Psychological and Behavioral Signs of Anorexia & Bulimia

According to the American Psychiatric Association's DSM-V, anorexia nervosa and bulimia nervosa have psychological features, which vary from patient to patient. Possible features include:

  • Many people with eating disorders have major depressive disorder. They may withdraw socially, be irritable, have insomnia, and experience reduced libido. In some patients, the symptoms of major depressive disorder are physiological responses to starvation and resolve as the patient restores their body weight during treatment.
  • Most people with eating disorders suffer severe anxiety. Anxiety may cause bulimics to continue eating when they are no longer hungry.
  • People with anorexia nervosa are often preoccupied with food, and may collect recipes or hoard food.
  • People with eating disorders are often perfectionists.
  • People with anorexia nervosa are often uncomfortable eating in public, often feel ineffective, and have a strong need to control their environment.

Physical Symptoms & Medical Complications of Anorexia and Bulimia

There are various physical symptoms and medical complications associated with eating disorders, including the following:

  • The most apparent physical symptom of anorexia is emaciation.
  • Amenorrhea (the absence of at least 3 consecutive periods) is common in bulimics and anorexics as a result of disrupted hormonal function. Poor nutrition and low body weight are associated with a reduced estrogen level and an increased risk for premature osteoporosis (bone loss).
  • Despite being malnourished, people with anorexia are often hyperactive. Lethargy may indicate depression or cardiovascular complication.
  • People with anorexia nervosa often wear layers of bulky, oversized clothing, and may appear younger than they are.
  • Anorexics are generally malnourished (the medical term for general malnourishment and physical wasting is cachexia, which is usually associated with chronic disease).
  • A woman with anorexia usually has atrophied (shrunken) breasts.
  • The skin of anorexics is often dry and has a yellow tinge.
  • Lanugo (the growth of fine, downy body hair) is common in anorexics.
  • Bulimics may have scars on the backs of their fingers where their front teeth scrape the skin during self-induced vomiting, tooth decay, erosion of tooth enamel, and extreme tooth sensititivity to hot and cold.
  • Bradycardia (slow heart rate) is common.
  • Eating disorder patients often complain of cold intolerance, dizziness, constipation, abdominal discomfort, and bloating.
  • Edema (swelling) may occur, usually in the legs, as a result of an electrolyte imbalance caused by starvation or excessive vomiting.
  • Other physical symptoms include hypotension (abnormally low blood pressure), potassium deficiency in the blood, and hair loss.

Anorexia and Bulimia Differential Diagnosis

Chronic illness (e.g., cancer) can cause anxiety, depression, and weight loss. Diabetes mellitus and hyperthyroidism can cause rapid weight loss, without loss of appetite. Some gastrointestinal disorders reduce the appetite and cause weight loss due to the abdominal pain, diarrhea, and cramping that occur after eating. Gastrointestinal diseases that interfere with nutrient absorption, such as irritable bowel syndrome and celiac disease, may inhibit the ability to gain weight. Advanced HIV disease, or AIDS, can also cause weight loss.

Psychiatric disorders that may be associated with starvation or purging include conversion disorder (loss or change in voluntary motor or sensory function that is not caused by a physical disorder), schizophrenia, and mood disorders (e.g., depression).

Anorexia & Bulimia Indications

There are many signs that indicate a risk for an eating disorder. Parents, health care providers, teachers, and coaches should look for the following behaviors, especially in teenagers:

  • having a weight that is 15 percent below normal that is not due to an underlying medical condition (anorexia; bulimics are usually within their normal weight range)
  • eating in secret (bulimia)
  • vomiting after eating (bulimia)
  • using medications, laxatives, or diet pills to control weight (bulimia)
  • chewing and then spitting out food (an eating disorder that resembles bulimia but is not classified as such according to the DSM)
  • experiencing amenorrhea (absence of menstruation) that is not due to an underlying medical condition
  • weighing oneself often
  • experiencing a mood change after eating or after weighing oneself
  • feeling dissatisfied with body weight or shape
  • feeling fat even though they are assured that they are thin
  • feeling a loss of control when eating
  • having a fear of gaining weight uncontrollably
  • being uncomfortable eating in front of others
  • being uncomfortable with comments from others regarding weight or eating

Most people occasionally experiences mood changes after eating too much and are dissatisfied with our bodies at times. This behavior is normal, unless it is persistent and part of a pattern. Anyone who is concerned about their behavior or the behavior of a friend or family member, should consult with a doctor, therapist, or other health care provider.

Publication Review By: the Editorial Staff at

Published: 01 Jan 2001

Last Modified: 14 Sep 2015