Anorexia Nervosa: Explanation, Signs, and Symptoms

Posted on 02 May 2012 16:08

The term anorexia nervosa comes from the Greek word for "lack of appetite" and a Latin word implying a nervous origin. It is a major emotional eating disorder and is characterized by three main criteria:

  • Significant self-induced starvation, or near-starvation
  • An extreme desire for thinness or being extremely afraid of becoming fat
  • The presence of medical signs and symptoms resulting from starvation

The short-hand anorexia is often used for this condition but this term only denotes loss of appetite as a symptom, and can occur as a result of many medical conditions. It is important, then, to recognize that anorexia nervosa describes an emotional disturbance resulting in anorexia, and not just any extreme lack of appetite. The term anorexia may also be misleading in the early stages of the disorder, since lack of appetite rarely occurs early on.

Those with anorexia nervosa sometimes eat only minimal amounts of food, causing body weight to drop dangerously. They may perceive themselves to be fat, or be extremely afraid of becoming fat, even though they may look perfectly normal to everyone else or even be very thin or emaciated. This perception and fear is accompanied by depression. Signs of anorexia include obsessive exercise and calorie or fat-gram counting. Like bulimia nervosa, self-induced vomiting may occur. In fact, only half of those with the disorder will lose weight by drastically reducing calories alone. The other half will use extreme dieting along with binge eating and purging behaviors. Some will purge even after eating only small amounts of food. It is also possible for bulimia nervosa to occur as a separate, but concurrent, disorder. Signs of depression, anxiety, and irritability usually occur.

Many sufferers may use alcohol and other drugs to help cope with the psychological distress, anxiety, guilt, depression and shame. Also, appetite suppressant drugs such as diet pills, methamphetamines, cocaine, nicotine may be used. Diuretics may be abused to control "water weight" and laxative abuse is common as well.

Usually beginning in adolescence, anorexia nervosa is much more prevalent in females than males, by 10 to 20 times. It has been reported to occur in up to 4 percent of adolescent and young adult students and has been reported more frequently in recent years, with prepubertal onset becoming more common, although the most common age of onset is midteens (14 to 18 years) with about 5 percent occurring in the early 20's. It is estimated to occur in 0.5 to 1% of adolescent girls.

Other Signs and Symptoms

  • Rapid weight loss occurring over several weeks or months
  • Continual dieting even though the person is very thin or when weight is very low
  • Intense fear of or preoccupation with gaining weight
  • Often eating in secret or having other strange eating habits or rituals
  • A seeming obsession with food, calories, or nutrition
  • Very interested in cooking and the desire to cook large gourmet meals for other which they rarely consume themselves
  • May often express that they "feel fat", regardless of actual weight
  • Unable to objectively assess their own weight
  • Overly self-critical, self-loathing, or perfectionist attitude
  • self esteem tied into body shape or weight
  • Frequent illness due to malnourishment
  • Loose baggy clothing to hide the weight loss
  • Social withdrawal
  • In females, infrequent or irregular menstrual periods (it is important to note that endurance training in female athletes can also cause this "amenorrhea " and therefore this symptom alone should not be taken as a sign of anorexia nervosa)
  • Sleep disturbances including insomnia, early morning waking, or oversleeping

Physical signs other than low body weight

  • Raynaud's syndrome: tips of fingers and toes cold and red, or white and blue in color, due to poor circulation
  • Irregular heartbeat
  • Low blood pressure
  • Low body temperature
  • Lanuga hair: a fine layer of hair covering the body, grown to help create body heat in the absence of body fat and muscle
  • Dry skin
  • Brittle nails
  • Thinning hair on scalp
  • Caluses forming on hands
  • Constipation or diarrhea
  • Yellowing skin

Associated Disorders

  • Bulimia nervosa
  • Body dysmorphic syndrome
  • Depression
  • Social phobia
  • Obsessive compulsive disorder


Anorexia nervosa has the highest death rate of any eating disorder. Among those followed for a sufficient length of time, up to 20% die as a result of the disorder, with around 5-10% dying within 10 years of onset. Up to 30% of these deaths are suicides, and anorexics are 50 times more likely to commit suicide than the general population.


Many people with anorexia nervosa will actively refuse treatment. As an ethical dilemna is inherit in treating a disorder that is an irrational drive to lose weight or remain thin when that person does not wish to be treated, initial assessment and treatment are often delayed for months or years. when treatment is undertaken, it is often due to the demands of loved-ones and the patients often drop out of treatment. When treatment is accepted, any components that involve increasing food intake, gaining weight or reducing physical activity may be resisted, even though psychotherapy and family therapy may be accepted. It is also not uncommon for treatment to be accepted, even in a inpatient setting, but the treatment protocols to be subverted in secret. Patients might throw out food, secretly use laxatives, or refuse certain treatments. When treatment is forced, an anorexic might use legal means to protect themselves from being treated.

Although the full legal and ethical considerations of treatment are beyond the scope of this explanation. One of the main ethical issues in the refusal of treatment is the issue of competence and the concept of autonomy. Even though family and friends find it difficult to watch their loved one engaged in behavior seen as foolish, destructive, and even deadly, it is generally agreed that patients who possess the competence to make treatment choices should be allowed to do so. So the question is whether someone suffering from anorexia nervosa has the capcitiy to understand and make rational treatment decisions. Determination of the right to refuse treatment is associated with foru main elements:

  • the potential risk of the condition
  • the likely benefit of treatment
  • likely harm of treatment
  • competence of the individual to make a reasonable medical decision

Although many anorexics might accept treatment during an emergency crisis precipitated by their condition, there is a difference between recognizing an emergency and identifying an impending emergency. Therefore, the potential risk component of competence is not as clear-cut and "obvious" as one might think. In fact, some deaths from anorexia nervosa occur after very little clinical warning, such as a sudden cardiac event. The following signs and symptoms could be used to determine the need for immediate medical attention:

  • Rapid weight loss of greater than 15lbs in four weeks
  • Seizures
  • Fainting episodes
  • Organic brain syndrome
  • Slow heart rate of less than 40 beats per minute (bradycardia)
  • Frequent chest pain from exercise
  • Heart dysrhythmia
  • Kidney dysfunction or low urine output of less than 400cc per day
  • Excess loss of body fluid and a rise in blood sodium levels (i.e. volume depletion)
  • muscle spasms caused by low blood calcium (tetany)
  • rapid diminishing of exercise tolerance


Many anorexia nervosa patients recover, and sometimes recovery occurs spontaneously. Those who receive treatment in specialized anorexia nervosa programs seem more likely to recover than those treated in generalized programs. The results of treatment, however, cannot be reliable predicted at this time. It is clear that the results of short-term intervention such as refeeding and psychiatric treatment does improve quality of life for the short-term, but long-term prognosis is generally considered to be guarded. The earlier treatment is undertaken, the better the chances for recovery.

Athletes and Anorexia Nervosa

Female athletes, especially, can suffer from anorexia nervosa, especially in those sport which emphasize and require low-body weight, thinness, or a certain body image, such as ballet, gymnastics, figure skating, long distance running, and other endurance sports. However, disordered eating often occurs in serious athletes which is not necessarily anorexia nervosa or another eating disorder, but a unique but associated manifestation of ahtletics. This has been given its own term: anorexia athletica. For more information see Female Ahthletes - Eating Disorders.

Further Resources

National Alliance on Mental Illness. http:///
National Association of Anorexia Nervosa and Associated Disorders.
National Eating Disorders Association. Anorexia Nervosa.
Eating Disorders: Facts About Eating Disorders and the Search for Solutions.

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2. Barlow, David H., Vincent Mark. Durand, and Sherry H. Stewart. Abnormal Psychology: An Integrative Approach. Toronto: Nelson Education, 2009.
3. Warner, Heather. Real Life Issues: Eating Disorders. Richmond: Trotman, 2004.
4. Tan, Jacinta OA, Helen A. Doll, Raymond Fitzpatrick, Anne Stewart, and Tony Hope. "Psychiatrists' Attitudes towards Autonomy, Best Interests and Compulsory Treatment in Anorexia Nervosa: A Questionnaire Survey." Child and Adolescent Psychiatry and Mental Health 2.1 (2008): 40.

This page created 02 May 2012 16:08
Last updated 29 Jan 2017 00:26

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