Symptoms

The first signs and symptoms of anorexia nervosa are changes in eating habits and beliefs concerning body image. Patients become choosy, give up eating certain food and make up reasons to miss meals. They eat fewer and fewer calories and smaller portions. Their family try to help them with offering special food and meals. They will limit the quantity of food consumed ingesting a minimal amount that is well bellow their body’s caloric needs. Soon these patients will give up eating with their family. They start preparing their own food, dividing up small portions and chewing very slowly. Finally they refuse to eat. (Tringer, 2010).

Anorexia nervosa means self-fasting and serious weight loss. Among the symptoms are signs of depression or anxiety concerning their body. Weight phobia generates obsessive worry, anxiety and fears about weight gain and obesity even in case of serious thinness. Patients want to loose more and more weight and this behaviour causes excessive weight loss which endangers teenage girls when in this period they should put on weight. Their body image disorders make them view themselves fat although they are very thin. At the same time they can judge well their contemporaries’ body and have real views about their peers’ thinness. Only their own body is characterised with body image disorder.  (Túry, 2005).

 Due to anorexia nervosa vital foodstuff and nutrients will not be introduced into their body therefore the so called macro and micro nutrients are missing and without them the immune system cannot react effectively (Pászthy and et al, 2007). Immune deficiency caused by fasting is listed into the group of secondary immune deficiency. Individuals who were earlier healthy their protective functions will decay. In this case if the root causes are eliminated immune deficiency can be treated. These patients can get infected much easier, the course of diseases will be longer and complications occur more often. Serious infection may cause death (Abbas, 2000). It is worth mentioning that patients who are struggling with anorexia nervosa protect themselves against infections for quite a long time. What has been observed is a strange phenomenon, that is, they are exposed to infections in the recovery period. Medical doctors have experienced that when patients started eating again and getting on weight suffered from long running diseases (Pászthy and et al, 2007).

Anorexia nervosa disorders produce several other symptoms. Patients’ essential functions slow down; will have shortness of breath, slow irregular pulse, low body temperature and low blood pressure. Skin is covered with foetus like fluff hair and hair becomes thin and may fall out. Lack of proper body weight causes menstrual cycle disorders and absence of menstruation as well as extreme physical activities and intensive trainings (Túry, 2005). Patients consciously train their body in order to loose weight. The constant urge of doing activities or sports can be useful, for example, biking, running, jogging and it can also be done without any aims, just aimlessly lingering about. Patients sit instead of standing and run instead of walking. Trainings are generally lonely, regular activities. They will become compulsive without any pleasure. They feel remorse if they stop doing trainings. Patients will eat if they deserve it, that is, they have done their task. The other form of training is constant unrest which is always present and it often occurs with sleeping disorders. This condition is maintained until sufferers have become seriously ill (Túry, 2005).

The most commonly known type of anorexia nervosa is the restrictive one whereby patients restrict their food intake. Earlier they refused to eat sweets and cakes but nowadays they will not touch any fatty meals and meat. They pretend to eat. They cut up their food into small pieces; chew slowly proving their family that they eat enough. They use lots of spices, drink either too much or too little and always count the calories. They do not want to socialise and avoid eating with other people. They often eat at nights not confessing what and how much they eat. Naturally it generates conflicts in families (Túry, 2001).

The other type of anorexia nervosa is binge eating/purging type. It means frequent episodes of consuming large amount of food. Patients develop dangerous behaviours such as self-induced vomiting. They feel strong shame and guilt about their eating habits; they eat to the point of discomfort. They often use laxatives and diuretic stuff. These episodes are very harmful and may endanger their life. Due to vomiting patients start eating more again and they feel that they can control the portions of what they eat.

Comparing the two types of anorexia table 1 (Túry, 2001)

	Restrictive type	Purging type
Devouring food	Not typical	Typical
Self-induced vomiting, using laxatives	Not typical	Typical
Fasting/dieting	Typical	Not typical
Accompanying psychic diseases	Rare	Regular

Table 1 The two types of anorexia nervosa, the restrictive and the purging ones (Túry, 2001 p. 24).

The accompanying psychic disorders of anorexia nervosa should also be mentioned such as getting irritable and moody, loosing libido, spending too much time choosing food, compulsive rituals, decayed concentration, decreased alertness (Steiger, 2004), setting high standards and being perfectionists (Anderluh and et al, 2003).

Patients with these disorders deny their problems. They often refuse to work with therapeutics therefore it may happen that they do not consider themselves as “real” patients (Túry, 2005).