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Characteristics of Anorexia Nervosa Continued

Bridget Engel, Psy.D., edited by Kathryn Patricelli, MA

Dysfunctional Thinking

When the body is suffering from starvation, it will trigger natural survival mechanisms. These biological systems produce feelings of intense hunger and repeated thoughts of food to remind us to eat and stay alive. Once triggered, these thoughts of food are kept going and exaggerated by incorrect and irrational thoughts or errors in thinking (known as cognitive distortions). For example, someone with an eating disorder may justify a binge if she eats one cookie, since that small slip has ruined a perfect day of dieting.

These errors in thinking can become so inescapable and rooted in the brain that people lose the ability to understand reality and the dangerousness of their behaviors. Body image distortion is a particularly common problem for people with anorexia. They do not see themselves as dangerously thin. Instead, they often still see themselves as fat. This ongoing misjudgment of body image interferes with their ability to acknowledge that they have a problem that requires help. Many people with anorexia set unrealistic weight loss goals and believe that satisfaction will follow from meeting them. Despite dramatic weight loss, they are still unhappy because they still believe they are fat and should lose more weight.

Health problems

Even short periods of restricting behaviors can cause serious and life threatening medical complications. Not getting enough vitamins and minerals in the diet and severe weight loss cause changes in electrolyte levels. Electrolytes are electrically charged chemicals in your blood and cells that help to keep your heart and body functioning properly. Imbalances can cause tiredness, overall weakness, confusion, decreased concentration, and even seizures. Electrolyte problems and hormone imbalances can also lead to trouble falling asleep or staying asleep (insomnia). A deficiency in potassium can cause reduced reflexes, tiredness and heart abnormalities.

Long-term dieting and poor nutrition can decrease the level of iron in the blood. This causes frequent or easy bruising and tiredness. Low levels of sugar in the blood (known as hypoglycemia) can lead to shakiness, anxiety, restlessness, and sometimes fainting. A condition may also occur when there is not enough calcium in the blood. This can result in muscle spasms, numbness or tingling in the hands and feet, decreased vision, and long-term tiredness. Weak or brittle bones (osteoporosis) and teeth are also significant signs of an eating disorder, as is low bone density.

Long-term vomiting can cause chronic bad breath, rupturing of the esophagus (part of the throat), bloating, damage to the lining of the stomach, and s other stomach problems. Weak abdominal muscles caused by chronic vomiting can lead to a buildup of stomach poisons and byproducts. This will eventually weaken the immune system. Gastroesophageal reflux disease (GERD) can also develop. GERD is a potentially life threatening condition. The contents of the stomach back up into the esophagus and cause inflammation and heartburn symptoms. Constipation, abdominal pain, bladder incontinence, and urinary tract infections are all common symptoms because of poor nutrition in the diet. Long-term use of laxatives can also cause chronic diarrhea.

Body temperature regulation problems are common for individuals with anorexia. They often complain of being cold, no matter how warm it is outside. Growth of long, downy hair on the face, arms and body (called lanugo) is a sign that a starving body is attempting to stay warm. There are other symptoms as well, including delayed or permanently stunted growth. Severe dehydration is also not uncommon. This often leads to water retention, which causes swollen hands and feet and impaired kidney functioning. Not taking in enough fat over time causes skin to become blotchy, dry and gray or yellow. Also, fingernails become brittle and hair weakens and falls out.

Many people who have had anorexia for long periods of time develop serious heart problems. A decrease in the size of the heart muscle and chamber can happen. This causes fainting, disruptions in blood pressure, and irregular or slow heartbeats. Without appropriate medical treatment, heart problems and other body system issues can lead to serious complications and even death.

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