According to the DSM-5 the criteria for Anorexia Nervosa are:
• Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health) .
• Either an intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain (even though significantly low weight).
• Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Signs and Symptoms of Anorexia Nervosa
Anorexia is characterized by dramatic weight loss and an extremely restrictive pattern of eating. People suffering from Anorexia have an extreme fear of gaining weight and becoming fat, even though they are underweight. Their body weight is the primary factor in their sense of self-esteem. They engage in extensive body checking behaviors, such as looking in mirrors and weighing themselves,”checking” to see if they are fat. They may make repeated comments about feeling fat even though they have recently lost a dramatic amount of weight. They obsessively count their calories and avoid foods high in fat or sugar. They frequently become vegetarians. They often engage in excessive exercise, persisting even when they are injured or obstructed by foul weather. They may prepare a lot of food for other people, but not eat it themselves. They often try to avoid public and family meals, giving excuses as to why they can’t eat. They may cover up with baggy clothes. Purging behavior, such as excessive exercise or vomiting is seen in about 40% of cases.
People with anorexia are often high in perfectionism, extremely hard working, very competitive and highly driven. They may show traits of obsessive compulsive disorder, with a great deal of personal rigidity and fears of dirt, mess and contamination. Many people with Anorexia have an extremely low sense of self worth and do not feel they deserve to eat. They often have trouble spending money on themselves. They can also have a significant degree of anxiety, and struggle with depression. They often become extremely withdrawn and irritable as the disorder progresses and will lash out at anyone who tries to stop them in their pursuit of extreme thinness.
Physical Problems that Develop as Anorexia Progresses
As a person descends into anorexia, they have increasingly negative health problems that develop. The menstrual cycle will often be interrupted indicating a problem in calcium and hormone regulation. This problem in hormone and calcium regulation can signal that body is losing bone density through osteopenia and osteoporosis. The person feels cold all the time, as circulation shuts down due to low metabolic rate. They may develop a fine downy hair on their face and elsewhere. The digestive system can also slow down and the person can suffer with constipation. Their heart rate slows down to an abnormally low level and they risk having a dangerously irregular heart rhythm. They lose muscle mass and experience fatigue as their body metabolizes their muscles for fuel. They begin to have a great deal of difficulty with sleep. Occasionally they may experience a fainting spell, or lightheadedness.