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If you have anorexia, you probably know what the symptoms are. They have been a major part of your life for months or even years. And yet, you may deny that you have a problem or think you can control it.

Here's a list of the physical signs and feelings you may have with anorexia.¹

• You are very underweight for someone of your age and height. Your doctor might say that your body mass index (BMI) is too low. But you don't see why you need to put on weight.
• You eat very little, if at all, or only eat food that is low in calories.
• You fear putting on weight and becoming fat even though you are very thin.
• You feel fat even though people tell you how thin you are.
• You won't admit that you have a serious illness.
• If you're female, your periods stop. This is because anorexia affects your hormones.

Some people keep from gaining weight by:¹

• Exercising all the time
• Taking diet pills
• Starving themselves.

You may have tried one or all of these.

You may binge on large amounts of food, usually in secret. To avoid putting on weight you might then make yourself vomit, use laxatives or take pills that make you lose water stored in your body. Doctors call this purging. To learn more, see:

• What is bingeing?
• What is purging?

Bingeing and purging are also seen in people with other eating disorders, such as bulimia. But there are differences between people with anorexia and people with bulimia. The main difference is that people with anorexia are very underweight. People with bulimia tend to be a normal weight. To read more see Other eating disorders.

If you've had anorexia for a long time, you may also get other symptoms. As the lack of food starts to affect your body, you may:^{1 2 3 4 5 6 7}

• Stop having periods if you're female
• Feel tired and weak, and have aching muscles
• Get dizzy spells, feel short of breath and feel your heart beating hard (get palpitations)
• Have fine downy hair on your body and face
• Get cold easily and often have cold hands and feet
• Start to lose your hair
• Get constipated
• Feel full and sometimes get stomach pains after eating only a little food
• Get dehydrated, which makes you feel thirsty, sick and exhausted
• Get dry, yellowish skin.

If you have severe anorexia, you may also:

• Show signs of starvation, including swollen limbs (called edema by doctors) or a slow heartbeat, which can mean your heart isn't pumping blood around your body very well. This can make you feel tired and dizzy
• Sometimes shiver and not be able to stop, or have other signs of a low body temperature.

To find out more about the harmful effects of anorexia, see What anorexia can do to your body.

Anorexia can cause all the physical symptoms listed above. But starving your body of food can also affect your mood and emotions. Here are some of the things that can happen.

• You may have problems concentrating and it can be hard to think straight. You may find it hard to remember things.
• You may feel very unhappy (depressed) and worried (anxious). Everyone feels like this once in a while, but not eating enough food makes these feelings worse.
• You have probably lost interest in sex or in having a relationship.
• You may feel suicidal or want to hurt yourself.
• You become obsessive about certain things, like keeping clean and tidy.
• You can't talk to other people about how you are feeling.

If you make yourself vomit after you've eaten, you may have other problems. Here are some of them.

• Your teeth may become discolored: This is caused by the acid in vomit taking the enamel off your teeth. Acid also causes tooth decay. Any damage to your teeth is permanent.
• You may get heartburn: Vomiting all the time weakens the valve at the bottom of the tube that carries food from your mouth to your stomach (doctors call this tube your esophagus). If the valve is weak, it allows stomach acid to splash up into the tube, causing heartburn.
• You may get rough patches of skin on your knuckles: You can get these if you use your fingers to make yourself vomit.

If you think a friend or family member may have anorexia, see Worried someone close to you might have anorexia?

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.