Excessive weight loss – especially if a person reaches a weight that is less than 85 percent of the ideal weight for their age and height – is the initial sign of anorexia nervosa. In addition, individuals with anorexia nervosa may express an intense fear of gaining weight or exhibit a negative body image (e.g., belief that they are fat despite being extremely thin). They may also exhibit anxious or ritualistic behaviors during mealtimes (e.g., making excuses to avoid eating, playing with food on plate) and/or exercise excessively or compulsively (anorexia athletica). Some individuals with anorexia nervosa also dress in layers or baggy clothes to hide their weight loss.   

Other signs and symptoms of anorexia nervosa may include:

• Social withdrawal
  
  
• Depression
  
  
• Insomnia
  
  
• Chronic fatigue, lightheadedness and/or concentration problems
  
  
• Headache
  
  
• Anemia (decreased red blood cells)
  
  
• Absence of menstruation (amenorrhea) in females of menstruating age for at least three consecutive menstrual cycles
  
  
• Breast atrophy (loss of breast mass in females)
  
  
• Muscle atrophy (deterioration of muscles)
  
  
• Constipation
  
  
• Dry skin, including brittle hair and nails
  
  
• Hair loss
  
  
• Tooth decay and gum disease (due to prolonged self-induced vomiting)
  
  
• Cold hands or feet; loss of body temperature (hypothermia)
  
  
• Irregular heart rate (bradycardia)
  
  
• Low blood pressure (hypotension)
  
  
• Swelling of the parotid and submandibular (salivary) glands
  
  
• Development of lanugo (fine body hair) on the trunk (in advanced stage)