People with anorexia nervosa usually find it very difficult to recognise their condition. They will probably try to hide their condition from their family, as well as other people close to them. They will also try to hide their eating habits.

Losing weight deliberately

The main symptom of anorexia is losing a lot of weight deliberately, for example, by:

• eating as little as possible (under-eating),
• making yourself vomit, and
• doing too much exercise (over-exercising).

Someone with anorexia wants their weight to be as low as possible - much less than the average for their age and height. They are so afraid of gaining weight that they cannot eat normally.

After they have eaten, they may try to get rid of food from their body, by making themselves vomit regularly. Signs of this could include:

• leaving the table immediately after meals, and
• hard skin on their knuckles, caused by putting their fingers down their throat.

They may also try to make food pass through their body as quickly as possible. For example, by taking:

• laxatives (medication that helps you empty your bowels), or
• diuretics.

However, laxatives and diuretics have little effect on the calories absorbed from food.

Eating and food

Although anorexia means 'loss of appetite', people with anorexia nervosa do not usually lose their appetite. They like food and feel hungry.

However, they do not think about food in the same way as other people. This can show itself in various ways. For example, they may:

• tell lies about eating or what they have eaten,
• give excuses about why they are not eating,
• pretend they have eaten earlier,
• tell lies about how much weight they have lost,
• find it difficult to think about anything other than food,
• spend lots of time reading cookery books and recipes, and
• cook big meals for other people, but eat little or none of the food themselves.

Someone with anorexia nervosa strictly controls what they eat. For example, by:

• strict dieting,
• counting the calories in food excessively,
• avoiding food that they think is fattening,
• eating only low-calorie food,
• missing meals (fasting),
• avoiding eating with other people,
• hiding food,
• cutting food into tiny pieces - to make it less obvious that they have eaten very little, and the food is easier to swallow, and
• taking appetite suppressants such as slimming pills or diet pills.

They may also drink lots of fluids that contain caffeine, such as coffee, tea and low calorie fizzy drinks.

Self-esteem, body image and feelings

People with anorexia often believe that their value as a person is related to their weight and how they look. They think that this is what makes other people like them. And that other people will like them more if they are thinner - they see their weight loss as positive.

They often have a distorted view of what they look like (body image). For example, they think they look fat when they are not. They may try to hide how thin they are, by wearing loose or baggy clothes.

Anorexic people usually have low self-esteem or self-confidence. They may withdraw from relationships, becoming distant from members of their family and friends.

Anorexia can also affect someone's school work or how well they perform in their job.

They may find it difficult to concentrate and lose interest in their usual activities. They may have few interests, even though they seem to be busier than usual.

Other signs of anorexia

Eating too little for a long time can cause health problems, resulting in physical symptoms.

People with anorexia may find their hair, skin and nails are affected. For example:

• fine downy hair (lanugo) may grow on their body,
• hair on their face may increase, or
• their pubic hair may become sparse and thin.

Their heartbeat may be slow or irregular, which can lead to poor circulation. They may also:

• have pain in their abdomen,
• feel bloated or constipated,
• have swelling in their feet, hands or face (oedema),
• feel very tired (fatigue) - as their sleep patterns may have changed,
• have low blood pressure (hypotension),
• feel cold or have a low body temperature (hypothermia), and
• feel light-headed or dizzy.

In young people, puberty and the growth spurt that goes with it may be delayed. They may gain less weight than expected, even if they do not lose it. They may be smaller than other people the same age.