When seriously underweight, many individuals with Anorexia Nervosa manifest depressive symptoms such as depressed mood, social withdrawal, irritability, insomnia, and diminished interest in sex. Such individuals may have symptomatic presentations that meet criteria for Major Depressive Disorder.Because these features are also observed in individuals without Anorexia Nervosa who are undergoing starvation, many of the depressive features may be secondary to the physiological sequelae of semistarvation. Symptoms of mood disturbance must therefore be reassessed after partial or complete weight restoration. Obsessive-compulsive features, both related and unrelated to food, are often prominent. Most individuals with Anorexia Nervosa are preoccupied with thoughts of food. Some collect recipes or hoard food. Observations of behaviors associated with other forms of starvation suggest that obsessions and compulsions related to food may be caused or exacerbated by undernutrition. When individuals with Anorexia Nervosa exhibit obsessions and compulsions that are not related to food, body shape, or weight, an additional diagnosis of Obsessive-Compulsive Disorder may be warranted.
Other features sometimes associated with Anorexia Nervosa include concerns about eating in public, feelings of ineffectiveness, a strong need to control one's environment, inflexible thinking, limited social spontaneity, and overly restrained initiative and emotional expression.
Compared with individuals with Anorexia Nervosa, Restricting Type, those with the Binge-Eating/Purging Type are more likely to have other impulse-control problems, to abuse alcohol or other drugs, to exhibit more mood lability, and to be sexually active.