Deliberate self-starvation with weight loss is the key feature of anorexia. Fueled by an intense, persistent fear of gaining weight, they engage in continuous dieting, refusing to eat at all or rigidly restricting what they will eat. They often exercise compulsively as well, to burn up the few calories they may take in.
They are preoccupied with food, calories, nutrition, and/or cooking, and know exactly how much they're taking in and how much they're burning up. They weigh themselves frequently and can often tell to the ounce how much they weigh. People with anorexia do not, however, have such a clear idea of how they look: Their bodies can look like skeletons, but the reflection they see in the mirror looks to them to be "too fat." If a girl wears size two, she's not happy till she's in size one.
This lack of realistic self-perception is often accompanied by a strong tendency to isolate from family and friends, especially those who might criticize their weight loss. They prefer to eat alone, as well, and in that way have more control over their intake. The urge to persist in dieting is so strong that they may allow themselves to eat more than they'd like in order to conceal their true situation.
Their weight will continue to drop, however, and they will exhibit other physical symptoms as well. The lack of food changes the hormone balance in their bodies, so girls will stop having menstrual periods, or delay starting menstruation if they haven't already started. They may develop unusual face or body hair, called lanugo, associated with hormonal imbalances. Because their bodies aren't receiving enough calories to produce heat, they may feel cold all the time.
People with bulimia "binge and purge." That is, they eat a lot, then throw it up, use laxatives to cause diarrhea, exercise obsessively to burn calories, or all three. They also show an unusual preoccupation with food: They may or may not "diet," but they do focus a lot of time and attention on details of shopping, cooking, and eating. They may isolate themselves because they usually do their binge eating in secret.
It's also common for them to "disappear" after meals so that they can vomit up what they have eaten. They may use drugs to induce vomiting, or gag themselves with their fingers after eating to throw up. Reddened fingers from induced vomiting are one physical sign of bulimia. They may have a lot of heartburn or problems with the throat or esophagus caused by vomited stomach acid. People with bulimia also often have irregular menstrual periods, since bodily hormones are thrown out of balance by the eating disorder.
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