Symptoms of anorexia nervosa

Symptoms of anorexia nervosa may be mild and transient or long-lasting and severe. Most patients are thin when they develop weight preoccupation and restrict food intake. Anxiety and worry about weight increase even as emaciation develops.

Anorexia is a misnomer, as appetite persists even when the patient has reached the level of cachexia. Patients are preoccupied with food: studying diets and counting calories, hoarding, hiding, and throwing away food, collecting recipes, and painstakingly preparing food for others. Patients are often manipulative, lying about the food they eat, and covert behaviors such as self-induced vomiting are the main psychological symptoms of anorexia. Compulsive overeating, accompanied by vomiting and the use of laxatives and diuretics (binge-purge behavior), is observed in 50% of cases. Other patients use only restriction of food intake. Most patients with anorexia use excessive physical exercise to control their weight.

Bloating, indigestion, and constipation are common. Patients typically lose interest in sex. Depression is common. Somatic symptoms of anorexia include bradycardia, low blood pressure, hypothermia, lanugo or mild hirsutism, and edema. Even patients who appear cachectic remain quite active (including following vigorous exercise programs), do not develop symptoms of nutritional deficiency, and are not susceptible to infections.

Endocrine symptoms of anorexia include prepubertal or early-pubertal patterns of luteinizing hormone secretion, low thyroxine and triiodothyronine levels, and increased cortisol secretion. In theory, any organ system may be affected if the patient is severely malnourished. Menses usually cease. Dehydration and metabolic alkalosis may occur, and potassium levels may be low; these are aggravated by induced vomiting, laxatives, and diuretics. Cardiac muscle mass, chamber size, and cardiac output are reduced. Some patients experience prolongation of the QT interval (even after adjusting for heart rate), which, together with the risks posed by electrolyte disturbances, may lead to tachyarrhythmias. Sudden death may occur, most commonly due to ventricular tachyarrhythmias.

M. V. Korkina (1986) identifies several periods of the disease, depending on which symptoms of anorexia predominate: initial, anorectic, cachectic, and the stage of reduction of nervous anorexia.

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Symptoms of anorexia in the first period

The first period is the formation of dysmorphomania (dissatisfaction with appearance, desire to correct the deficiency).

Symptoms of anorexia in the second period

The second stage is anorectic; it ends with a weight loss of 25-50% of the initial body weight and is represented by a wide clinical symptomatology, secondary somatic disorders, and changes in the endocrine system. The symptoms of anorexia for this period are as follows: patients dissimulate their illness, claim that they have no appetite, but during a psychological examination they demonstrate a high food need; they do not have true anorexia. They limit themselves in food intake, use intense physical exercise. 50-60% of patients cannot withstand the feeling of hunger and resort to inducing vomiting after eating, in some patients vomiting is associated with attacks of bulimia. Vomiting is initially accompanied by unpleasant vegetative manifestations, but quickly becomes habitual. After it and washing the stomach with a large amount of water, a feeling of lightness and pleasure from "cleansing" arises. Patients also use passive methods of losing weight - taking diuretics and laxatives. Almost all of them experience amenorrhea at this stage: symptoms of anorexia such as bradycardia and hypotension appear. At the same time, high motor activity is maintained. Hypothermia, chilliness, dry skin, alopecia, constipation, and edema are noted.

Symptoms of anorexia cachectic period

Weight loss of more than 50% of the initial body weight leads to cachexia, and in the absence of medical care, the cachectic stage develops. Patients completely lose critical attitude to their condition, subcutaneous fat is absent, hypertrichosis, dry skin, edema, trophic changes, bradycardia, hypotension, and severe electrolyte imbalance are observed. These symptoms of anorexia without therapeutic intervention lead to death.

Symptoms of anorexia are determined by the presence of dysmorphophobic experiences (this mainly comes down to the conviction of excessive weight), fear of possible obesity, and a pronounced desire to lose weight. Behavior aimed at losing body weight is noted in the form of self-restriction in nutrition with periods of deliberate starvation, intensification of physical activity, taking laxatives, and self-induced vomiting. As a rule, intense weight loss is noted with a loss of at least 15% of body weight, and there is no menstrual cycle. Amenorrhea may be accompanied by significant weight loss, but in 25% of women it precedes it.

Primary somatic or endocrine pathology is not detected. During the period of formed syndrome of nervous anorexia, the body weight deficit with pronounced cachexia is 30-50% or more of the body weight before the disease. In the dynamics of the syndrome, four stages are distinguished:

1. primary, initial;
2. anorectic;
3. cachectic;
4. stage of reduction of nervous anorexia.

Symptoms of anorexia are often combined with nervous bulimia syndrome. The disease usually begins at the age of 14-20. It is extremely rare in young men. Significant weight loss usually leads to the development of secondary somatoendocrine changes.