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Symptoms, Characteristics & More

Are you or a loved one struggling with Anorexia? Get Help Now.

Are you or a loved one struggling with Anorexia Nervosa? For over 30 years, the compassionate, world-class team at The Center • A Place of HOPE has helped thousands overcome Anorexia. Call 1-888-884-4913 / 425-771-5166 today to speak with an eating disorder treatment specialist. It is a free, confidential call and you can learn what a treatment program would look like for you.

Anorexia Symptoms

Anorexia, or self-starvation, is a disease and it can be fatal if left untreated. Recognition of its symptoms can be the first step toward saving yourself or someone you love from this dangerous disease. The following is a list of the observable symptoms:

  • Refusal to maintain body weight
  • Fear of gaining weight
  • Talks about “feeling fat”
  • Difficulty with eating full meals
  • Rigidity with what they will eat
  • An obsessive preoccupation with body size
  • Over-exercising
  • Intense dissatisfaction with physical appearance
  • Personality change from outgoing to withdrawn
  • Limit food intake to “arrow selection of low-Cal foods
  • Hoarding, concealing, crumbling or throwing away food
  • Menstrual difficulties

Behavioral Characteristics.

Anorexic patients see their restricted caloric intake as a very brave and arduous thing to do. They tend to prize challenges over comfort. By contrast, bulimic patients view their behaviors as shameful and disgusting.

In order to recover, patients need help learning to understand the connection between their beliefs about themselves and their eating disorder behaviors. They often view themselves with such hatred that they feel deserving of the painful eating disorder behavior. They need to see that their eating disordered behavior is not an achievement, hut avoidance of true life challenges; not distinctive, hut simply stereotypic. They need to realize their behavior does not clarify their life, but confuses it; and they need to see that the disorder does not serve higher goals, but actually blocks the realization of those goals.

The individual suffering from destructive eating disorder behavior must begin to challenge a negative mindset and learn to create and allow positive feelings and thoughts about themselves.

Anorexia Nervosa

Bingeing and Food Control

Excessive dieting, food control, and fasting. Collects recipes, and likes to cook/bake, but sometimes refuses to eat with family. Tension at mealtime, Fear of food; avoidance of consumption.


Compulsive exercising. Fasting

Eating Behavior
Food ritual; calorie counting, rigid rules and schedules.
Sleeping Behavior
Insomnia and early morning awakening.
Clothing and Dressing Rituals

Frequent weighing, layering of clothes.

Social Behavior

Social withdrawal, physically and emotionally. Focus on job and or school work.

Abusive Behavior

Slow suicidal progression. Self hatred and feeling of unworthiness

Emotional and Cognitive Characteristics

Individuals suffering from eating disorders have restricted emotions and often cannot identify their feelings. What they are aware of is extremely negative thoughts related to their body – an effective diversion from their emotional turmoil and pain. Their thoughts are obsessively locked onto the Irrelevant and their feelings are avoided and hidden, even from themselves.

Anorexia Nervosa

Body Image Problems
Intense fear of becoming fat. Distorted body image.
Perfectionist Behavior

Perfectionist: thinnest, smartest, neatest. Dichotomous thinking: all or nothing, black or white.


Depression and low sense of self-worth.

Decreased interest in sex.
Social Behavior

Self-centered and non-social, isolation from others, irritable.

Cognitive Symptoms

Difficulty thinking clearly, potential severe cognitive deficits due to malnourishment.

Adapted from Mary Pabst, MSW, Maryland Association for Anorexia Nervosa and Bulimia (MANA) from Panhellenic Task Force

Anorexia Linked To Pleasure-Regulating Brain Chemical

Women who suffer from anorexia have increased chemical activity in a part of the brain that controls reward and reinforcement, something that may explain why they are driven to lose weight but don’t get any pleasure from it, according to a new study. Researchers used brain-imaging technology on 10 women who had recovered from anorexia and 12 healthy women.

In the anorexic women, they found overactivity by dopamine receptors in a part of the brain known as the basal ganglia. Dopamine is a brain chemical that is associated with regulating pleasure. “The take-home message is dopamine in this area may be very important in how we respond to stimuli, how we view positive and negative reinforcement,” said Dr. Walter Kaye, a psychiatry professor at the University of Pittsburgh Medical Center and one of the researchers involved in the study. Dr. Guido Frank, a child psychiatry fellow at the University of California at San Diego and also a leader of the study, said the hope is that the research can lead to the development of drugs to treat anorexia.

“It’s very, very hard to treat. They recognize it’s wrong, but they still don’t eat,” Frank said. The research was reported online in the journal Biological Psychiatry. About 1 percent of American women suffer from anorexia, a disease than can also affect men. It has the highest death rate of any psychiatric illness, Kaye said. Women suffering from anorexia have obsessional personalities, avoid harm and prefer a routine, said Dr. Douglas Bunnell, past president of the National Eating Disorders Association and clinical director of the Renfrew Center of Connecticut. These women tend to resist therapy and have a distorted perception of themselves, he said.

Although only a small number of women get anorexia in its purest form, there are many more people who suffer from some form of an eating disorder, Bunnell said. Making the connection between anorexia and what’s happening in the brain is important for understanding and treating eating disorders, he said. “There’s still considerable stigma attached to these disorders, particularly for families. People think it reflects something you did as a parent,” Bunnell said. Dr. Craig Johnson, director of the eating disorders program at Laureate Psychiatric Hospital in Tulsa, Okla., said anorexia was historically viewed as a disease brought on by its victims or just a diet gone bad.

“Up until this point we have been left with more sociocultural explanations for the illness and regretfully that has resulted in some levels of minimization, if not glamorization, of the illnesses,” Johnson said. Though the ultimate goal from the latest study would be to develop treatments for anorexia, the work may also provide data important in anorexia prevention and identifying people at risk of developing the disease, Johnson said. Frank said researchers still don’t know what is causing the dopamine receptor to be overactive, but more research may provide an answer. Kaye and other researchers are involved in a large, multiyear study looking into a genetic link to the disease and an eventual cure. Funded with $10 million from the National Institute of Mental Health, the study is looking at hundreds of families that have two or more members with anorexia.

The Dark Side of Diet and Exercise

The virtues of dieting and physical fitness pervade our consciousness. But either can go too far, leading to self-starvation or compulsive exercising–or both. In fact, one may actually cause the other, warns W. David Pierce, Ph.D., of the Sociology and Neuroscience faculties at the University of Alberta.

Here, he discusses a dangerous and increasingly pervasive phenomenon called “activity anorexia.”

Nancy K. Dess: What is activity anorexia?

W. David Pierce: Activity anorexia is a problematic behavior pattern in which a drastic decrease in eating causes progressively more exercise, which further reduces eating, in a vicious cycle.

NKD: How have you studied this in the laboratory?

WDP: In a typical experiment, rats live in a cage with a running wheel. At first, they can eat and run freely. Then they are shifted to one daily meal. Rats with no chance to run stay healthy, but rats allowed to run develop startling effects: Their running increases from hundreds to thousands of revolutions per day, and their eating decreases. Not all rats develop this pattern to the same degree, but many would die if it continued.

NKD: Why does this happen?

WDP: Consider Darwin’s theory of evolution through natural selection. Animals would have gained a survival advantage by migrating when food was scarce, and by staying on the move until an adequate supply was found. A trek moved them away from famine and increased the odds of finding food–and surviving to pass on this trait. We’ve shown that as food becomes scarce, rats, especially females, will work harder to earn a chance to run. Thus, events in the distant evolutionary past can be traced to a behavioral reinforcement process.

NKD: How does that play out for humans in contemporary culture?

WDP: Our culture brings dieting and exercise together. Current cultural values of thinness and fitness ensure that many people–especially women–receive social reinforcement for dieting and exercising. At some point, for some people, the eating/activity mechanisms begin to operate independently of culture. Their original goals or motivations become irrelevant.

NKD: What about anorexia nervosa, which is clinically diagnosed on the basis of extreme thinness, fear of fat and distorted body image. How is that related to activity anorexia?

WDP: Professionals’ definitions make them sound completely different, but they may not be. The diagnostic criteria for “anorexia nervosa” focus on what people think and feel–about themselves, their bodies, and so forth. Activity anorexia is about what people do–how much they eat and exercise. My colleagues and I have argued that most cases diagnosed as anorexia nervosa, a “mental illness,” are actually cases of activity anorexia, a problematic behavior pattern. You see, what people consciously think can be misleading.

NKD: For example?

WDP: A Canadian woman denied exercising but said she liked to walk. When asked where she walked, she replied, “To …”

NKD: Cleveland.

WDP: Basically, yes. To the mall–five kilometers away, four or five times a day. She didn’t think of it as exercising. So careful assessment of actual behavior, in addition to what people think or feel, is critical.

NKD: But does it really matter how we define the problem?

WDP: I think so. Of those receiving a diagnosis of anorexia nervosa, between 5% and 21% will die. If eating and exercising are central to the problem, then more attention should be focused on these behaviors. Specifically, sudden changes in exercise or eating–“crash” dieting–are warning signs, at least as important as a desire to be thin. Understanding this problem fully is key to figuring out how to prevent it or treat it effectively–which is literally a matter of life and death.

Nancy K. Dess, Ph.D., is a professor of psychology at Occidental College and senior scientist at the American Psychological Association in Washington, D.C.

Mid-Life Anorexia

Anorexia and bulimia are eating disorders usually associated with teenaged girls, but you may look at the disorders differently once you hear a local woman’s story. In some eating disorder treatment programs, 25% of the women are over the age of 35. The trend is so new that doctors don’t really know how many middle-aged women have eating disorders.

Baby boomers share the same struggles as younger women, but the reasons for their eating disorders are different. When anorexics get weighed, they’re made to step on a scale backwards, because to them, the number is their enemy. Suzanne Ryan weighed only 110 pounds, but if she were to see that number, it would send her into a tailspin. Suzanne agreed to talk to us after four weeks at an outpatient program at Beaumont Hospital.

“I’m feeling a little shaky because I was restricting yesterday,” she told Action News from the hospital. “I haven’t taken any laxatives, but I sure want to. It’s like, what’s the need for the self abuse?”

When Suzanne turned 40, the anorexia she thought she had conquered years ago suddenly returned. “It was like no time had passed,” she remembers. “It was like, ‘I can control this.’” The trigger was the death of her mother, who had abused her. “This was like four or five doing, ‘You ate nice today, so here’s some candy.’ I thought they were Hershey’s, but they were ex-lax,” she now says. That started years of starvation and laxative abuse.

In her early teens, Suzanne weighed only 75 pounds. What triggers eating disorders for middle aged women? “With middle-aged women, usually there’s a loss, a betrayal,” Suzanne’s doctor, eating disorder expert and Beaumont Psychiatrist Dr. Alexander Sackeyfio explains. For Suzanne, death and divorce may have triggered the disorder. “When they start restricting their eating it cuts down anxiety and they feel better,” Dr. Sackeyfio says. “They go back to try to reactivate that.”

The doctor says it’s not always old eating disorders starting up again. Some women never got treatment, and for others, especially women with money, the disorder is new. “The loss to them is a mark of wealth, dignity, organization,” Dr. Sackeyfio explains. “To them, they feel they are doing better by being able to maintain the small size.” “How do you get women to change their perception? The best you can do is continue with education,” he says. “It’s not healthy to be very thin. Thinness is an illness. It can actually deprive you of your bone structure. It can deprive you of heart functioning, and it can deprive you of kidney functioning.”

Suzanne, once 5’10″, is two inches shorter from osteoporosis. Over the years she has been hospitalized, had an irregular heartbeat, and suffered a stroke. “I feel it, I mean I really feel it in my kidneys at times and I feel it in my chest,” she told us from the hospital. “I feel it in my mind, and that scares me.” Suzanne is now out of the hospital and back at her Farmington Hills home, not cured, but hopeful. “I want to live and I want to be happy and I want to love myself, and I tell myself that every day, whether I believe it or not,” she says. Doctors say there is one advantage for older women battling eating disorders: they tend to be more aware of the health problems and are more likely than younger women to accept help and embrace treatment.

Anorexia Nervosa Prevention

There is no known way to prevent anorexia. Early treatment may be the best way to prevent the disorder from progressing. Knowing the early signs and seeking immediate treatment can help prevent complications of anorexia.

Seeking early diagnosis and treatment can play a significant role in preventing the illness from progressing to a more serious condition. While there is no way to prevent anorexia, there are many ways adults can help children and teens develop a healthy view of themselves and learn to approach food and exercise with a positive attitude. Doing this may prevent some children and teens from developing anorexia. This information is not intended to replace the advice of a doctor.

Read more articles and reports on Eating Disorders by going to The Center • A Place of HOPE.


Are you or a loved one struggling with Anorexia Nervosa? For over 30 years, the compassionate, world-class team at The Center • A Place of HOPE has helped thousands overcome Anorexia. Call 1-888-884-4913 / 425-771-5166 today to speak with an eating disorder treatment specialist. It is a free, confidential call. Learn what an eating disorder treatment program might look like for you.


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