As you lose more and more weight (especially if you reach that dangerous mark of 20 to 25% of your acceptable, "normal" weight) your body undergoes some dramatic physical changes. Your face and body take on an emaciated appearance. Your eyes may seerri vacant and hollow, your bones protrude, and your stomach and chest seem to cave in. Your hair falls out and you may develop fine, downy hair (lanugo) on other parts of your body. Your skin changes in color and texture—it gets dry and rough, sometimes purplish or darker than normal. Sometimes your skin becomes yellow-tinged due to a condition called "hypercarotenemia" which is present in more than 80% of anorexics. The cause is not known and seems to be unique to the form of malnutrition that results from anorexia. Your fingernails take on a bluish tinge, which may extend to your wrist bones. It may also occur from your toes to above your kneecaps. Sometimes your fingernails develop ridges.
Sleeping can become a problem, in part because it can be painful to lie down if you've lost too much weight and there isn't enough fat left on your body to cushion your bones. You might not be able to sleep because you're so hungry that your mind is flooded with thoughts and images of food and eating (or not eating). You may push yourself to stay up past the point of exhaustion, fighting off sleep, because you believe that the struggle to stay awake bums extra calories. (This is not true, by the way, but it's another example of the erroneous ideas that make anorexia so hard to dispute.) You may be physically cold most of the time and discover that moving around a lot helps warm you, so you become compulsive about exercising. The exercise also gives you an excuse to allow yourself to eat, because you will burn off the calories in your workout.
If you don't have enough fat on your body, your muscles will be used for food and fuel, so your muscle tone decreases. Since the heart is really a large muscle, anorexia puts it in great physical danger; both its capacity to work efficiently and blood pressure in response to exercise will be reduced. When the heart is tested with an electrocardiogram, abnormalities, such as irregular beat, are often discovered. Death in anorexic patients is often due to cardiac complications; in most cases, death is sudden.
You may experience pain in your muscles, joints, and bones. Such pain can mean that you have developed osteoporosis (a disease that thins your bones and makes them fragile and thus easy to break) as a result of the self-starvation. You may even have stress fractures in those bones. Or you may have osteopenia, a less severe loss of bone mineral density (BMD) but one which signals hormonal and nutritional deficiencies serious enough to require medical attention.
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