Almost Anorexic: Pinpointing serious eating disorder symptoms in advance

Spectrum disorders are never black-and-white: Recognize early signs of anorexia as documented in Harvard Health Publications’ ‘Almost Anorexic.’

Almost Anorexic

The DSM-5 criteria for full-fledged anorexia are fairly stringent, despite anorexia nervosa having one of the highest mortality rates of any psychiatric disorder. As a healthcare professional, you know that diseases and disorders rarely fit into neatly defined, black-and-white categories; there is nearly always a spectrum along which an individual patient's condition will fall, with many shades of grey. Maybe you've noticed that a patient or someone else close to you is exhibiting disordered eating behaviors but wouldn't qualify for the DSM diagnosis. What should you do?

Almost Anorexic was written to address these questions and more. The book was authored by Dr. Jennifer Thomas of Harvard Medical School and Jenni Schaefer, a writer and singer who recovered from almost anorexia herself. Almost Anorexic is part of The Almost Effect™ series of books written by Harvard Medical School faculty and other experts to "offer guidance on common behavioral and physical problems falling in the spectrum between normal health and a full-blown medical condition." Recognizing and addressing early symptoms can help to address a problem before it becomes more severe.

"The hallmark feature of anorexia nervosa is a significantly low body weight due to self-imposed food restriction. Accompanied by an intense fear of fatness or relentless behavior that interferes with weight gain, anorexia is also characterized by body-image disturbance. Not only do individuals with anorexia typically ‘feel fat’ despite being thin; they may also base their self-worth almost entirely on their ability to control their eating and weight." (Almost Anorexic, p.2)

"When people think of anorexia nervosa, they usually think of a person who is extremely underweight. But that doesn’t describe most people with eating disorders," says Jenni Schaefer. Especially in a culture that glamorizes models and extremely thin people, individuals struggling with body image and eating disorders can go unnoticed until they become dangerously thin. People struggling with anorexia are unable to recognize their own disorder and often still see themselves as being overweight, no matter how thin they get.

Anorexia is often stereotyped as a teenage girl-condition, but it can affect both women and men of all ages. What are some signs of "grey area"/spectrum symptoms and behaviors to look out for?

Guidelines for healthy, almost anorexic, and severe/clinical-level eating disorder symptoms

NormalAlmost AnorexiaDSM-level Eating Disorder
Stable WeightFrequent weight changesSeverly underweight
Normal eatingFrequent restrictionsSevere restriction
Positive body imageNegative body imageChronic negative body image
No binge eatingMild or infrequent binge eatingFrequent or severe binge eating
No compensatory behaviorMild or infrequent compensatory behaviorFrequent or severe compensatory behavior

Almost Anorexic discusses all of these symptoms in greater depth and also provides additional tests, guidance, and resources for seeking help. Visit for a free and confidential online screening test and several recovery-oriented exercises from the book.

The book also includes a table called “Do’s and Don’ts of Supporting a Loved One” which can be found here.