The most profound clinical feature of anorexia nervosa is extreme caloric restriction to induce weight loss. People can have anorexia nervosa even when at normal weights; it is the restriction and the weight loss rather than actual body weight that are the key features. Anorexia nervosa can be conceptualised as a disorder of control and denial where low body weight is mistakenly perceived to be normal or excessive and is central to a person’s self-worth [11]. In many instances, the rigid control of food intake and weight can be best thought of as an attempt to cope with, cause or prevent a life event or mood (e.g., prevent puberty, reduce anxiety, deter abuse) [423]. Although not all physical symptoms will be noticeable, AOD workers should be aware of the potential for medical complications, many of which may improve or be reversed with early intervention [1409]. Physical signs a person may present with may include [1409, 1414, 1416]:
- Bradycardia (slowed heart rate).
- Low blood pressure.
- Abdominal pain, discomfort and/or constipation.
- Peripheral oedema (swelling of lower legs or hands).
- Bruising and/or broken blood vessels.
- Loss of menstruation (in females), and low testosterone levels (in males).
- Fatigue.
- Lethargy or hyperactivity.
- Cold sensitivity or intolerance.
- Loss or thinning of hair.
- Acne.
- Xerosis (dry skin).
- Lanugo hair on the body (fine hairs on the back, face, arms).
- Dehydration.
Other complications may include neurological abnormalities, changes in cardiac structure (e.g., ventricular atrophy), decreased bone density or osteoporosis, hypoglycaemia or diabetes, liver enzyme abnormalities, and elevated cortisol levels.