Even when emaciated, the person claims to feel fat, denies that anything is wrong, doesn't complain about lack of appetite or weight loss, and usually resists treatment. The person usually doesn't see a doctor until brought by family members who are concerned. Half the people who have anorexia nervosa binge and then purge by vomiting or taking laxatives and diuretics. The other half simply restrict the amount of food they eat. Most also exercise excessively to control weight.
Women stop having menstrual periods, sometimes before losing much weight.
Women and men may lose interest in sex. Anorectics who become very thin tend to remain active, even pursuing vigorous exercise programs. They don't have symptoms of nutritional deficiencies and are surprisingly free of infections. Depression is common, and people who have this disorder frequently lie about how much they have eaten and conceal their vomiting and their peculiar dietary habits. Hormonal changes resulting from anorexia nervosa include markedly reduced levels of estrogen and thyroid hormone and increased levels of cortisol.