Anorexia nervosa is among the more common eating disorders seen throughout the world. It is most common in developed nations. Most of us think of the extremely emaciated body as being the typical sign of anorexia. This is accompanied by other signs and symptoms indicative of poor nutrition, such as pale skin, thinning hair and brittle nails.
While being very thin and being obviously malnourished are two signs of anorexia nervosa, this may not always be immediately evident in the early stages. A host of other signs and symptoms, some of which are not very obvious, are also present with anorexia nervosa beyond the lower than normal body weight and extremely thin appearance.
Read more on types of eating disorders.
What happens in anorexia nervosa?
Anorexia nervosa is a conditon where a person opts not to eat sufficient food in an attempt to prevent weight gain. As a result there is extreme weight loss to the minimal nutrition. It is characterized by a fear of gaining weight which is represented by abnormal dietary habits. Anorexia nervosa is not inadequate nutrition due to unavailability of food as may occur with poverty.
The tern anorexia means a lack of appetite and occurs as a symptom in various diseases. It is usually short lived in other medical conditions. In anorexia nervosa, starvation is voluntary despite being driven by psychological factors. Malnutrition is a consequence of this abnormal dietary behavior. The conditions persists for long periods, even years and decades.
The insufficient nutrition has a host of consequences for the body. The body does not receive enough nutrition to maintain energy levels and regulate normal physiological activities. Apart from weight loss, there are disruptions in almost every physiological process necessary to maintain health and well being. Death is a possibility in severe cases where there is no medical intervention.
How To Spot Anorexia Nervosa
The most obvious signs of anorexia nervosa are a thin emaciated appearance as well as a lack of appetite. While the latter may be evident to family and friends from the early stages of the disease, extreme weight loss may not be immediately obvious. Loss of body fat and muscle mass which occurs in anorexia nervosa is a gradual occurrence that arises over weeks and months.
A body mass index (BMI) alone may not be a factor as in the early stages a person with anorexia nervosa may still be within the normal range. However, there is continuous weight loss. A BMI of under 18.5 (underweight range) is one of the main signs of anorexia nervosa when it is accompanied by reduced food intake and some of the signs and symptoms discussed below.
Most of the following signs and symptoms are non-specific. This means that it is not clearly indicative of anorexia nervosa and are common symptoms in various other disorders and diseases. However, when these symptoms are present along with a refusal to eat (either at all or a reasonable amount of food) and there is weight loss, then anorexia nervosa should be suspected.
Fatigue in anorexia nervosa is a consequence of several factors. The low calorie intake means that the body has less fuel to produce energy. Nutritional deficiencies which are a common consequence of anorexia nervosa also leads to fatigue. Low blood pressure, low heart rate and anemia means that less oxygen is distributed throughout the body. In addition, anorexia nervosa causes a host of other disturbances such as insomnia which can also contribute to fatigue.
Difficulty falling asleep or staying asleep for a sufficient period of time are other signs of anorexia. As with other symptoms like fatigue, insomnia arises for various reasons. Sleep is a reflection of overall health and anorexia nervosa compromises the healthy functioning of the body. Hunger, hormonal disturbances from a lack of nutrition and low body weight as well as other disturbances can compromise normal sleep patterns.
Dizziness and even fainting spells are common in anorexia nervosa. There are several reasons why this may occur including low blood glucose levels, low blood pressure, low body temperature and insufficient sleep. As a result of this dizziness, there may also be poor coordination and balance. Fainting spells are also more likely to occur when the physiologic demands on the body increase, like with strenuous physical activity.
Lack of Menstruation
It is not uncommon for postpubertal females with anorexia nervosa to experience irregular menstruation and even an absence of menstruation. The latter is known amenorrhea, and specifically as secondary amenorrhea. It arises with the hormonal disturbances due to the low calorie intake and low body weight. Consquently women may experience a diffculty falling pregnant. However, it is important to exclude pregnancy as a possible cause of secondary amenorrhea.
With insufficient food intake, there is little indigestible food to constitute sufficient stool (feces).Dehydration is another contributing factor. Collectively the lack of fiber and insufficient water intake results in constipation. In addition, the low metabolic activity as a result of anorexia nervosa further contributes to constipation. This refers to very few bowel movements, usually less than three in a 7 day periods as wel as passing hard dry stools with difficulty.
Many anorexics experience cold sensitivity. As with many of the other signs and symptoms, this occurs for several reasons. The loss of subcutaneous fat means that there is less insulation to retain body heat. In addition, the low metabolic activity which is a consequence of very low calorie intake reduces the body temperature. This cold sensitivity may be obvious as using clothing that does not correlate with the environmental temperature or an intolerance to cold environments.
Pale Dry Skin
Paleness is another common sign of anorexia nervosa. The low blood pressure and low heart rate, anemia which arises as a consequence of iron deficiency and the cold sensitivity causes the superifical blood vessels to narrow and blood flow under the skin to be reduced. This causes the pale appearance. In addition, the skin may be excessively dry further contributing to the sallow appearance often seen in people with anorexia nervosa.