Anorexia nervosa is not about dieting, appearance concerns, or health conciousness. It’s a serious and potentially life-threatening mental health disorder.
One of the most painful realities of anorexia is that the very behaviors that signal illness — restricting food, maintaining rigid control over eating habits, or losing excessive amounts of weight — can feel like signs of success to the individual experiencing them. To family members and loved ones, behaviors that may look from the outside like “self-discipline” or a “healthy lifestyle” can, in fact, be early warning signs of a disorder that is affecting the mind, body, and nearly every facet of life.
Recognizing the symptoms early matters. It can be the difference between years of suffering and progressive health issues and a path toward healing and well-being. What follows is a careful, evidence-based guide to the signs and symptoms of anorexia, drawn from the most trusted research, so that if you see them in yourself or someone you care about, you will understand them as signs of a potentially deadly mental health disorder.
What to Look For: Signs + Symptoms
Anorexia nervosa is not limited to single set of symptoms or behavioral changes. It affects the body, mind, and daily life in deeply interconnected ways, and its symptoms can be both obvious and invisible.
For some, the most striking changes are physical — weight loss, fatigue, or changes in skin and hair. For others, it begins in the mind, with thoughts that grow more rigid, fears that spiral, or social choices that slowly narrow around food and body image.
Understanding anorexia means recognizing that its symptoms are not simply about eating less. They reflect an all-encompassing mindset that affects not only what a person eats but how they see themselves, how they interact with the world, and how they respond to stress and change. By looking at the physical, psychological, behavioral, and social signs together, we can better understand how complex and disruptive this disorder really is — and why early recognition is crucial for recovery.
Physical/Medical Symptoms
Low body weight/BMI and weight loss. One of the clearest signs of anorexia is when someone’s weight drops well below what’s expected for their age, height, and overall health. In “typical” anorexia, this often looks like steady weight loss over time. In “atypical” anorexia, a person’s weight might still fall into the “normal” range, yet their body is under the same kind of stress and facing many of the same medical risks as someone who is visibly underweight. In fact, research shows that adolescents with atypical anorexia can still experience dangerous complications of malnutrition (Journal of Eating Disorders, BioMed Central, 2023).
Vital sign changes. Anorexia doesn’t just affect how someone looks — it affects how their body works. The heart may slow down (a condition called bradycardia), blood pressure can drop, body temperature may run unusually low, and some people feel lightheaded or faint when they stand up quickly. These are signs that the body is conserving energy to survive. Even in atypical anorexia, where weight may not appear “alarmingly low,” these medical changes can still happen at significant rates (Journal of Eating Disorders, BioMed Central, 2023).
Gastrointestinal problems. Digestive problems are common in anorexia and can make eating even more stressful. Individuals may struggle with bloating, constipation, stomach pain, or feeling overly full after small meals. Some even develop difficulty digesting certain sugars like lactose or fructose. A systematic review found that these issues are linked not only to low food intake, but also to actual changes in how the gut processes and absorbs nutrients (Journal of Eating Disorders, BioMed Central, 2022).
Other physical symptoms. Beyond weight changes, anorexia can show up in smaller, everyday ways. Hair may thin, skin can become dry, and nails might turn brittle. Many women stop getting their periods. Fatigue, weakness, and feeling cold most of the time are also common. Over the long term, bone density can drop, raising the risk of fractures, and dental problems may develop, especially if purging behaviors are involved.
Psychological + Cognitive Symptoms
Distorted body image and overvaluation of shape or weight. One of the most painful aspects of anorexia is the disconnect between reality and perception. A person may be medically underweight yet truly believe they are “too big.” But body image distortion goes far beyond what someone sees in the mirror — it can affect how they feel in their body, how they move, and even how they remember their own shape (Journal of Eating Disorders, BioMed Central, 2025).
Intense fear of gaining weight. Even small changes on the scale, or simply the thought of gaining weight, can trigger intense fear. This fear often drives restrictive eating patterns and the avoidance of foods or situations that feel “unsafe.”
Rigid thinking. Research shows that many people with anorexia struggle with rigid thinking. They may feel stuck in strict food rules or routines, unable to adapt when things change. Some of these thinking patterns can continue even after weight is restored, which is one reason relapse risk can be high (Archives of Clinical Neuropsychology, Oxford Academic, 2025).
Mood issues, anxiety, and depression. Anorexia often overlaps with other mental health struggles. Anxiety disorders, obsessive-compulsive tendencies, and depression are especially common. Studies show that the longer the condition persists, the more severe these psychological challenges become, further complicating recovery. (Biopsychosocial Medicine, BioMed Central, 2019).
Behavioral Symptoms
Food restriction. Food restriction may look like eating significantly fewer calories, eliminating entire food groups, skipping meals, or eating extremely small portions.
Compensatory behaviors. Some people with anorexia use purging behaviors (compensatory behaviors) to prevent weight gain after they eat. Compensatory behaviors include self-induced vomiting, laxative or diuretic misuse, and excessive exercise. These behaviors can be dangerous and further weaken the body.
Preoccupation with food, calories, or dieting. It’s common for food and eating behaviors to take up an outsized amount of mental space in individuals with anorexia. A person may spend much of the day planning what to eat, worrying about what they already ate, or obsessively checking labels to avoid certain foods or stay below a rigid number of calories.
Ritualized eating habits. Meals may come with strict rules or routines: only eating at certain times, cutting food into precise pieces, or chewing each bite a set number of times, for instance. These rituals can give a sense of control but often add to existing anxiety and isolation. A person may opt to skip meals with others so they can more easily engage in their rituals without fear of feedback or concern from others. They may also experience intense distress and feelings of self-hatred if they don’t perfectly adhere to each ritual.
Social Symptoms
Withdrawal from social activities. Because so many social events revolve around food, people with anorexia often start avoiding them. Skipping dinners with friends or family gatherings may feel easier than dealing with the stress of eating in front of others.
Shame, secrecy, and avoidance. Eating may happen in secret, or a person may deny they’re eating too little. Feelings of guilt and shame often build around food, making it harder to talk openly or ask for help.
Strained relationships. Over time, the illness can create friction with family and friends. Arguments about food, body image, or control are common, and relationships may become distant as the disorder takes center stage.
Variation in Symptoms
No one experiences anorexia exactly the same. Some people show more physical symptoms early; others show psychological symptoms first. Severity and symptoms often depend on:
How long the illness has been present
Age at onset (e.g. adolescent vs adult)
Sex/gender, medical history, whether there is “typical” vs “atypical” anorexia
Whether there are co-existing mental health conditions (anxiety, OCD, depression) or physical health complications
When to Seek Help
If someone is experiencing several of these symptoms — especially low body weight (or rapid weight loss), distorted body image, intense fear of weight gain, and avoiding social or eating situations — early intervention is key.
At Magnolia Creek in Alabama, our mental health professionals and dietitians specialize in treating eating disorders. They can perform assessments including physical exams, labs (for electrolyte levels, cardiac health, bone health, etc), psychological evaluation, nutritional assessment, and more. These assessments can help guide you towards the right treatment plan that will best meet your needs.
The Big Picture: Why These Symptoms Matter
These symptoms aren’t just “bad habits” or “phases.” Anorexia has one of the highest mortality rates of any psychiatric illness. It can cause long-term damage to the heart, bones, reproductive system, digestive tract, and brain. Psychological suffering can deepen with shame, isolation, depression, and anxiety. But many individuals recover fully or significantly given the right support, compassion, and evidence-based care.
A key power for those suffering (and those looking out for them) is knowledge. Recognizing anorexia symptoms early — not minimizing or normalizing distress — is a step toward care, support, and healing.
Finding Hope + Healing
Anorexia nervosa is a serious eating disorder that requires professional treatment and ongoing support. Early intervention can make a significant difference, helping individuals restore their health and build lasting recovery. At Magnolia Creek, we specialize in evidence-based anorexia treatment, offering personalized care in a compassionate, healing environment.
If you or a loved one is showing signs of anorexia, don’t wait to seek help. Contact Magnolia Creek today to learn more about our comprehensive eating disorder programs and take the first step toward recovery.
References
- Charrat, J.-P., Massoubre, C., Germain, N., Gay, A., & Galusca, B. (2023). Systematic review of prospective studies assessing risk factors to predict anorexia nervosa onset. Journal of Eating Disorders, 11, 163.
- Buck, P., Joli, J., Zipfel, S., & Stengel, A. (2022). Carbohydrate malabsorption in anorexia nervosa: a systematic review. Journal of Eating Disorders, 10, Article 189. BioMed Central
Thibault, I., et al. (2025). Anorexia Nervosa in Adolescence: A Comprehensive Study of Multidimensional Factors Associated with Symptom Severity 1 Year Following the Diagnosis. Child Psychiatry & Human Development, 56, 824-833. - Noon, R., & Pathan, T., et al. (2025). A systematic review to explore a neuropsychological profile that pre-dates anorexia nervosa. Archives of Clinical Neuropsychology, 40(2), 330-344.
- Physical and psychological aspects of anorexia nervosa in relation to illness duration (Japanese cohort study). (2019). Biopsychosocial Medicine, published online. (n = 204 female AN patients).
