Because the consequences of eating disorders can be so severe, early diagnosis is crucial. Eating disorders in general can disrupt physical and emotional growth in teenagers and can lead to premature osteoporosis, a condition where bones become weak and more susceptible to fracture; increased infertility; and raise the risk of miscarriages or low-birthweight babies.

Anorexia may be especially deadly for women with insulin-dependent diabetes if they omit or under-use insulin to control their weight.

Among the physical effects of anorexia are:

• anemia, often caused by iron deficiency, which reduces the blood's ability to carry oxygen and causes fatigue, difficulty breathing, dizziness, headache, insomnia, pale skin, loss of hunger and irregular heart beat

• elevated cholesterol, this occurs because the eating disorder affects liver function, reducing bile acid secretions that contain cholesterol and enabling more cholesterol to remain in the body rather than being secreted.

• low body temperature and cold hands and feet

• constipation and bloating

• shrunken organs

• low blood pressure

• slowed metabolism and reflexes

• slowed heart rate, which can be mistaken as a sign of physical fitness

• irregular heartbeat, which can lead to cardiac arrest

• slowed thinking and cognitive and mood changes secondary to long-term starvation

Women with anorexia have an intense dread of becoming fat. Food and body size become obsessions. It is common for women with anorexia, for example, to collect recipes and prepare gourmet meals for family and friends, but not eat any of the food themselves. Instead, they allow their bodies to wither away and "disappear," gauging their hunger as a measure of their self-control. Women with anorexia diet not to lose a few pounds but because they want to improve their feelings of self-esteem and love. Depression and insomnia often occur with eating disorders.

If you have anorexia, you may tend to keep your feelings to yourself, seldom disobey authority and are often described as "too good to be true." You also are likely to be a perfectionist, a good student and an excellent athlete. Anorexia is common in dancers and competitive athletes in sports such as gymnastics and figure skating, where success depends not only on athletic performance, but on having the "perfect" body, as well.

Symptoms of anorexia nervosa can include:

• distorted body image and intense persistent fear of gaining weight

• excessive weight loss

• menstrual irregularities

• excessive body/facial hair

• compulsive exercise

Bulimia nervosa

Bulimia nervosa involves using food and eating for emotional calming/soothing. Binging becomes a way to relieve stress, anxiety or depression. Purging the calories relieves the guilt of overeating until the cycle becomes a habit. Women with bulimia are usually more impulsive, more socially outgoing and less self-controlled than those with anorexia. They are also more likely to abuse alcohol and other substances.

Bulimia is harder to recognize than anorexia. Generally, the symptoms are subtle, and bulimic women aren't usually thin. Even so, if you have bulimia, you may be starving nutritionally because you are not getting the vitamins, minerals and other nutrients you need. Symptoms of bulimia include:

• preoccupation with food

• binge eating, usually in secret

• vomiting and extreme use of laxatives or diuretics after binges

• menstrual irregularities

• compulsive exercise

Among the physical effects of bulimia are:

• dehydration

• chronic diarrhea

• extreme weakness

• damage to bowels, liver and kidneys

• electrolyte imbalance and low potassium levels, which lead to irregular heartbeat, and in some cases, cardiac arrest

• tooth erosion from repeated exposure to stomach acid

• broken blood vessels in the eyes and a puffy face due to swollen glands, which are telltale signs of self-induced vomiting

• cuts and calluses across the fingers from thrusting a hand into the throat

• ruptured esophagus due to forced vomiting

Women with bulimia may also experience binge eating. Symptoms include:

• episodes of binge eating when not physically hungry

• frequent dieting

• feeling unable to stop eating voluntarily

• awareness that eating patterns are abnormal

• weight fluctuations

• depressed mood

• feelings of shame

• antisocial behavior

• obesity

If binge eating leads to obesity, the medical consequences may include:

• high blood pressure

• high cholesterol

• gall bladder disease

• diabetes

• heart disease

• certain types of cancer

The outlook for women with bulimia is generally better than it is for women with anorexia. Women with bulimia are less likely to require hospitalization, although approximately 20 percent of women still struggle with the disease after 10 years and beyond.

Tests for Eating Disorders

There is no medical test that can diagnose an eating disorder. For that you need a psychological or other diagnostic test. However, your health care professional may draw some of your blood for tests to determine if you are suffering from any medical consequences related to an eating disorder:

• electrolyte balance-to check for dehydration, malnutrition, self-induced vomiting, and laxative and/or diuretic abuse. Electrolytes are a specific combination of minerals your body needs to maintain balance to function properly, such as sodium and potassium. Common symptoms of imbalance are leg cramps, heart palpitations, high or low blood pressure and swelling in the legs and feet. An electrolyte imbalance can lead to kidney failure, heart attack and death.

• B₁₂ and folic acid intake assessment. Lack of B₁₂ and folic acid can lead to, or be caused by problems with the metabolism of protein, carbohydrates and fat, and with the body's ability to absorb nutrients. Low levels can contribute to depression and anxiety.

• Blood glucose (blood sugar) level. Low levels can be the result of dehydration and malnutrition.

• Liver function tests because the malnourishment associated with eating disorders can lead to liver damage.

• Cholesterol measurements since anorexia or binge eating can increase blood cholesterol levels.

• Thyroid function tests to rule out any possible problems with the thyroid, which can affect weight. This is also an important test for someone in recovery who may be having a hard time gaining or losing weight.

Your health care professional will probably also perform a complete urinalysis, or analysis of your urine. This helps evaluate kidney function, urine sugar levels and ketone levels, as well as help diagnose systemic diseases and urinary tract disorders. Ketones, which can accumulate in the blood rather quickly when the body is starved of food and nutrients, indicate the body is "eating its own fat" for energy. Accumulation of ketones in the blood can lead to ketoacidosis, which can cause coma and death.

Your health care professional may also take a blood pressure reading and a bone density test, and perform an electrocardiogram to look for heartbeat irregularities.