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Anorexia is often the easiest of the eating disorders to diagnose because the physical symptoms are difficult to keep hidden. The symptoms, refusal to maintain a minimally normal body weight (characterized as less than 85% of what is appropriate for an individual's height), an intense fear of gaining weight, severe disturbances and perceptions about the shape of the body, amenorrhea, preoccupation with food, the hoarding of food, concerns about eating in public, cooking for others but refusing to eat, and rigid thinking (71), may readily become apparent to family, friends, or medical professionals.

A meta-analysis that reviewed five controlled studies, found that individuals with DM1 are at no greater risk for developing anorexia than the general population (72). However, an estimated 1% of all females develop anorexia at some point in their lives, and approximately 10% of people with anorexia will die from complications such as starvations, suicide, or an electrolyte imbalance, constituting the highest death rate of any mental illness (71). Therefore, observation and screening for those with DM1 is imperative, even if the rates are not higher than among those without DM.

Anorexia can cause infertility, osteoporosis, and irritable bowel syndrome; however, for those with anorexia and DM1 the risks are even greater. Women with diabetes and anorexia have a mortality rate of 34.6 per 1000 person-years, whereas those with anorexia without diabetes have only a 2.2 per 1000 person-years (73). This staggering difference highlights the essential need for physicians to screen for this disorder, regardless of its prevalence. In addition, people with diabetes face a slew of other potential complications. Skipping meals can put people with diabetes at risk for hypoglycemia, which can result in a variety of symptoms including mental confusion, impaired judgment, mood changes, seizures, coma, and possibly death (4).

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