penditure.
Physical signs and symptoms. Many of the physical sign s and symptoms of anorexia
nervosa are attributable to starvation. Amen orrhea is commonly present and appears to
be an indicator of physiological dysfunction. If present, amenorrhea is usually a conse-
quence of the weight loss, but in a minority  of individuals it may actually precede the
weight loss. In prepubertal females, menarche may be delayed. In addition to amenorrhea,
there may be complaints of constipation, abdo minal pain, cold intole rance, lethargy, and
excess energy.
The most remarkable finding on physical ex amination is emaciation. Commonly, there
is also significant hypotension, hypothermia, and bradycardia. Some individuals develop
lanugo, a fine downy body hair. Some de velop peripheral edema, especially during
weight restoration or upon cessation of laxa tive and diuretic abuse. Rarely, petechiae or
ecchymoses, usually on the extremities, may indicate a bleeding diathesis. Some individ-
uals evidence a yellowing of the skin associat ed with hypercarotenemia. As may be seen in
individuals with bulimia nervosa, individu als with anorexia ne rvosa who self-induce
vomiting may have hypertrophy of the salivary glands, particularly the parotid glands, as
well as dental enamel erosion. Some individu als may have scars or calluses on the dorsal
surface of the hand from repeated contac t with the teeth while inducing vomiting.
Suicide Risk
Suicide risk is elevated in anorexia nervosa,  with rates reported as 12 per 100,000 per year.