Anorexia Nervosa

If someone is developing anorexia, often changes in behaviour are noticeable before changes to physical appearance. Signs include:

• Saying they have eaten earlier or will eat later, or that they have eaten more than they have
• Not being truthful about how much weight they have lost
• Strict dieting and avoiding food they think is fattening
• Counting the calories in food excessively
• Eating only low-calorie food, or otherwise limiting the type of food they will eat
• Missing meals (fasting)
• Avoiding eating with other people
• Hiding food
• Cutting food into tiny pieces to make it less obvious they have eaten little or to make food easier to swallow
• Eating very slowly
• Taking appetite suppressants, such as slimming or diet pills
• Obsessive and/or rigid behaviour, particularly around food
• Irritability
• Excessive exercising – this might involve exercising when not physically well enough to do so, or feeling guilty or anxious about not exercising
• Vomiting or misusing laxatives (purging)
• Social withdrawal and isolation 
• Wearing baggy clothing to hide their body, due to self-consciousness or to make weight loss less noticeable
• Compromise of education and employment plans

Anorexia is a mental illness, and you might notice changes in the way you or someone you know feels before physical symptoms become obvious. Psychological signs include:

• Fear of fatness or pursuit of thinness
• Excessive focus on body weight
• Distorted perception of body shape or weight – for example, thinking they are much larger than they are
• Underestimating or denying the seriousness of the problem, or believing there isn’t a problem at all, even after diagnosis
• Spending a lot or most of their time thinking about food
• Anxiety, particularly about eating in front of other people
• Low confidence and self-esteem
• Difficulty concentrating
• Perfectionism and setting very high standards for themselves 
• Other mental illnesses, such as depression, anxiety, or obsessive-compulsive disorder (OCD)

Starvation affects all the body’s organs, including the brain and muscle tissue. People with anorexia nervosa often experience physical signs of starvation, which may include:

• Weight loss
• Irregular periods, or periods stopping altogether
• Lack of sexual interest
• Difficulty sleeping
• Tiredness
• Feeling dizzy
• Stomach pains
• Constipation
• Bloating 
• Feeling cold or have a low body temperature 
• Growth of soft, fine hair all over your body (called lanugo)
• Hair loss
• Physical weakness
• Loss of muscle strength
• Effects on hormone levels 
• Swelling in their feet, hands or face (known as oedema)
• Low blood pressure
• Poor circulation

Like any eating disorder, anorexia can have long-term physical effects, some of which may be permanent, including:

• Loss of bone density (osteoporosis)
• Erosion of tooth enamel
• Difficulty conceiving, infertility 
• Heart problems
• Damage to other organs, such as the kidneys, bowels and liver
• Weakened immune system
• Delayed onset of puberty or stunted growth in children and young teenagers

Most seriously, anorexia can be fatal if not treated in time. However, many physical effects of anorexia are reversible or can be prevented from worsening, and eating disorders are treatable, with full recovery possible.