Symptoms of Anorexia Nervosa & Anorexia Athletica
What Is Anorexia?
Anorexia nervosa and anorexia athletica are two forms of a kind of mental illness called an eating disorder. Anorexia nervosa is usually referred to as ‘anorexia,’ while the other form of the illness is called ‘anorexia athletica.’
The American Psychiatric Association (APA) recognizes anorexia as an eating disorder, but the organization modified the diagnostic criteria for the illness in 2013. This was because it recognized that anorexia has strong psychological components. The APA says, “Feeding and eating disorders are characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.” In other words, anorexia is about more than food and weight.
The APA doesn’t formally recognize anorexia athletica as a distinct illness, but the term is used in the mental health field. It refers to people whose disordered behavior is centered mainly around excessive, obsessive exercise. For people with anorexia, it’s centered mainly around food.
What are the Underlying Causes of Anorexia?
Anorexia nervosa usually appears in teens and young adults, but it can occur earlier or later in life too. Anorexia is more common in girls and women, but it’s on the rise in boys and men.
As with other eating disorders, the behavior that people engage in when they have anorexia has little to do with food or weight. Instead, it’s about using food and weight as a coping mechanism, to deal with ongoing sources of:
- Low self-esteem
- Past traumatic experience (like physical, emotional or sexual abuse)
- Other emotional problems
There are underlying factors that can make someone more likely to develop an eating disorder like anorexia. These include genetic factors, and social and cultural factors. For instance, specific personality traits and chemical imbalances in the brain can increase the risk of someone developing an eating disorder.
Signs and Symptoms of Anorexia Nervosa
The primary symptoms of anorexia are:
- An obsession with being thin, and
- An irrational fear of weight gain
These show up in a lot of ways, mostly to do with food restriction and its effects.
Someone with anorexia nervosa will show several of the following behaviors and symptoms:
- The perception of being overweight, regardless of actual weight – This continues even if the person’s weight is dangerously low.
- Making frequent comments about feeling “fat” or overweight
- Food-restricting behaviors, such as eating only small amounts of food or eating only specific “acceptable” foods
- Strict calorie counting
- Weighing food before eating
- Restrictive eating combined with excessive exercise
- Exercising when sick or injured
- Frequent use of diuretics, laxatives, or diet pills
- Self-induced vomiting
- Weighing oneself multiple times a day
- Self-esteem that’s overly associated with body image and closely tied to weight
- Talking incessantly about food or weight
- Possible behavior similar to bulimia nervosa, including cycles of binge eating followed by purging
- Avoiding social situations that involve food
- Denying feeling hungry
- Dramatic weight loss
- Dry skin and dull hair due to lack of nutrition
- Hiding weight loss with baggy clothes
- Hiding other anorexia behaviors, including the amount and types of food eaten – For instance, they may pretend they’ve eaten when they haven’t or may exaggerate the amount of food they eat in a day.
While people typically think of someone with anorexia as very thin, that’s not always the case2. People who are overweight may develop anorexia as they attempt to lose weight or may develop anorexic behaviors without losing weight. This underlines the fact that anorexia is defined by someone’s behavior, not their weight. It’s also important because people who develop anorexic behavior while overweight are often praised for losing weight. This encourages them to continue their disordered behavior even if they achieve a healthy weight.
How Do People Hide Anorexia?
Secrecy and shame are common themes in people with eating disorders. People who suffer from them spend a huge amount of energy trying to hide their food and weight-related behavior from family and friends.
Wearing Oversize or Baggy Clothing
People with anorexia often wear oversize clothing or dress inappropriately for the season by wearing cold-weather clothing on warm days. There are a few reasons for this:
- They want to hide their body, which they view as grossly overweight and unattractive, no matter how thin they are.
- People who are very underweight find it hard to retain body heat, and the extra clothing helps them stay warm. The extra clothing also helps them hide their weight loss from friends and family members.
When they eat with other people, food games help an anorexic person hide the fact that they’re not eating. Food games may involve:
- Cutting food into small pieces
- Hiding food under other food
- Balling food up in a napkin
- Moving food around on the plate
Anorexics play food games to try to create the illusion that they’re eating more than they really are.
Food restriction is a common behavior in people with anorexia. This often involves restricting all food, but may also involve restricting certain types of food. They might cut out one or more food groups, eat food of only one color, or eat only particular combinations of food.
They may also take part in food rituals, such as:
- Eating foods in a certain order
- Weighing or measuring everything they eat
- Always using the same dining ware
- Always leaving the same amount of food on their plate
Research shows that some people conceal their anorexia behind a vegetarian or vegan diet3 or behind the concept of “healthy” or “clean” eating. Hiding behind “healthy” or “clean” eating is called orthorexia. It often combines some components of both anorexia nervosa and anorexia athletica4.
To someone with an eating disorder, every calorie counts, and every minute is a chance to burn off calories. Besides excessively exercising, anorexic people tend to take every opportunity to walk, run, or take the stairs. They may constantly fidget—by tapping their fingers or bouncing on their feet—in an effort to burn more calories.
As happens in many mental illnesses, the life of a person with anorexia tends to shrink to their obsession. Their world becomes increasingly about controlling their food intake and their weight loss, so there’s no room or time for anything else. They may start to withdraw from friends and family, which gives them more time for their obsession and helps them avoid difficult questions about their behavior or appearance.
Another factor is that malnutrition may deplete a long-term anorexic of the energy they need to participate in the world around them. Research has found that poor nourishment can contribute to depressive symptoms, which may further their isolation5.
Anorexia nervosa can lead to many serious physical health problems. These can be fatal, such as heart and kidney failure. Potential physical side effects of anorexia include:
- Anemia and other blood chemistry disorders
- Electrolyte imbalances
- Low blood pressure
- Abnormal heart rhythms
- Muscle weakness
- Osteoporosis and bone fractures
- Kidney stones
- Delayed or impaired body development in children and teen
- Memory problems
- Menstruation irregularities and/or female infertility
- Dry hair and skin, and hair loss
- Lanugo (the growth of downy hair on the body and face)
What Is Anorexia Athletica?
Anorexia athletica is also called:
- Compulsive exercise
- Sports anorexia
It can develop in almost any teen or adult, but it’s most common in serious athletes who play sports that emphasize a lean or petite body type.
People with anorexia athletica don’t focus on their appearance, as people with anorexia nervosa tend to do. Instead, they focus on their athletic performance. They often measure their self-worth and their body’s worth by comparing themselves to successful competitors in their field.
Because exercise in general is beneficial, it’s hard for doctors to tell the difference between healthy and unhealthy exercise patterns. One common thread is that people with anorexia athletica spend more time exercising than they need to for health or athletic performance. They continue to exercise even when sick or injured.
As with anorexia nervosa, anorexia athletica is most common in people who have ongoing emotional problems like anxiety, depression, or low self-esteem. These problems show up as an obsession with exercise.
Signs and Symptoms of Anorexia Athletica
The symptoms of anorexia athletica share some similarities with the symptoms of anorexia nervosa. In both cases, an obsessive preoccupation is as an outlet or coping mechanism for emotional problems. There are crucial differences too. The main one is an intense focus on exercise and athletic performance vs. on food and weight.
Potential warning signs of anorexia athletica include:
- An ongoing preoccupation with exercise
- Loss of more than 5% of body weight
- Feelings of guilt or anxiety when the self-imposed exercise schedule isn’t followed
- Exercising instead of working or going to school
- Exercising despite being ill or injured
- Feelings of isolation while exercising
- Lying about the extent of their exercise schedule
- Thinking about food only as it relates to exercise
- Basing self-worth on the amount of exercise completed each day
- Hiding anorexia athletica by blaming their weight loss on the training and exercise needed to be competitive in the chosen sport
Anorexia Athletica Side Effects
When someone exercises obsessively without dedicated rest days, their body doesn’t get a chance to rest, recover, and heal. Overtraining is a well-recognized problem for athletes, especially athletes in competitive sports6. In the long-term, overtraining syndrome:
- Leads to chronic fatigue
- Reduces athletic performance
- Increases the risk of serious injury
- Suppresses the immune system
The consequences of anorexia athletica are similar. But because people with anorexia athletica are so obsessive about exercise, they risk doing even greater harm to their bodies.
Some possible side effects include:
- Fatigue, insomnia, and depression
- Menstruation irregularities (e.g. cessation of menstruation)
- Loss of muscle mass
- Damage to joints, cartilage, tendons, and ligaments
- Potentially fatal heart irregularities
Get Anorexia Help Now
Eating disorders are difficult to treat. Many people who develop them have a lifelong battle with their illness, but this doesn’t mean there’s no hope. You can manage your illness and improve your health and well-being with eating disorder treatment.
The difficulty of treating anorexia means that getting treatment ASAP is critically important. If you or a loved one is struggling with anorexia nervosa or anorexia athletica, reach out for help without delay, to improve the chance of a full recovery.
Choose a better life. Choose recovery.