting.
3. Changes in mood and emotional state.
4. Distorted body image.
5. Excessive exercise.
6. Denial of hunger and refusal to eat.
7. Engaging in food rituals.
8. Alcohol or drug abuse.
9. Extreme weight loss.

Causes of anorexia

People with anorexia often have common traits, including:

• Low self-esteem, feeling worthless or like you’re not good enough. Losing weight can start to feel like a sense of achievement or a way to feel a sense of worth.
• Perfectionism.
• Having another mental health conditions, particularly depression, self-harm and anxiety.
• Finding it hard to handle stress and cope with life.
• Obsessive or compulsive behaviours (read our page on obsessive compulsive disorder).

The exact cause of anorexia is still unknown, but it is probably a combination of biological, psychological and environmental factors.

1. Biological: Although it’s not yet clear which genes are involved, there may be genetic changes that make some people at higher risk of developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity and perseverance all traits associated with anorexia.
2. Psychological: Some people with anorexia may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which causes them to think they’re never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.
3. Environmental: Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.

When to see a doctor at HelloDoc Health

Many people with anorexia start with a treatment at a very late stage. Often because they first refused to go to a doctor, GP or psychologist for effective help. Their desire to remain thin overrides their concerns about their health.

If you have a loved one you are worried about, please urge her or him to talk to a doctor at HelloDoc Health. We are here to help! And because we provide our consults by videocall (or on-site) it usually is a safe first step for the patient. Next step after speaking with one of our doctors, could be an intake with a HelloDoc Health pschyologist that can take place in person or by videocall as well.

If you are experiencing any of the problems listed above, or if you think you may have an eating disorder, please get help as soon as possible. If you are hiding your anorexia from loved ones, try to find a person you trust to talk to about what’s going on.

More information or book an appointment?

Would you like to discuss your mental health issues (e.g. anorexia, eating discorder, depression, burn-out, anxiety, anger, panic, stress and/or trauma, etc.) with a multilingual doctor, psychologist or mental health therapist? We have a large team of doctors and specialists that can treat you. So please feel free to book a consultation at HelloDoc Health! 

Our consults start with 24.99 Euro and can be covered by most international health insurers.

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Sources: Mayo Clinic, Healthline, National Eating Disorders Association (NEDA), National Institute of Mental Health, National Association of Anorexia Nervosa and Associated Disorders, Eating Recovery Center, Mental Health Foundation