Symptoms of Anorexia Nervosa & Anorexia Athletica
What Is Anorexia?
Anorexia nervosa, commonly referred to as anorexia, and anorexia athletica are two different conditions that belong to a class of mental health problems known as eating disorders. Anorexia nervosa is officially recognized as an eating disorder by the American Psychiatric Association (APA). The diagnostic definition of anorexia was broadened by the APA in 2013 to emphasize its psychological components versus viewing it primarily as a weight disorder. “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.” People with the disorder also spend a good deal of time and energy hiding anorexia from others.
People with anorexia athletica achieve an extremely low weight through compulsive, excessive exercise. Anorexia athletica is not recognized formally by standard mental health diagnostic manuals, including those published by the APA. However, the term is used in the mental health field to denote disordered behavior on the eating disorder spectrum characterized by excessive, obsessive exercise.
Underlying Causes of Anorexia
Anorexia nervosa typically appears in teenagers and young adults, although it can occur earlier or later in life. Like other eating disorders, the behaviors manifested in anorexia nervosa generally have very little to do with food. Instead, they occur when an individual has problems coping with ongoing sources of anxiety, depression, stress or other types of emotional difficulties. Underlying causes include a combination of genetic predisposition and factors such as cultural and social environments, specific personality traits and chemical imbalances within the brain and body.
Stats and Facts
- At least 6% of adolescents suffer from eating disorders and more than 55% of teen girls and 30% of boys report some kind of “disordered eating” symptoms such as fasting, diet pills, vomiting or using laxatives.
- Eating disorders have the highest mortality rate of any mental illness.
- An estimated 33% to 50% of anorexia patients have a comorbid mood disorder such as depression, and about 50% have comorbid anxiety disorders such as obsessive-compulsive disorder and social phobia.
- Of 52 professional ballet dancers ages 13 to 20, 5.8% were diagnosed with anorexia athletica and 1.9% with a clinical eating disorder.
- An estimated 90% to 95% of people with anorexia nervosa are female.
Anorexia Nervosa Symptoms
People with anorexia develop an obsession with appearing thin and have an intense, irrational fear of gaining weight. Symptoms of anorexia include a range of behaviors and physical symptoms, including:
- Perception of being fat regardless of weight, even when it is dangerously low and of concern to those around them
- Hiding anorexia with baggy clothes and other secretive behaviors
- Self-esteem that is overly associated with body image
- Food-restricting behaviors
- Similar behaviors as those with bulimia nervosa including severe food restriction with bouts of binge eating, followed by purging behaviors such as vomiting or abuse of diuretic medications, enemas or laxatives
- Food restriction combined with excessive exercise
- Dramatic weight loss
- Eating only small amounts of a variety of foods or specific “acceptable” foods
- Strict calorie counting
- Weighing food before eating
- Frequent use of diuretics, laxatives or diet pills
- Self-induced vomiting
- Weighing oneself multiple times a day
- Talking incessantly about food or weight
- Withdrawal from friends and activities
- Exercising when ill or injured
How People Hide Anorexia
Secrecy and shame are common themes in eating disorders like anorexia and bulimia. The insidious nature of eating disorders is that while they’re often a cry for help, people suffering from them work tirelessly to mask their weight loss and eating behaviors from friends and family in order to continue these destructive coping mechanisms.
How people hide anorexia:
- Baggy clothing – People with anorexia often wear oversized clothing or dress inappropriately for the season, such as wearing cold-weather clothing in warm temperatures. There are a few possible reasons for this. People with anorexia view themselves as being overweight even though they might be grossly underweight. They’re often legitimately cold due to their low body mass index and are sometimes anemic as a result of their disorder. On some level, people with anorexia understand that people consider them too thin. They could be trying to hide weight loss from family members and friends to “get them off their back.”
- Food games – When eating with others, people hiding anorexia may move food around their plate, cut it into very small pieces, hide food under other food or ball food up into their napkin – pretty much anything but actually eating it. People with anorexia try to create an illusion that they’re eating when they’re really not.
- Food rules – How people hide anorexia can involve severely restrictive and sometimes bizarre diets. These may include eating foods they deem “safe,” cutting out one or more food groups, eating only one color of food, or eating odd combinations of food. They may also take part in a number of food rituals like eating foods in a certain order, measuring and weighing food, always using the same dining ware, or always leaving the same amount of food on their plate. Research shows that some people are hiding anorexia behind special diets like veganism.
- Always moving – Every calorie counts in the mind of someone with anorexia and every minute is a chance to burn off calories. In addition to over-exercising, anorexic people may always skip the elevator and take the stairs, walk most places, pace, and constantly fidget like tapping their fingers or bouncing their feet.
- Isolating – The person’s world gets narrower and narrower until it’s all about food and weight. They may begin to withdraw from social activities, friends and family so they can focus all of their attention on restrictive behaviors and exercise. Isolating means they don’t have to face questions about food and their weight. The lack of calories and intense preoccupation with weight loss can deplete them of the energy for social interactions. Some research has found that poor nourishment in anorexia can contribute to depressive symptoms, which may also cause isolating behaviors.
- Excuse-making – Hiding anorexia may involve a web of little lies that signal bigger problems. The person may routinely make excuses as to why they’re not eating with people in social situations. For example, they “just ate,” they had a big breakfast, they’re not feeling well or they’re meeting people later to eat.
Anorexia Nervosa Physical Effects
Anorexia nervosa can lead to a variety of serious issues, including potentially fatal heart and kidney failure. Potential physical side effects of anorexia include:
- Anemia and other blood diseases
- Low blood pressure
- Muscle weakness
- Osteoporosis-related bone fracture
- Kidney stones
- Memory problems
- Delayed or impaired body development
- Menstruation irregularities (e.g., amenorrhea)
- Female infertility
- Electrolyte imbalances
- Dry hair and skin
- Hair loss
- Lanugo (a downy layer of hair growth on the body and face)
What Is Anorexia Athletica?
Anorexia athletica is also known as compulsive exercise, hypergymnasia and sports anorexia. While it can occur in almost any teenager or adult, it most commonly affects serious athletes, especially those participating in sports that place an emphasis on lean, small body types. Instead of focusing primarily on their personal appearance, people with this disorder focus on their athletic performance. They measure their bodies and self-worth by comparing themselves to successful competitors in their respective fields.
Exercise is normally a beneficial activity, which can make it difficult for doctors to separate healthy exercise patterns from ones aimed at unhealthy patterns and hiding anorexia. However, people with anorexia athletica typically continue exercising even when these activities are clearly harmful. As with anorexia nervosa, the disorder commonly occurs in people with ongoing emotional difficulties, including depression, anxiety or low self-esteem.
Anorexia Athletica Symptoms
Potential signs of anorexia athletica include:
- An ongoing daily preoccupation with exercise
- Feelings of guilt or anxiety when normal exercise schedule is not followed
- Exercising instead of working or attending school
- Feelings of isolation while exercising
- Loss of more than 5% of healthy body weight
- Lying about the extent of exercise routine
- Exercising when significantly ill or injured
- 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 weight loss on the training and exercising needed to be competitive in a sport
Anorexia Athletica Side Effects
Even minor injuries can have long-term health consequences for those who exercise obsessively. Anorexia athletica can lead to short- and long-term problems such as:
- Loss of muscle mass
- Bone damage including stress fractures
- Joint, cartilage, tendon and ligament damage
- Menstruation irregularities (e.g., amenorrhea)
- Potentially fatal heart irregularities (in co-occurring anorexia athletica and anorexia nervosa)
Anorexia nervosa is typically treated with a combination of psychotherapy and medications that combat underlying problems such as depression or anxiety. Therapeutic approaches to anorexia include group therapy, family therapy and cognitive behavioral therapy. An estimated 50% of people with this disorder eventually recover. Treatment for anorexia athletica typically involves some form of psychotherapy, as well as appropriate use of medications.