There are many symptoms associated with anorexia and these can vary from person to person. Some of these are connected to how you behave and think, and some are physical. Behavioural symptoms include:
- eating very little, if at all, or restricting certain foods, such as those containing fat
- being secretive about food
- obsessively weighing yourself, and measuring and examining your body
- being obsessed with exercise
- being restless
- using appetite suppressants, such as diet pills
- making yourself sick after meals or using laxatives or diuretics (water tablets)
- wearing baggy clothes to disguise weight loss
- punishing yourself if you don’t lose enough weight or eat something you wouldn’t usually eat
- lying about eating
With anorexia, you become preoccupied with your weight and body size. You may:
- have a distorted body image
- deny being underweight or having a problem with food
- have mood swings
- feel depressed
- lose interest in other people
- go off sex
- find it difficult to concentrate
- worry more and more about your weight
- carry on losing weight, even when you’re below a healthy weight
If you have anorexia, you will probably have a body weight that is much lower than expected for your age and height – in adults, this is usually a body mass index (BMI) of less than 17.5. BMI is commonly used to work out whether you’re a healthy weight – it takes into account your weight and height. You’re a healthy weight if your BMI is between 18.5 and 24.9 – a BMI much above or below this means you may be at risk of serious health problems.
As well as weight loss, the physical signs of anorexia can include:
- fine, downy hair on your body and face
- feeling cold all the time
- red or purple hands and feet
- light-headedness and dizziness
- stomach pains
- hair falling out
- poor sleep
- dry, yellowish skin
- heartburn (indigestion)
- delayed puberty (because anorexia affects your hormones) and not growing to your full height
- missing three or more monthly periods (in women or girls who aren't pregnant or using certain types of hormonal contraceptive, such as the pill)
- not being able to get or keep an erection (in men and boys)
Anorexia is a serious medical condition, so getting help is very important. Admitting you have a problem is the first step, though it can be the hardest. Making that move means you’re more likely to be able to find the support and treatment you need to overcome anorexia and improve your life.
Talk to your GP first – he or she will ask about your life and eating habits and examine you. Your GP may refer you to a psychiatrist or psychologist who is trained in the treatment of eating disorders.
You should start treatment for anorexia as soon as you can. The aim is to re-establish a healthy attitude towards food and a consistent pattern of eating.
You can get better from anorexia but it may be a long process and in times of stress, you may relapse. It takes an average of five to six years to recover after diagnosis, but up to a third of people with anorexia never fully recover. However, with determination, patience and support, it can be done. For treatment to work, you must want to get better. See our frequently asked questions for more information.
Keeping a diary of your eating habits and learning about healthy eating and sensible weight control may help.
You may find that support groups are useful. It can be comforting to talk to others who have had the same feelings and experiences. Family members may also find it useful to attend self-help meetings for relatives and carers.
Talking therapies (for example, counselling) are often used to treat anorexia. They can help you to identify the feelings and fears that caused you to stop eating, and develop a healthier attitude towards food and your body.
There are various types of talking treatment that can help with anorexia, such as cognitive behavioural therapy (CBT). You may need to continue with these for months or years.
You may also find it helpful to have therapy that involves your family, either together with you or having separate counselling sessions. This helps everyone in the family to understand the disorder properly and support each other.
Medicines aren’t usually used to treat anorexia. However, they may be used to treat secondary symptoms, such as anxiety and depression.
Most people who have anorexia don't need to stay in hospital and will be treated on an outpatient basis. But if you have lost so much weight that your life is at risk, you may need to be admitted to hospital so that the fluids and nutrients that you have lost from your body can be replaced.
Forced treatment is always a last resort, because it can be distressing to lose control of what you're eating and drinking. This only happens if you’re very unwell, your life is in danger or you can’t make proper decisions for yourself any longer and need to be protected.
See our frequently asked questions for more information.
You may see a dietitian to get help and advice with healthy eating and weight gain. The aim is to get you back to regular eating, without starving yourself or vomiting.
You can only get back to a healthy weight through eating more, which can be very difficult to cope with at first. A dietitian will help you set achievable goals for weight gain, and can give you advice about eating on a regular basis and managing the worry you feel about eating. It’s possible that you will need to take vitamin supplements in addition to regular meals to help you gain vital nutrients.
The causes of anorexia aren't fully understood and are probably different for everyone. They may include emotional, physical and social reasons.
Having certain personality traits, such as perfectionism or being overly sensitive, may mean you’re more likely to be affected by anorexia. This may be because limiting how much you eat and managing your weight give you a sense of control and achievement. Other things that are also associated with anorexia include:
- low self-esteem
- mental illness, particularly depression
There are certain factors that make it more likely that you will develop anorexia. For example:
- an emotionally upsetting event, such as divorce or an abusive family relationship
- a family history of eating disorders or other mental health problems, such as depression
- living in a Western society
- being influenced by media images of thinness
- being overweight or obese in the past
- having a job or hobby where a very lean body type is desirable (for example, running, athletics, modelling or dancing)
Over time, anorexia can cause serious long-term health problems.
- You’re at an increased risk of osteoporosis (your bones become weakened), which means you’re more likely to break a bone. The more weight you lose, the more severe the condition will become, and the longer you have anorexia, the less likely it is that your bones will recover.
- There is a great risk of damage to your heart, including abnormal heart rhythms and heart failure. These are the most common causes of death in people with anorexia – an abnormal heart rhythm can quickly become life-threatening, even in teenagers.
- You’re likely to have problems with fertility and pregnancy. If your periods have stopped, it’s likely that you won’t be able to get pregnant and if you do, you’re at a greater risk of miscarriage and postnatal depression. Your baby is also more likely to have a low birth weight. See our frequently asked questions for more information.
- If you have anorexia, you’re more likely to develop mental health problems, such as anxiety and depression, and also to abuse alcohol or illegal drugs. People with anorexia are at a much greater risk of attempting suicide – it’s thought that up to one in five people with anorexia try to kill themselves.
If you have severe anorexia, it's important that you receive appropriate treatment. If left untreated, the condition and its complications can be fatal.
It can be upsetting for loved ones to see you putting your health at risk. It's natural that they will want to help, even though you may find unwanted pressure or criticism make matters feel worse.
You may wish to make your own choices but may need a great deal of support. If you recognise you have a problem, others may be able to assist with practical matters such as finding medical help and support groups.
How long does it take to recover from anorexia nervosa?
The time it takes to recover from anorexia varies greatly from person to person.
Anorexia can last for years and, on average, it takes five to six years after you have been diagnosed to recover. However, some people never fully recover from the condition and may relapse during times of stress.
About half of all people with anorexia make a full recovery. Others find that their condition improves with time. Only about two out of 10 people don't recover and go on to have a long-term eating disorder.
It's important that you seek help for anorexia as early as possible. This is because the sooner you get help, the better your chances are of recovery. Getting better from an eating disorder can be a difficult process, but it can be done. To recover, you will need to start eating more food, put on weight and change how you think about yourself and food. For most people being treated as outpatients, the aim is to put on 0.5kg of weight per week.
I've heard that anorexia nervosa can stop your periods and make you infertile. I have had anorexia in the past but have since recovered. Will I be able to get pregnant?
Yes. If you're having regular periods and are a healthy weight, you will probably be able to become pregnant.
If you have anorexia, your periods might stop. This happens because anorexia causes changes in the hormones that control your reproductive system. If your periods have stopped because of anorexia, you probably won't be able to get pregnant because you aren't ovulating (producing eggs).
Many women find that their periods come back after they start to recover and are a healthy weight. If your periods have started again, you should be able to get pregnant.
However, if you're still underweight and not eating enough, you may not be able to gain the amount of weight that you need to during pregnancy. If you aren’t eating enough, you won’t have the nutrients needed to sustain both you and your unborn baby. As well as putting your health in danger, this means there is a risk that you might have a baby with a very low birth weight, which can lead to him or her having other health problems. Therefore, it's better if you attempt to recover from anorexia before you try to get pregnant.
Try to eat a varied, well-balanced diet and stay at a healthy weight for several months before getting pregnant. You will need to stay at a healthy weight throughout your pregnancy to make sure that you stay well and your baby develops properly.
If you have anorexia and are already pregnant, let your GP and midwife know because you may require special care. For example, you may need extra appointments to monitor the growth and development of your baby. It’s also a good idea to speak to your GP if you’re thinking of getting pregnant and have had anorexia in the past.
Will I need to be admitted to hospital to be treated for anorexia nervosa?
No, it's not likely. Anorexia is usually treated without you having to be admitted to hospital.
You can be treated for anorexia as an outpatient. This means that you go to hospital to see your doctor but you won't have to stay overnight.
You only need to stay in a hospital ward or a special eating disorder unit if you're seriously ill or very weak. You may also need to stay in hospital if you have already had outpatient treatment but your anorexia hasn't improved, or if there is a risk that you might try to harm yourself.
- Anorexia nervosa. Beat. www.b-eat.co.uk, accessed 29 May 2012
- Bulimia nervosa. Beat. www.b-eat.co.uk, accessed 29 May 2012
- Eating disorders: key facts. Royal College of Psychiatrists. www.rcpsych.ac.uk, published 2009
- Facts and figures. Beat. www.b-eat.co.uk, accessed 29 May 2012
- Eating disorders. Prodigy. www.prodigy.clarity.co.uk, published October 2009
- Morris J, Twaddle S. Anorexia nervosa. BMJ 2007; 334:894–98. doi:10.1136/bmj.39171.616840.BE
- Eating disorders and pregnancy: some facts about the risks. National Eating Disorders Association. www.nationaleatingdisorders.org, published 2005
- Eating disorders. Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. National Institute for Health and Clinical Excellence (NICE), 2004. www.nice.org.uk
- Eating disorders. Royal College of Psychiatrists. www.rcpsych.ac.uk, published January 2008
- Anorexia nervosa. BMJ Best Practice. www.bestpractice.bmj.com, published August 2012
- Eating disorders – complications of anorexia. University of Maryland Medical Center. www.umm.edu, published January 2009
- Anorexia nervosa fact sheet. Womenshealth.gov. www.womenshealth.gov, published June 2009
We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short form below will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.
Let us know what you think using our short feedback form Ask us a question
Produced by Polly Kerr, Bupa Health Information Team, October 2012.
Let us know what you think using our short feedback form Ask us a question
About our health information
At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. Here are just a few of the ways in which our core editorial principles have been recognised.
Information StandardWe are certified by the Information Standard. This quality mark identifies reliable, trustworthy producers and sources of health information.
Plain English CampaignWe hold the Crystal Mark, which is the seal of approval from the Plain English Campaign for clear and concise information.
What our readers say about us
But don't just take our word for it; here's some feedback from our readers.
“Simple and easy to use website - not alarming, just helpful.”
“It’s informative but not too detailed. I like that it’s factual and realistic about the conditions and the procedures involved. It’s also easy to navigate to areas that you specifically want without having to read all the information.”
“Good information, easy to find, trustworthy.”
Our core principles
All our health content is produced in line with our core editorial principles – readable, reliable, relevant – which are represented by our diagram.
In a nutshell, our information is jargon-free, concise and accessible. We know our audience and we meet their health information needs, helping them to take the next step in their health and wellbeing journey.
We use the best quality and most up-to-date evidence to produce our information. Our process is transparent and validated by experts – both our users and medical specialists.
We know that our users want the right information at the right time, in the way that suits them. So we review our content at least every three years to keep it fresh. And we’re embracing new technology and social media so they can get it whenever and wherever they choose.
Here are just a few of the ways in which the quality of our information has been recognised.
The Information Standard certification scheme
You will see the Information Standard quality mark on our content. This is a certification programme, supported by NHS England, that was developed to ensure that public-facing health and care information is created to a set of best practice principles.
It uses only recognised evidence sources and presents the information in a clear and balanced way. The Information Standard quality mark is a quick and easy way for you to identify reliable and trustworthy producers and sources of information.
Certified by the Information Standard as a quality provider of health and social care information. Bupa shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of Bupa.
We comply with the HONcode (Health on the Net) for trustworthy health information. Certified by the HONcode for trustworthy health information.
Plain English Campaign
Our website is approved by the Plain English Campaign and carries their Crystal Mark for clear information. In 2010, we won the award for best website.
Website approved by Plain English Campaign.
British Medical Association (BMA) patient information awards
We have received a number of BMA awards for different assets over the years. Most recently, in 2013, we received a 'commended' award for our online shared decision making hub.
If you have any feedback on our health information, we would love to hear from you. Please contact us via email: firstname.lastname@example.org. Or you can write to us:
Health Content Team
15-19 Bloomsbury Way