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The most common anorexia symptoms explained

Last Modified: 5/22/2018

The unique mental and physical effects of anorexia can present some challenges to physicians trying to provide a diagnosis. Margherita Mascolo, MD, Board-Certified Internal Medicine Specialist, Medical Director, ACUTE Center for Eating Disorders and Associate Professor of Medicine, University of Colorado, who will be speaking to Parkview Health physicians next week as part of a series of eating disorders education events, provides more on the science behind common symptoms.

Patients suffering from an eating disorder present a diagnostic dilemma to even the most astute physicians, as these patients often minimize their symptoms and at times hide any evidence of their disease.  I wanted to share with you some of the most common symptoms of an eating disorder in an effort to educate the public and perhaps help patients that are struggling with an eating disorder to get them the medical attention they really need. 

The most common complaints of patients with eating disorders and malnutrition are related to the gastrointestinal system.  This is no surprise for several reasons.  First of all, there is such a strong connection between the brain and the gut that any mood alteration can affect the gastrointestinal tract and vice versa. 

As the body becomes more and more malnourished as a result of starvation, there are several protective mechanisms that the organism sets in place in order to deal with such a reduced caloric intake. As a consequence of starvation, the gastrointestinal tract slows down to absorb as much as possible from the few calories ingested.  The longer it takes food to pass from the mouth to the rectum, the more nutrients it can absorb.  This results in delayed emptying of the stomach (gastroparesis) and delayed transit of food throughout the entire gastrointestinal tract (small and large bowel). This slowed transit results in complaints such as early satiety/fullness, bloating, nausea, acid reflux, abdominal pain, and constipation. 

This series of physical manifestations is very unfortunate as it negatively reinforces the underlying eating disorder.  When patients begin to try and eat they physically feel ill, nauseated, and have pain which causes them to revert back to their eating disorder behaviors.  Sadly, the continued caloric restriction leads to worsening of these physical complaints and only perpetuates the cycle of restriction and its physical consequences. 

Other common complaints of patients suffering from an eating disorder include fatigue, lack of energy, dizziness, near-fainting, and feeling cold.  As the body becomes more malnourished, one of the compensatory and protective mechanisms it sets into place is to down-regulate its metabolism in an effort to burn as few calories as possible and still maintain vital functions.  This state of hibernation results in a slowed heart rate (bradycardia) as well as low blood pressure (hypotension) which can make patients feel tired and fatigued.  The body also drops its core temperature which can make patients feel very cold, especially in their hands and toes; this is aggravated by the decrease in body fat and thus insulation that goes along with malnutrition.  Dizziness and near-fainting can be due to a combination of low blood pressure, low heart rate, and bradycardia. 

On physical exam, some of the most common findings in patients with anorexia nervosa are: dry skin with a yellow hue, brittle nails, thin scalp hair, lanugo hair which is fine, furry hair found on the face, neck, arms, back, and legs, and purplish-blue hands and feet.  All these findings are very non-specific but can indicate an underlying eating disorder and invite more specific questions.

Want to learn more? Register to attend Eating Disorders 101: The Latest Information You Need to Know, April 25, 8 a.m. – 4:30 p.m. If you or a loved one are suffering from these or other symptoms, please call the Parkview Behavioral Health Help Line at (800) 284-8439 or (260) 373-7500. 


Mehler, PS and AE Anderson.  Eating Disorders. Baltimore: Johns Hopkins UP, 2010. Print.
Mehler, PS. Diagnosis and Care of Patients with Anorexia Nervosa in Primary Care Settings.  Ann Int Med. 2001; 134:1048-1059.
Mehler, PS, Cleary, B, and Gaudiani, JL.  Osteoporosis in Anorexia Nervosa.  Eat Disord. 2011; 19:194-202.  

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