A nurse is caring for a client. Which of the following client statements should the nurse identify as an indication of anorexia nervosa?

A. A statement like “I know I am skinny” reflects awareness of being underweight, but it does not indicate the behaviors or preoccupation typical of anorexia nervosa. Some clients with anorexia may actually perceive themselves as overweight, even when underweight. B. Enjoying form-fitting clothes to show off the body suggests body confidence rather than the body image distortion seen in anorexia nervosa. Anorexia is usually associated with fear of weight gain and dissatisfaction with body shape, not pride in appearance. C. Having “so much energy” is not a defining characteristic of anorexia nervosa. In fact, clients often experience fatigue, weakness, or lethargy due to malnutrition. D. Spending lots of time searching for new recipes is consistent with preoccupation with food, which is a hallmark of anorexia nervosa. Individuals with anorexia often fixate on food, plan meals meticulously, or engage in food-related behaviors as part of controlling their intake and monitoring calories.