Cognitive Behavioral Therapy

Anorexia Symptoms - A Cognitive Behavioral Therapy Guide

Anorexia symptoms fall into five main categories.

Posted January 8, 2013

Anorexia symptoms fall into five main categories. Understanding the symptoms of Anorexia is essential for sufferers and families. What's really important is that you understand that these are symptoms of the disorder and not defects of you as a person.

Cognitive Symptoms

- People with anorexia are often obsessed with food. They may wander the aisles of the supermarket, or spend hours Googling recipes or watching Top Chef.

- Another cognitive symptom of Anorexia is rigid rules, such as the weight of a serving of oatmeal the person allows themselves to eat, or the number of ab crunches they must do per day. The person may feel extremely upset if there is a possibility of not being able to act in accordance with their rules.

- Obsessionality caused by anorexia often extends beyond eating topics. For example, increased perfectionism around work or study.

- Difficulties with concentrating and decision making.

- Denial of having a problem. People with anorexia often don't recognize the seriousness of their problem.

- Seeing the symptoms as an expression of values or free will rather than as common symptoms of a disorder. Psychologists use the phrase "ego-syntonic" to describe this common feature of Anorexia.

Emotional Symptoms

- Shame about having a problem. Anorexia often strikes previously sensible and level-headed people who were not expecting to develop a "mental disorder."

- Low mood.

- Anxiety about gaining weight or about eating or exercise routines being disrupted.

- The person may not be anxious about their health, or they may be anxious about symptoms such as hair loss but not about the possibility of dying from low weight (due to denial of the seriousness of the problem, as mentioned previously).

Behavioral Symptoms

- The majority of people with with Anorexia start binge eating at some point. These binges may be "subjective binges" (where the person feels out of control but doesn't eat an excessive amount, such as eats two slices of pizza), or "objective binges" (such as eating a whole pizza).

- Eating rituals, such as always eating in the same place with the same utensils.

- Avoiding social eating.

- Wearing baggy clothes.

- Lying about eating (e.g., person saying they've eaten lunch when they haven't. Includes lying to therapists).

- Weighing self very frequently or avoiding weighing self.

- Checking rituals such as checking thighs do not touch.

- Spending more time studying or working because difficulty concentrating reduces efficiency.

- Avoiding certain "forbidden foods"

Interpersonal Symptoms

People with anorexia often withdraw socially and sexually. Social withdrawal is often related to wanting to avoid public eating situations, but it can also be related to low mood, feelings of shame, or rigid food or exercise routines. For example, if the person does 2-3 hours of exercise per day they may even avoid going on an amazing vacation if they wouldn't be able to do their exercise ritual.

Conflict can occur in family and romantic relationships due to the symptoms.

Physical Symptoms

An individual's physical symptoms of Anorexia need to be assessed by their physician. However, common physical symptoms include:

- reduced brain volume (There is some evidence that this is reversible by resuming normal eating and weight)

- hair loss

- lanugo (fine hair growing on the body such as on the face)

- slow heart rate and other heart damage

- bone density loss

- poor circulation and feeling cold all the time

- Experts disagree about how skinny someone needs to be to qualify for a diagnosis of Anorexia. Most often Body Mass Index of 17.5 is used, but other experts have proposed using BMI<19 provided all other criteria for the disorder are met. (Strict vs. lenient criteria for Anorexia)

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