Anorexia nervosa: Australian treatment guide for consumers and carers, 2005

Assessment and diagnosis

Page last updated: June 2005

What are the early clues to anorexia nervosa?
Other symptoms as a result of weight loss and illness progression
The first assessment
Initial consultation with another health professional

What are the early clues to anorexia nervosa?

Anorexia may affect people in some occupational groups more than in others. Some occupations or sports which favour lower body weight (such as modelling, ballet, being a jockey or gymnast) are examples. Some people may be asked at assessment if their mother had an eating disorder because of the tendency for anorexia to run in families.

At first onset, it may be difficult to distinguish anorexia nervosa from dieting behaviour or other forms of eating disorder. There are physical, psychological and behavioural signs that a person may have developed anorexia nervosa.

Early physical clues may include:
  • Loss of periods or failure to begin menstruating in young girls
  • Weight loss without evidence of any other illness that would explain weight loss.
Early psychological clues may include:
  • An obsessive concern about body weight and shape and dieting
  • An unrealistic perception about being fat
  • An extreme fear of getting fat or gaining weight or of eating.
Early behavioural clues may include:
  • Cutting out foods once enjoyed
  • Excessive exercise
  • Vomiting and using laxatives (purging) as part of a pursuit of thinness
  • Avoiding sharing meal times with others because of food anxieties. Top of page

Other symptoms as a result of weight loss and illness progression

Weight loss can bring about a range of other physical and mental health problems. Psychological problems can include:
  • Starvation of the body which also starves the brain and alters thinking and concentration
  • Depression and irritability
  • Becoming moody and angry in relation to eating
  • Some people having rituals around eating to avoid anxiety
  • Body image becoming gradually more distorted.
Apart from obvious weight loss, other physical consequences of starvation may include:
  • Blacking out
  • Loss of periods
  • Anaemia (lack of iron)
  • Changes to the texture of skin, nails and hair
  • Loss of hair
  • Fine body hair growing on the back, arms and face as the body tries to stay warm
  • Metabolism slowing to save energy - signs include slowing the pulse, reduced blood pressure and lowering of body temperature (you will feel cold more often when this happens).
A common mistake is to confuse the purging and vomiting form of anorexia nervosa with bulimia nervosa. Bulimia nervosa, while also a serious eating disorder, is less likely to cause a medical emergency because by definition, its sufferers are not underweight, and do not suffer this extreme of physical consequences.

Get help as soon as you suspect anorexia.

Anorexia causes severe malnutrition.

Starvation can cause structural brain changes, which may have long-term consequences for cognitive functioning.

Starvation of the heart can lead to heart failure and sudden death.Top of page

The first assessment

Your General Practitioner (GP), mental health or community health centre can provide you with a first assessment to discuss your concerns about developing anorexia nervosa.

Many people are teenagers when they first suspect they have anorexia nervosa. It is best to tell a family member what you suspect, and to seek their help in going to the first assessment. People you live with can give important perspectives that may be crucial to diagnosing the condition.

GPs are often the first point of contact. They can provide a diagnosis, full physical check up, and organise other health professionals who may need to be involved, including a referral to a psychiatrist.

GPs will cover the following aspects in the initial or follow-up consultations:
  • A summary of your general state of health
  • Information on the medical complications of the illness
  • Information and explanations about the illness itself
  • The roles of the different health professionals
  • Services and information available, including a referral to a psychiatrist.
At follow-up appointments, matters to discuss with the GP may include:
  • Results of any tests to re-affirm diagnosis
  • Clarifying referral options (eg waiting lists)
  • The aims and duration of specific treatments
  • The cost of treatment with different health professionals. Top of page

Initial consultation with another health professional

Other mental health workers such as youth health and women's health professionals should be able to recognise anorexia nervosa and therefore can provide a diagnosis, but cannot physically examine you. They can give you the same sort of information as a doctor can about anorexia nervosa, but medical tests to assess your overall physical health can only be done by a doctor.

An important part of diagnosing anorexia nervosa is the mental health assessment, and in particular, the link between behaviour around eating and your thoughts and feelings about eating, your weight, shape and body.

A Psychological or Mental Health Assessment may include:
  • Questions about current or past depression
  • Questions about your moods and thoughts
  • Feelings about your weight, body and looks
  • Anxiety about eating
  • General perception of how life is going otherwise, and in particular, your perceptions about changes to your routines in relation to past activities, school or social life
  • Exercise routines, other activities, socialising, alcohol /drug use
  • Relationships at home, school and work
  • Coping patterns and support available to you.