The main symptom of anorexia is losing a lot of weight deliberately; for example, by:
- eating as little as possible
- making yourself vomit
- doing too much exercise
A person with anorexia will want their weight to be as low as possible – much less than the average for their age and height. They are so afraid of gaining weight, they cannot eat normally.
After they have eaten, they may try to get rid of food from their body by making themself sick regularly. Signs of regular vomiting could include:
- leaving the table immediately after meals
- dental problems such as tooth decay or bad breath, caused by the acid in vomit damaging their teeth and mouth
- hard skin on their knuckles, caused by putting their fingers down their throat
The need to obsessively burn calories usually also draws people with anorexia to ‘high-impact’ activities, such as running, dancing or aerobics. Some people will use any available opportunity to burn calories, such as preferring to stand rather than sit.
They may also try to make food pass through their body as quickly as possible; for example, by taking:
- laxatives (medication that helps empty the bowel) or
- diuretics (medication that helps remove fluid from the body)
However, in reality, laxatives and diuretics have little effect on the calories absorbed from food.
Eating and food
Although anorexia means ‘loss of appetite’, people with anorexia nervosa do not usually lose their appetite; they like food and feel hungry.
However, they do not think about food in the same way as other people. This can show itself in various ways; for example, they may:
- tell lies about eating or what they have eaten
- give excuses about why they are not eating
- pretend they have eaten earlier
- tell lies about how much weight they have lost
- find it difficult to think about anything other than food
- spend lots of time reading cookery books and recipes
Someone with anorexia nervosa strictly controls what they eat; for example, by:
- strict dieting
- counting the calories in food excessively
- avoiding food they think is fattening
- eating only low-calorie food
- missing meals (fasting)
- avoiding eating with other people
- hiding food
- cutting food into tiny pieces – to make it less obvious that they have eaten very little, and to make the food easier to swallow
- taking appetite suppressants such as slimming pills or diet pills
They may also drink lots of fluids that contain caffeine, such as coffee, tea and low-calorie fizzy drinks, as these can provide a low-calorie, short-term burst of energy.
Some people with anorexia also begin to use illegal stimulant drugs known to cause weight loss, such as cocaine or amphetamines.
Self-esteem, body image and feelings
People with anorexia often believe that their value as a person is related to their weight and how they look. They think other people will like them more if they are thinner, seeing their weight loss as a positive thing.
They often have a distorted view of what they look like (their body image) - for example, they think they look fat when they are not. They may try to hide how thin they are by wearing loose or baggy clothes.
Many people will also practise a type of behaviour known as ‘body-checking’, which involves persistently and repeatedly:
- weighing themselves
- measuring themselves, such as their waist size
- checking their body in the mirror
Anorexic people usually have low self-esteem or self-confidence. They may withdraw from relationships, becoming distant from members of their family and friends.
Anorexia can also affect the person’s school work or how well they perform in their job.
They may find it difficult to concentrate and lose interest in their usual activities. They may have few interests, even though they seem busier than usual.
Other signs of anorexia
Eating too little for a long time can result in physical symptoms such as:
- fine downy hair (lanugo) growing on their body
- more hair on their face
- their pubic hair becoming sparse and thin
Their heartbeat may be slow or irregular, which can lead to poor circulation. They may also:
- have pain in their abdomen (tummy)
- feel bloated or constipated
- have swelling in their feet, hands or face (known as oedema)
- feel very tired (fatigue), as their sleep patterns may have changed
- have low blood pressure (hypotension)
- feel cold or have a low body temperature (hypothermia)
- feel light-headed or dizzy
In children with anorexia, puberty and the associated growth spurt may be delayed. They may gain less weight than expected (if any) and may be smaller than other people the same age.
Women and older girls with anorexia may stop having their periods (known as amenorrhoea, or absent periods). Anorexia can also lead to infertility.