Information on Anorexia Nervosa

People suffering from anorexia nervosa are starving themselves. They have an intense fear of putting on weight/of being fat. They take strict control of their eating, so they become obsessed with food, counting calories and working out elaborate ways of avoiding food and restricting their food intake.
They may also try to lose weight by excessive exercise, using slimming pills, and/or by various purging methods, e.g. vomiting or using laxatives.

The diagnostic criteria used by the NHS:

• Significantly lower body weight than appropriate for the person's age and height, caused by their refusal to maintain a minimum normal weight
• Intense fear of gaining weight
• Disturbance of body image or denial of the dangers of their low weight

Symptoms include:

• Significant loss of weight
• Food intake increasingly restricted: number of calories and variety of foods
• Thoughts dominated by food, eating and cooking
• Fear of becoming fat, which often intensifies as weight decreases
• A distorted view of their body shape/weight – think they are fat when they are underweight
• Inflexible, rigid, black-and-white thinking
• Need for control - especially around food
• Slow pulse, low blood pressure
• Feeling cold, poor blood circulation to extremities, so cold hands and feet and chilblains
• Fine downy hair grows on the face and body to conserve heat (lanugo)
• Hair becomes dry and falls out and skin becomes dry
• Swollen hands and feet
• Constipation and bloating - stomach pains
• Loss of muscle and bone strength (osteoporosis); weak and dizzy
• Lack of menstrual periods
• Low libido (sex drive)
• Heart problems, palpitations

Some observable signs:

• Refusal to maintain body weight
• Obsessive fear of gaining weight, continuing to diet when a supposed “goal weight” has been reached
• Increased interest in food eg cooking, recipe books, talking about food
• Eating less than others, while wanting to cook for others and encouraging them to eat more
• Eating at rigidly prescribed times, carefully controlled amounts
• Obsessive calorie counting
• Cutting food up into tiny pieces
• Reducing the range of foods eaten, strict dieting, avoiding fattening food, only eating low-calorie food, periods of fasting  
• Hiding and  throwing away food
• Becoming phobic about eating with others, worrying that others are watching them when they eat
• Skipping meals and avoiding social pursuits which involve eating
• Body image disturbance, complaining of being fat when they look thin
• Wearing baggy clothes
• Repeated weighing and measuring of body, checking body shape in mirror
• Lie about what and when they ate, lie about their current weight – find ways to “cheat” the scales
• Personality change: moody, secretive, irritable, previously flexible personality becoming intractable
• Social isolation
• Tiredness and reduced concentration, but often still striving for perfection, so studying, working and exercising harder
• Self-harming and suicidal thoughts
• Underestimate/deny how serious their condition is

Some people with anorexia also purge to keep their weight low – see bulimia for the problems caused by vomiting and laxative use.