The people closest to you are the ones who know you best – parents, children, spouses, and your closest friends. They know a person’s moods, habits, likes and dislikes, and so on. However, the people closest to you are unlikely to be doctors or eating disorder specialists, and aren’t likely to know the early symptoms of anorexia nervosa which might indicate that the first steps toward anorexia nervosa treatment are needed.
It’s not unknown for individuals who have an eating disorder, such as anorexia nervosa, bulimia nervosa, or other types to gloss over and obscure their symptoms when questioned about it. They may even hide the evidence that they have an eating disorder. Many family members and loved ones are surprised when the evidence of an eating disorder becomes irrefutable.
That’s why it’s important to know the subtle signs of an eating disorder like anorexia nervosa. Family members aware of a budding issue can consider how they can help their loved one – and stop this devastating disorder in its tracks.
Symptoms of Anorexia Nervosa
If you Google the term “symptoms of anorexia nervosa” there will be a ton of pictures of thin young women, mostly white, with their ribs showing, etc. While that is a very visible symptom of the disorder, it is far from being the only one. Malnutrition and emaciation are results of a long-term disorder or an extremely severe one.
But it’s not the only one – the early signs of anorexia nervosa are more subtle and might require careful observation to notice. In fact, increasing the knowledge base of the loved ones who are closest to an individual can allow them to understand that there is a need for anorexia nervosa treatment.
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Fatigue
Everyone gets fatigued sometimes, even young adults who are brimming with youthful energy. It makes a certain amount of sense – it takes a lot of energy to grow from a child to an adult, and teens and young adults definitely need their sleep. There are other factors that can cause fatigue as well. For one thing, athletics and other extracurricular activities can be demanding.
During the early adult years, from 18 to 21, which is when many people who have an eating disorder first show the signs of an eating disorder, many young people juggle studies, extracurriculars, social lives, and jobs.
Often, this amalgamation of strenuous activities can lead to a decline in sleep and an increase in overall fatigue. During this time period, a teen girl or boy’s body often needs additional sleep due to developmental and hormonal changes. In spite of this need, research has determined most teens don’t get the recommended 8 to 10 hours of sleep per night. With this kind of pressure, it’s no wonder these years often bring increased tiredness and fatigue.
However, another reason for that fatigue can be a lack of caloric intake. As you probably know, calories act as fuel for our bodies – we need them to keep our brains working and our hearts beating. Anorexia nervosa is by definition a behavioral pattern that restricts caloric intake – and thusly decreases the amount of fuel the body takes in. If you notice your loved one is constantly showing fatigue (especially if you notice they eat very little), it can be a clear warning sign of anorexia nervosa developing.
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Constipation and Abdominal Issues
Constipation is another common occurrence in the United States that might be easily overlooked as a warning sign of anorexia nervosa. Many people’s diets lack adequate fiber, which can cause constipation. Constipation can also have other causes, like eating certain kinds of food to excess or using opioid painkillers, meaning it happens to millions every day – hardly a bright red flag for anorexia nervosa.
All this makes constipation and the abdominal pain that comes with it a symptom of anorexia nervosa that’s too easily overlooked, even for those people closest to the individual who has an eating disorder. It’s also unlikely that anyone – eating disorder or no – is going to be openly discussing their bowels, and of course, this sign is also one that could be an indication of numerous other medical conditions.
But for parents and other loved ones who suspect there may be an issue with an eating disorder, any reports of constipation or abdominal pain should be closely observed. Since they’re frequent symptoms of anorexia nervosa and other eating disorders, they can warrant taking a closer look by both immediate family members and medical professionals.
In other instances, a teen or young adult could point to the necessity of a special diet or one that is more restrictive as a requirement of a sport they are playing or an extracurricular activity they are engaged in. For example, a gymnast or wrestler may need to maintain a certain weight limit in order to meet the parameters established for the sport. A distance runner may need a surplus of carbohydrates to provide fuel for the extended races they’ll engage in.
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Insomnia
Teenagers and young adults need extended sleep periods, more so than older adults, because of the rapid growth both mentally and physically that they undergo during this time. Adolescence, ironically, often can bring bouts of insomnia. In fact, for many people in this age group, this is the first time they have had to grapple with being unable to sleep in spite of needing and wanting to do so.
Although insomnia or general sleeplessness can present themselves as a normal part of adolescent development, it’s also a common side effect of caloric restriction and other disordered behaviors associated with anorexia nervosa. This makes insomnia a subtle indicator of a larger problem that’s difficult to notice. If parents or loved ones of a young adult notice a sudden onset of insomnia in conjunction with other signs of anorexia nervosa, it’s wise to look into the situation more deeply.
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Extreme Weight Loss and Thinness
The classic symptom of anorexia nervosa is extreme weight loss. Even this classic sign, though, is not as clear cut as one might assume from the movies and other depictions seen in the media. For one thing, most people with anorexia nervosa have a skewed idea of their weight – even when their natural body shape has leaned toward being thin in the first place. In a situation like this, the weight loss may not be extreme, even though caloric intake has been restricted.
Another important thing to consider is that while a thin appearance is most often associated with anorexia nervosa rather than other eating disorders like binge eating disorder or ARFID, it’s not exclusively associated with anorexia. Extreme thinness can result from selective eating disorders, excessive exercise disorder, or bulimia nervosa as well. Simply put, thinness is a result of anorexia nervosa, but not exclusively so.
Thinness or emaciation is a clear warning sign that a disorder is developing – but it’s also easy for most teenagers to hide. As body awareness and shyness about their body begins in early adolescence, it’s not unusual for teenagers to avoid undressing in front of others, or to begin wearing baggy or oversized clothes to obscure their body’s shape or size. They might take a liking to sweatpants, baggy shirts and other clothing that is too big for them. Behaviorally, the adolescent or young adult in question might begin avoiding situations where baggy clothes are a no-go, such as the beach or swimming pool, gymnastics or ballet performances, or formal events where tight dresses are the norm.
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Thinning Hair and Dry Skin
Due to anorexia nervosa’s signature avoidance of eating, there is a lack of the vitamins and minerals required by the body to maintain good health. As an eating disorder progresses, there may be noticeable differences in the person’s hair and skin. The skin might begin to dry out and crack, as well as taking longer to heal from small cuts or acne scars. The hair might break more easily or fall out in greater quantities than previously experienced.
The teenager in question may not complain about this or even raise the subject, those people closest to them might notice a difference. This could be a part of a larger pattern that’s common to all the above symptoms – hiding the problem or denying there is one. People with eating disorders often feel guilt or shame about the disorder and will go to great lengths to hide it.
Even One of These Symptoms Deserves Closer Attention
With the fact that denial is common among people with eating disorders in mind, the sudden presence of even one of the symptoms on this list deserves further investigation. If nothing else, a consultation with their family doctor or therapists could rule out the presence of an eating disorder or indicate that further treatment is necessary.
While any one of the symptoms could be innocuous, they could be indicators that there is more at stake than a bout of insomnia or a preference for baggy clothes. Certainly, when there are two or more such signs present, it warrants an appointment with an expert who can more correctly make a diagnosis of anorexia nervosa or another eating disorder.
At Monte Nido and Affiliates, the friendly and experienced clinical staff can help guide the family and friends of a troubled young adult. Oftentimes, the loved ones will have nothing more than suspicions and don’t know how to take the next steps in securing help. By performing an assessment, the talented and compassionate staff can help determine if an anorexia nervosa diagnosis is warranted, and help plan the next steps for treatment.
Monte Nido’s eating disorder treatment centers provide a complete continuum of care for eating disorders at both residential and day treatment facilities across the county, and we pride ourselves on treating the whole person in a manner that facilities long term recovery. Contact us for more information today.
Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.