No, she's always been thin, but with no obvious deterioration that you would get from long-term drug use. Her skin, hair and eyes are quite healthy looking in person, based on the last time I saw her a couple of years ago.
It has been speculated that she may have a touch of Marfan syndrome.
Anorexia is a cultural heritage of a religion for some along with the anti-semitism, inclinations toward organized corruption and more common anti-family attitudes in such families. I’ve seen it all too closely in person before. Terrible ordeal for unsuspecting outsiders who find out about the in-laws sometime after a marriage.