Ophelia is a college-aged woman with a history of dieting. Over the past few months, she has drastically reduced how much food she consumes. She views her constant hunger pain as a positive sign that she is maintaining control over her eating. Even though her weight is now below average, Ophelia still views herself as overweight. As her health care provider, you suspect possible anorexia nervosa. Which other sign or symptoms would be present with anorexia nervosa