Signs of Anorexia

There are numerous physical signs that are used along with a person’s symptoms to identify and diagnose anorexia nervosa. Medically speaking, signs are things that can be observed or measured objectively. Some of these signs can be visually observed, while others are identified through lab tests or scans. 

Awareness of these warning signs is very important if you or a loved one has a suspected eating disorder. It can help you get the treatment you need to recover and minimize the long-term health risks of anorexia. 

Visible Signs of Anorexia

Visual signs are often first identified by family and friends of someone with anorexia. Observing more than a few of these visible signs in a person is typically a reason to seek a full medical workup for suspected anorexia. 

The top visual signs of anorexia nervosa include: 

• Rapid weight loss/underweight
• Brittle nails
• Hair loss
• Lanugo (fine hair on the body)
• Pale complexion
• Cold extremities with a blue tint
• Delayed puberty
• Poor dental health
• Dehydration (dry lips/mouth, sunken eyes)

Medical Signs of Anorexia

Sometimes visual signs of anorexia can be missed in the early stages. In these cases, anorexia is often identified through routine lab tests that might be done at a person’s annual physical or preventative care appointment. Other times, more in-depth medical tests are ordered when anorexia has already been diagnosed in order to identify health risks and help guide the treatment plan. 

 The top medical signs of anorexia nervosa include: 

• Low blood pressure
• Low heart rate
• Anemia
• Low white blood cell/platelet counts
• Electrolyte imbalances
• Impaired thyroid function
• Vitamin/mineral deficiencies
• Amenorrhea/infertility in females
• Low bone density
• Gastrointestinal abnormalities 

Signs of Anorexia Explained

Rapid weight loss

Being severely underweight is a hallmark sign of anorexia nervosa and is a result of intentional starvation. Underweight is defined as having a body mass index (BMI) less than 18.5 in adults or falling below the 5th percentile on growth charts in children and adolescents. 

Another important sign of anorexia is rapid weight loss. In particular, weight loss of more than 1 kilogram (2.2 pounds) per week for more than two weeks puts a person with anorexia at a higher risk of serious complications. 

Cardiovascular impairment

There are numerous cardiovascular signs that can signal a case of anorexia. Low blood pressure (hypotension) and low heart rate (bradycardia) are signs that are commonly identified at a doctor’s office checkup. Further workup can be done via an electrocardiogram, a test that can identify other heart rate abnormalities. 

When the body is starving, it tries to conserve energy by slowing down many essential functions, including heart rate. In severe cases, hospitalization is required to stabilize these cardiovascular abnormalities. 

Abnormal blood tests

Numerous blood tests can indicate the presence of anorexia. A complete blood count may show anemia, low white blood cell count, or low blood platelet count. Abnormal liver function tests and electrolyte panels are also signs of anorexia. A low serum potassium level is particularly concerning since this can be life-threatening. Thyroid hormones may also be impaired due to starvation, leading to hypothyroidism, or low thyroid function. 

Multiple micronutrient deficiencies are another sign of anorexia that can be identified from blood tests. Chronic severe food restriction means a person is not consuming an adequate amount of vitamins and minerals. The most common micronutrient deficiencies in anorexia are zinc, vitamin D, copper, thiamin, vitamin B12, and folate. 

Delayed puberty

Experiencing a delay in the onset of puberty is one of the signs of anorexia. Specific to females, anorexia can lead to amenorrhea (loss of periods) or irregular periods. Poor fertility and infertility are also signs of anorexia. When the body is starving, it focuses energy on preserving essential bodily functions for survival, so reproduction functions are suppressed as a result. 

Low bone density

When a person is underweight from anorexia, bone mineral density can be impacted. This is of particular concern in children and adolescents since their bodies are still growing. It is recommended to have bone density tested in adolescents who have been underweight for more than one year, typically done through a DEXA scan (dual x-ray absorptiometry scan). 

Dermatological signs

Dermatological signs such as hair loss and brittle nails are signs of anorexia and are related to nutritional deficiencies and the effects of starvation. Lanugo tends to appear on the body due to the body’s attempts to stay warm at a low weight. This is a type of hair that is very fine and soft. It generally appears on the face and along the spine. In addition, a pale complexion and cold blue fingers and toes are observed due to reduced blood flow.

Gastrointestinal distress

Gastrointestinal dysfunction is a common sign of anorexia due to the slowing of digestion resulting from starvation. People with anorexia may experience bloating, pain, and constipation. These symptoms tend to worsen the more weight is lost. It can make the patient's refeeding and recovery process uncomfortable because they often feel very full and bloated on a small amount of food. 

Poor dentition

Though more common in bulimia nervosa, where self-induced vomiting occurs more routinely, cavities and enamel erosion can also be signs of anorexia. This is something that dentists are aware of and screen for during preventative exams. 

Seek Help

If you have identified these signs of anorexia in yourself or a loved one, don’t wait to seek help. Nourish will match you with a registered dietitian who specializes in anorexia treatment. Your dietitian will help coordinate care with other healthcare providers on your team to ensure you get the best treatment possible. 

With online sessions covered by insurance, Nourish makes it easy to access the care you need. Get started today. 

Sources
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Brown, C., & Mehler, P.S. (2017). Medical Complications of Anorexia Nervosa and Bulimia Nervosa

https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-021-00452-2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520973/