Anorexia nervosa involves limiting or stopping food and drink consumption. Behaviours can include hiding food and then throwing it away or avoiding ‘dangerous’ high-calorie foods. People with anorexia can adopt rules about ‘good’ and ‘bad’ foods, or only eat foods of a certain colour, or adopt very structured eating times.^5,13

They may have an interest in recipe books and even cook for others but will avoid eating alongside guests. Fasting and obsessive calorie counting are common. Appetite suppressants or drugs which are claimed to speed up digestion may be being used.

The person can regularly weigh themselves or avoid the bathroom scales and mirrors, having a distorted image of themselves, thinking they appear bigger than they are (body dysmorphia), instead doing excessive exercise and wearing baggy clothing. Perfectionism, depression, anxiety or obsessive compulsive disorder (OCD) are often present.⁵

Symptoms include constipation, stomach cramps and bloating, tiredness and oedema of the hands, feet or face. Anorexia can cause rapid weight loss, and the person may feel very cold and weak. Menstruation may become regular or cease (amenorrhoea). Hair can fall out or become very thin, while a fine hair (lanugo) can start to appear on the arms and face and elsewhere on the body. Mental changes include impaired concentration and a loss of libido, and the person may become more reclusive.^5,13

Long term effects include muscle loss, bone weakness, low blood pressure and poor circulation.¹³