Diagnostic criteria for Anorexia Nervosa from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V)

1. Restriction of energy intake relative to requirement, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Signs & Symptoms of Anorexia Nervosa

Not everyone with anorexia experiences all of the same symptoms and behaviors. This is a fairly extensive breakdown of some of the most common behaviors that you might notice in someone who has anorexia. If you notice that you or someone you love, is experiencing some or many of the items on this list, we encourage you to seek help.

Weight & Shape Concerns – Individuals with anorexia struggle with an intense preoccupation with their weight and shape. Overall, there is an indication that weight loss is of primary importance and it begins to take precedence over other important life roles and responsibilities. You may notice some of the following thoughts and behaviors occurring:

• Dramatic weight loss, or failure to make expected weight gains during periods of normal growth (i.e. during childhood, adolescence, pregnancy)
• Excessive weighing of oneself; setting progressively lower and lower goal weights
• Other body checking behaviors such as looking in mirrors, measuring or assessing body parts or frequently asking others for reassurance with questions like “do I look fat?”
• Changes in weight, even slight fluctuations up or down, have a significant impact on  mood and self-evaluation
• Frequent comments about feeling “fat” or overweight despite weight loss
• Body distortions focused on particular parts of their body being “fat” or too big
• Excessive exercise – adhering to a rigid exercise regimen despite foul weather, fatigue, illness or injury

Food & Eating Behaviors – It may seem counterintuitive, but individuals with anorexia often spend a great deal of time thinking about, obsessing over and even preparing food. In an attempt to avoid weight gain, individuals will often develop rigid food rules and become preoccupied with thoughts of food and methods of controlling their intake. Common signs and symptoms related to food and eating include:

• Denial of hunger
• Dieting, restricting or otherwise limiting food intake
• Rigid counting/calculating of calories and/or fat grams (sometimes via smartphone apps or other food/exercise monitoring programs)
• Refusal to eat certain foods, progressing to restrictions on entire categories of food (e.g. no carbohydrates, no meat, no processed foods);
• Collecting or hoarding recipes
• Cooking elaborate meals for other people but not eating the food
• Development of food rituals (e.g. eating foods in a certain order, excessive chewing, rearranging food on a plate)
• Possible use of laxatives, diet aids or herbal weight loss products
• Consistent excuses to avoid mealtimes or situations involving food

Changes in Personality and Social Behavior – Individuals at risk for anorexia are often high-achieving individuals with a tendency towards perfectionism. These personality characteristics can become heightened during the disorder. Other behavior changes and warning signs might include:

• Increasing isolation; withdrawal from friends and activities that were once enjoyed
• Symptoms of depression and anxiety (this can be a sign of an underlying co-occurring disorder or may be a biological response to extreme low body weight)
• Irritability, moodiness
• Interpersonal conflicts
• Defensive stance when confronted about weight or eating behaviors
• Low energy and fatigue
• Use of pro-Ana websites (internet groups that promote/support anorexia)
• Posting of “thinspiration” on social networking sites (images of emaciated models used as inspiration to pursue anorexic behaviors)
• Wearing layers or baggy clothes to hide weight loss (and to keep warm as body temperature drops)

It can be very easy to confuse behaviors in the early stages of anorexia with a simple desire to “eat healthy”, “get in shape” or “just lose a few pounds”. Unfortunately, for people who are genetically at-risk for an eating disorder, these seemingly harmless goals can quickly escalate into rapid weight loss and a full blown eating disorder. This is one reason why it’s important for parents, educators, physicians, and coaches to be fully aware of the red flags.

Health Consequences & Medical Complications of Anorexia Nervosa

In addition to the signs and symptoms of anorexia listed above, you may also notice significant changes in their health and physical functioning.In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. The body is forced to slow down all of its processes to conserve energy, resulting in serious acute and long-term medical consequences including:

• Abnormally slow heart rate and low blood pressure
• Damage to the structure and function of the heart; increased risk of heart failure and death
• Reduction of bone density (osteopenia and osteoporosis) which results in dry, brittle bones
• Muscle loss and weakness
• Severe dehydration, which can result in kidney failure
• Edema (swelling)
• Fainting, fatigue, lethargy and overall weakness
• Dry skin and hair, brittle hair and nails, hair loss
• Anemia (can lead to fatigue, shortness of breath, increased infections, and heart palpitations)
• Severe constipation
• Prepubertal patients may have arrested sexual maturity and growth failure.
• Drop in internal body temperature, with subsequent growth of a downy layer of hair called “lanugo,” which is the body’s effort to keep itself warm
• Amenorrhea (loss of menstrual cycle)
• Infertility, increased rates of miscarriage and other fetal complications
• Increased risk for suicide

You can also read about the health consequences of Bulimia Nervosa and Binge Eating Disorder.