Written by: Gunborg Palme, certified psychologist and certified psychotherapist, teacher and tutor in psychotherapy.
First version: 28 Nov 2006. Latest revision: 10 Dec 2006.
Question(s):
Why do many anorectics think they are fat when they are very thin?
Answer:
It can be said that we have two bodies: one that others can see and one that we think we have. Consequently, we can be fat and believe that we are thin and therefore don't need to reduce. Or, we can be like teenage Karin who only weighed 28 kg when she cried to her therapist that she was too fat and must slim!
Many people with eating disorders think they are fat when they have eaten too much or when they feel anxiety.
When calm and relaxed, they might see themselves more realistically. Their starvation is a continual risk factor for a compulsive eating attack. They know that they might not stop eating and are afraid of losing control.
Fear of becoming fat can be experienced as being fat. Many people who have been thin as children continue to think of themselves as thin when adults, even if they are overweight. For overweight children, the opposite is true, even if they develop anorexia nervosa!
Eating disorder patients base their evaluation of themselves exclusively on their weight and body image.
They think that if they are thin enough they can face the challenges of life: find a partner, a satisfying job, have friends, and be admired.
This cognitive prejudice leads them to have non-stop problematic thoughts about their body (such as: "I have a swollen belly", "my legs are too fat", "I am a useless fat woman", " I have gained a kilo so today and tomorrow I have to refrain from food", "I am so fat that I disgust people", "I cannot weigh more than 40 Kg", etc.) and in time they are prone to become perfect obsessions.
In addition there is also the incapacity to evaluate the body image from an objective point of view.
For these reasons a lot of eating disorder patients reach underweight and malnutrition levels that can seem incredible, if you forget that their self-esteem corresponds to their capability to maintain their weight under strict control.
When you are a victim of this self vision, the whole situation of life, even things that have nothing to do with the body, can set people off worrying about the body and weight, causing anxiety and new attempts at further control.
To break this cognitive-behavioural vicious circle that exists between the unwell body image and the excessive importance that these patients give to the body and body image is one of the principal tasks of Eating disorder therapy.
There are indeed a range of techniques aimed at body restructuring that, linked to other therapeutic techniques, help patients to overcome contempt for their bodies and begin to love it again.
Anorectics May Think They are Fat
Excessively Slim Ideals is a Cause of Eating Disorders; Eating Disorders and Fashion Magazines
Written by: Gunborg Palme, certified psychologist and certified psychotherapist, teacher and tutor in psychotherapy. First version: 26 Nov 2006. Latest revision: 26 Nov 2006.
Question :
Can the current abnormal demands for slimness cause eating disorders?
Answer:
When beauty queens of former times and nowadays are compared it is obvious that they have become much slimmer. An appearance which was considered normal 50 years ago is rare today. In order to be as slim as fashion demands they are compelled to go around starving. Most women today feel that they are under an obligation to be slim. This results in an increasing number of them getting eating disorders.
Anorexia often begins with an attempt to be slimmer. Bulimia nervosa develops in 50 % of former anorectics when they can't manage to restrain their eating anymore.
Food containing a lot of sugar and fat dominate the market and if eaten regularly they soon cause an increase in weight. A person can get problems with self-image and eating through ideals which are spread by mass media. Many young women with a normal body shape get the idea that they are overweight and start slimming even though it is harmful for them.
In ancient China they bound the feet of young girls in order to prevent their feet growing to normal size and as a result they became invalids.
New Eating Disorder Identified
ScienceDaily (Sep. 5, 2007) — A University of Iowa professor is making a case for a new eating disorder she calls purging disorder.
The disorder is similar to bulimia nervosa in that both syndromes involve eating, then trying to compensate for the calories. What sets the disorders apart is the amount of food consumed and the way people compensate for what they eat. Women with purging disorder eat normal or even small amounts of food and then purge, often by vomiting.
Women with bulimia have large, out-of-control binge eating episodes followed by purging, fasting or excessive exercise.
"Purging disorder is new in the sense that it has not been officially recognized as a unique condition in the classification of eating disorders," said Pamela Keel, associate professor of psychology in the UI College of Liberal Arts and Sciences, "But it's not a new problem. Women were struggling with purging disorder long before we began studying it."
In a paper published in the Archives of General Psychiatry, Keel shares the results of a study indicating that purging disorder is a significant problem in women that is distinct from bulimia.
Keel recruited participants for three groups: women without eating disorders; women who purge to compensate for binge episodes; and women with purging disorder who purge to control their weight or shape but do not have binge episodes. Participants came from the Boston and Iowa City/Cedar Rapids areas and were within a healthy weight range. The women completed self-report questionnaires and clinical interviews. They also had blood drawn before and after consuming a liquid test meal and reported their feelings throughout the meal, including feelings of fullness, hunger, sadness or tension.
Keel discovered that women with purging disorder tend to share some characteristics with bulimics: Both experience greater depression, anxiety, dieting and body image disturbance than women without eating disorders.
But the study also provided evidence that purging disorder is a distinct illness. Women with purging disorder differed from women with bulimia on a physiological mechanism that influences food intake. Those with purging disorder also reported greater fullness and stomach discomfort after eating compared to women with bulimia and women without eating disorders.
Keel said more research on purging disorder is needed to better understand the condition and to support its inclusion in the classification of eating disorders.
"Because we tend to only study formally defined disorders, this creates a gap between the problems people have and what we know about those problems," Keel said. "Identifying this disorder would stimulate research on its causes, treatment and prevention, which could alleviate the distress and impairment women with the illness suffer."
UI researchers are seeking participants for a follow-up study. Normal-weight women ages 18 to 45 who binge and purge, fast or exercise, or who only purge, may be eligible to participate in the study. The format of the follow-up study will be similar to the previous study.
Keel hopes to find out why some women feel the need to purge after eating what most people would regard as a normal or even small amount of food. She hopes this information will provide insight into what types of treatments may be effective for purging disorder.
"Right now there are no evidence-based treatments for purging disorder," Keel said. "It would be a disservice to women with purging disorder to assume that treatments that work for bulimia nervosa will work for purging disorder, given the differences we found between the syndromes. Additional research is crucial for advancing our understanding of purging disorder."
Adapted from materials provided by University of Iowa.
Chosing The Right Diet For You
There are so many different and varied diets floating around today that it can be quite difficult to make a decision regarding which one is right for you when you feel it’s time to lose weight. Some diets emphasize low fat while others insist low calories are the way to go. Still yet, other diet gurus are adamant that in order to meet your weight loss goals you must cut out all forms of carbohydrates. One diet seems to combine factors from at least two other well known diets with claims to produce an optimum fat burning weight loss program. Then there are the various other diets that have circulated around the world for years with numerous success stories such as the cabbage soup diet and the cider vinegar diet. Which diets really work and more importantly; which diet is right for you?
One of the most important factors you must consider when contemplating any diet plan is whether you will learn how to eat healthy and nutritionally sound through the plan. Unfortunately, a number of different diets that boast incredible results do so through nutritionally bankrupt methods. Often referred to as fad diets, these weight loss programs encourage you to indulge in eating habits that can do more harm than good.
Many weight loss programs promise almost instantaneous results and for awhile at least; it seems as though your weight loss dreams may have finally come true through the presence of this type of diet. Then the sad reality sets in. You realize there is no possible way you can stay on this diet for the rest of your life. This is an important factor to consider; because ideally you should be looking for a healthy weight loss and maintenance program not a diet. Although a very low-calorie, high or liquid diet or even a diet that only lasts for a few days may allow you to initially lose some weight, you will inevitably find that your weight loss problems recur when a vengeance at a later point. Instead of looking for a miracle cure, look for a weight loss program that can help you to achieve your goals on a permanent basis.
For those of us who would prefer to avoid exercise like the plague, any weight loss program that promises we can reach our goals without that dreaded E word is a lifesaver. Unfortunately, long term weight loss simply isn’t possible without taking part in a sensible exercise routine. Sad, but true.
When considering engaging in any weight loss program or diet, always ask yourself the following questions 1. Will I learn to take part in a healthy, nutritionally sound eating plan through this diet? 2. Is this a diet I can stick with long term? and 3. Does this diet combine sensible eating with moderate exercise?
When you find a diet or weight loss program that meets all of these conditions, you know that you have found the right diet for you. As with any diet, it’s always a good idea to check with your physician before engaging in any weight loss program.
About the Author: Joey Dweck is the Founder & CEO of http://www.WeightLossBuddy.com. a website committed to 24/7/365 support, expert advice, and helping people find a buddy(s) who will not only help them lose weight, but who will also help them change to a healthier lifestyle. And it's all Free. Source: www.isnare.com
What Are Electrolytes?
Reprinted from Eating Disorders Today
By Michael Myers, MD
Summer 2004 Volume 2, Number 4
©2002 Gürze Books
What Are Electrolytes?
Electrolytes are the salts in your body. The most common salts are sodium, potassium, and chloride. Often associated with abnormalities in electrolytes are abnormalities in the bicarbonate level. Although not technically an electrolyte, bicarbonate is important in maintaining the body's acid base balance. Located in the blood and cells, electrolytes are important in keeping your body functioning correctly.
How Are Electrolytes Controlled?
Your kidneys, lungs, and other glands, including the adrenal glands very tightly control the levels of electrolytes in your body. The adrenal glands, which sit on top of the kidneys and secrete hormones, are especially important in controlling electrolytes. For example, if you eat or drink salty foods, the kidneys will excrete the extra salt to prevent excessive sodium and water from being retained, which could otherwise result in fluid overload and heart failure. Another example is sweating. Sweat is composed of both water and electrolytes (primarily sodium chloride, commonly known as table salt). Your body responds to sweating by changing the way the kidneys filter the blood to regulate the amount of water and electrolytes that are excreted in the urine. This results in the concentrated urine you may excrete if you exercise without consuming enough fluids.
Why Are Electrolytes Important?
All cells maintain an electrical charge across the cell membranes that surround them, which permits cells to perform their normal functions, such as allowing nerve cells to control muscles and allowing muscle cells to contract and relax. The electrolytes in the serum (blood) produce this electrical charge, which is literally the energy of life. If electrolytes exceed their normal, tightly controlled range, normal functions will cease. Muscles may weaken and cramp, nerves may fail to conduct impulses correctly, or the brain (which, after all, is a collection of nerve cells) may not function correctly, leading to confusion, lethargy, or even seizures.
What Conditions Cause Abnormal Electrolytes?
The most common medical conditions that cause electrolyte imbalances are persistent vomiting and diarrhea. In either case, one loses not only fluids, but also significant amounts of electrolytes. Many medications, such as diuretics ("water pills") that are used to treat either high blood pressure or fluid retention, can result in electrolyte problems. Many endocrine diseases, such as diabetes, can also cause electrolyte imbalances. Whatever the etiology, treatment requires replacement of not only the water portion, but also the electrolytes, usually in the form of salty fluids.
Mike Myers, MD, is a family physician in Orange County, CA specializing in weight management and eating disorders for the last 24 years.
Medication for Anorexia Nervosa and Bulimia Nervosa
Reprinted from Eating Disorders Today
By Diane Mickley, MD
(This article is for information purposes only. Before taking any medication, individuals should consult their physician. Neither the author nor the publisher of this article are advocating the use of medication without proper medical supervision.)
Anorexia nervosa and bulimia nervosa are associated with altered levels of neurotransmitters, or chemical messengers in the brain. This is particularly true of serotonin levels. It makes sense, then, that medications developed to improve the function of neurotransmitters might be useful in the treatment of eating disorders. Research over more than a decade has shown that medications can indeed be valuable in the treatment of bulimia nervosa. More recent research has shown some promise for the use of medications in treating anorexia nervosa as well.
SSRIs
Several different categories of psychiatric medications have been shown to be beneficial, but the most widely studied are the SSRIs (Selective Serotonin Reuptake Inhibitors), the first and most famous of which is fluoxetine, or Prozac. Other SSRIs include sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalopram/escitalopram (Celexa/Lexapro). All raise the levels of serotonin available in parts of the brain. Venlafaxine (Effexor) is a related drug that raises both serotonin and norepinephrine.
Though popularly dubbed antidepressants, these drugs are used for a wide array of psychiatric diagnoses, including anxiety, phobias, panic attacks, obsessive-compulsive disorder (OCD), premenstrual dysphoria (PMS), post-traumatic stress disorder (PTSD), and impulse control disorders. Many of these are common additional problems in patients with eating disorders and their families.
Anorexia Nervosa Medications
The initial goal in treating anorexia nervosa is the immediate restoration of normal weight. This is urgent for physical health and is a crucial first step in psychological recovery as well. Because people with anorexia nervosa are often sad and obsessional, it is logical to hope that SSRIs might help. Although they are widely prescribed for this purpose, research studies and the clinical experience of specialists both show that SSRIs DO NOT help low-weight patients recover. Malnutrition appears to preclude their usual benefits.
A common adage holds that food is the medicine for anorexia nervosa. Weight gain alone does often normalize mood in anorexia nervosa, but it can be hard to accomplish and frequently requires hospitalization. Although certain psychiatric medications can cause weight gain in the general population, none has had this effect with malnourished anorexic patients. Recent exciting studies suggest that olanzapine (Zyprexa) and other medications in this class may finally offer a drug that can help some low-weight anorexia nervosa patients. Olanzapine lessens anxiety and obsessional thinking, and some anorexic patients find they feel less paralyzed due to rigid thinking and behavior on this medication.
Olanzapine was originally marketed for schizophrenia, and although anorexia nervosa is not a psychotic illness, there is certainly a delusional quality about feeling fat when you are dangerously starved. Clinicians find that on olanzapine, some people with anorexia nervosa are better able to grasp their situation and engage in treatment. Low-dose, short-term use may facilitate that elusive transition from low to healthy weight for some people, speeding the initial steps to recovery and sometimes averting hospitalization.
Once someone with anorexia nervosa has been successful in restoring weight, maintaining those gains is the next hurdle. Unfortunately, immediate relapse is common. Here's where fluoxetine enters the picture. Although this drug does not help anorexia nervosa while the patient's weight is low, after the weight has been regained, fluoxetine may significantly lessen the risk of relapse when used as part of a comprehensive treatment program.
Bulimia Nervosa Medications
The initial goal for bulimia nervosa is also symptom management-in this case, stopping the binge/purge behaviors. Two treatments have been documented by evidence-based scientific studies to have the best short-term success rates. The first is cognitive behavioral therapy (CBT), and the second is high-dose fluoxetine. Results are roughly comparable, with a suggestion that the two together may be better than either one alone. However, since only a quarter of patients achieve symptom remission with these approaches, further treatment is generally needed.
The largest bulimia nervosa treatment trial in the world documented the benefits of high-dose fluoxetine. This led to approval of fluoxetine by the FDA specifically for the treatment of bulimia nervosa. Treatment is recommended to begin and continue at a dose of 60 mg. (The dose of 20 mg commonly used for depression was no better than a placebo.) Bulimics benefit from fluoxetine regardless of whether they are depressed. Moreover, if fluoxetine is going to be helpful, the results will be apparent within 4 weeks. At least one study has shown this to be a successful initial approach when used by primary care providers.
Are other medications in the SSRI category also helpful? Published studies have now shown sertraline to benefit bulimia nervosa at a higher dose range (150 mg). Although clinicians commonly do use other SSRIs for this purpose, the data to assess their benefit and dosage is simply not available. Other classes of antidepressant medications have also been shown to be helpful for the treatment of bulimia nervosa and binge eating disorder.
Topiramate, a totally different category of medication that was developed for treating epilepsy. It is now commonly used for migraine headaches, and it is an exciting new option for patients with bulimia nervosa, binge eating disorder, and simple obesity. Studies in patients with these disorders show binge reduction, reduced preoccupation with eating, and weight loss. Topiramate is used in relatively low doses (100-200 mg) for eating disorders and weight loss. Gradual initial dose increases are required to avoid mental sluggishness. Other side-effects are common but generally not serious. Patients who are taking hormones, including oral contraceptives, may also require dose adjustment due to interaction with topiramate. Zonisamide is another promising agent in this class.
Side-Effects
None of the medications described above have any potential to be addicting. Often their use can be transitional, for several months to a year or two, while recovery progresses and solidifies. However, since eating disorders frequently occur in patients with depression or anxiety disorders, some of these people will benefit from longer-term use of medication.
What about side-effects? As in all medical care, doctors must weigh the risks of the treatment compared to the risks of the illness. Fortunately, most of the side-effects of the medications used for eating disorders are relatively minor, especially compared to the serious dangers of being anorexic or bulimic. The most frequent side-effect of olanzapine is significant sedation, especially at the beginning. The SSRIs may have mild initiation side-effects including nausea, headache, fatigue, or insomnia, and less commonly agitation and over-excitement. These often pass within a week or two but they may persist and should always be discussed with the physician. More enduring side-effects may include vivid dreams, sweating, and a reduction in sexual interest or performance. Medications that leave the body quickly (paroxetine, escitalopram, and venlafaxine) should be tapered off, since sudden discontinuation can produce flu-like symptoms. Recently, the news media has focused on whether teenagers respond as well and safely to SSRIs as adults do. A small percent of adolescents (and a few adults) experience akathisia while taking common psychiatric drugs. Akathisia is a kind of motor restlessness, a feeling of "jumping out of your skin," which should be reported to your physician. In addition, concerns have been voiced about an increased risk of suicide among children and teens taking SSRIs, even though overall suicide rates have dropped significantly as SSRI use has become widespread. Government agencies are currently evaluating this question.
The exciting overview is that continuing progress is being made in understanding the biology of anorexia nervosa and bulimia nervosa, as well as how medications can help. Specialists in the field will be aware of the latest developments and the latest information about the uses and benefits of available medications. The best outcome-ideally, complete recovery-is most likely with an up-to-date and experienced eating disorder team working in firm alliance with the patient and family.
Author Diane Mickley, MD, FACP, FAED is the Founder and Director of the Wilkins Center for Eating Disorders in Greenwich, CT. She is also the Associate Clinical Professor in the Department of Psychiatry at the Yale University School of Medicine.
What can I do to help someone who has bulimia?
Reprinted from Bulimia: A Guide to Recovery
by Lindsey Hall and Leigh Cohn
The support of a spouse, parent, sibling, or friend is one of the most valuable tools a person with bulimia can have. If someone close to you has bulimia, you can face it together in many different ways, but remember that they are the one with the problem. Loved ones can research treatment options, read appropriate books, attend lectures, talk to experts, and lend a supportive ear, but only the bulimic herself can do the work.
Keep in mind that an eating disorder is a way to feel in control of one's life. Sometimes, what is intended to be helpful and considerate can be interpreted as controlling by the person with the disorder. Communicate that you are available to help, but that is not your job to patrol their behavior. You are there to support and encourage them in their sturggle to get well, but only if that is what they want.
An eating disorder is a protective device used to handle pain. If it was easy to give up, the person would have done so already. Someone who uses food as a coping mechanism needs understanding and compassion. The reality of bulimia may shock or disgust you, but separate the individual from her binge-purge behavior. She deserves love and appreciation for who she is apart from the bulimia, and compassion for the pain that has driven her to it. if a loved-one became disabled or ill, you would still be there for them—bulimia is disabling and life-threatening.
At the same time, do not be manipulated or lied to for the sake of binges. Do not "enable" the disorder by looking the other way or pretending that the problem is not serious. If you stock the refrigerator with food only to have it flushed down the toilet, be honest and assertive about your rights and needs. Bulimics should not be allowed to abuse your trust or pocketbook; having bulimia is not justification for treating loved ones poorly. Also, don't turn meals into battles—food is not the issue.
Parents of bulimics especially need to be aware of their limitations in helping their children. Often, the relationship is too close for objective evaluation. Let your daughter open up to you with her feelings, and if she does not make progress with your support within a short time, encourage professional therapy for bulimia. It may also be appropriate for parents to seek out professional advice or a bulimia support group for help with their own feelings of frustration and helplessness.
Parents usually play a part in the development of their child's behavior, and in many instances, may have to face issues and make adjustments of their own. This is not to say that they are the cause of the eating disorder, but rather that they may have contributed to it in some way and need to acknowledge that. Parents may need to reevaluate their values, ways of communicating, family rules about food, ways of handling feelings, parenting roles, and the family's decision-making process. Guilt, anger, frustration, denial, and cynicism are all likely sentiments.
As hard as this all sounds, family therapy has proved to be one of the most successful methods of overcoming bulimia. With better communications, increased self-knowledge and mutual acceptance of what has happened in the past, parents and children can focus on the important task of recovery in the present.
Advice for Loved Ones Suffering from Bulimia
Reprinted from Bulimia: A Guide to Recovery
by Lindsey Hall and Leigh Cohn
- Remember that your loved one has the problem, and it is up to them to do the work.
- Make a pact of complete honesty.
- Be patient, sympathetic, non-judgmental, and a good listener. Let your loved one know that you care and have her (or his) best interests at heart.
- Accept that recovery is a process and does not happen quickly. Help your loved one to be patient, as well.
- Do not be controlling of your loved one's life; you are limited in what you can do to help. You may need to learn about letting go.
- When your loved one's behavior affects you, express yourself without placing guilt or blame. Try not to take her (or his) actions personally. Use "I" messages, explaining your feelings and concerns. You may need to disengage to take care of yourself.
- Have compassion. Your loved one may be overwhelmed as she (or he) gets in touch with the painful issues underlying the behavior. Your loved one will need your support at these times more than ever.
- Always remind yourself that your loved one uses bulimia as a substitute for confronting painful feelings or experiences. Ask what, if anything, you can do to help. Encourage her (or him) to find healthier ways to deal with pain.
- Do not try to guess what she (or he) wants. Encourage your loved one to express needs. If you have questions, ask.
- Encourage her (or him) to enter professional eating disorder therapy, keeping in mind that no single approach to recovery works for everyone. Be available for joint counseling. Be flexible and open in supporting her (or him) to do whatever approach is chosen. For example, you may know someone who goes to a particular therapist, but your loved one might relate better to another.
What is Bulimia?
Reprinted from Bulimia: A Guide to Recovery
By Lindsey Hall and Leigh Cohn
Bulimia is an obsession with food and weight characterized by repeated overeating binges followed by compensatory behavior, such as forced vomiting or excessive exercise. For an epidemic number of women and men, bulimia is a secret addiction that dominates their thoughts, undercuts their self-esteem, and threatens their lives.
The symptoms of bulimia are described by the Egyptians and in the Hebrew Talmud; and bulimia (Greek for "ox-hunger") was widely practiced during Greek and Roman times. In the later half of the twentieth century, though, eating disorders, and particularly bulimia, have been identified as widespread cultural phenomena. Bulimia is also termed bulimia nervosa and bulimarexia. In 1980, the American Psychiatric Association formally recognized bulimia. In its fourth edition, the Diagnostic and Statistical Manual of Mental Disorders (APA, 1994) lists the following criteria that an individual must meet to be diagnosed:
A. Recurrent episodes of binge eating, with an episode characterized by (1) eating in a discrete period of time, usually less than two hours, an amount of food that is significantly larger than most people would eat during a similar period of time and under similar circumstances; and, (2) a sense of lack of control over eating during the episode, such as a feeling that one cannot stop eating.
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or enemas (purging type); or, through fasting or excessive exercise (nonpurging type).
C. These behaviors occur at least twice a week for at least three months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The behavior does not only occur during episodes of anorexia nervosa.
These cases are also life-damaging and need to be taken seriously. Although the overt symptoms of bulimia revolve around food behaviors and a fear of gaining weight, bulimia is actually a way to cope with personal distress and emotional pain. Eating binges take time and focus away from more disturbing issues, and purges are an effective way to regain the control and feelings of safety lost during the binge. Also, while bulimic behavior may have started as a seemingly-innocent way to lose weight, the cycle of bingeing and purging usually becomes an addictive escape from all kinds of other problems.
What is Anorexia Nervosa?
Reprinted from Anorexia Nervosa: A Guide to Recovery
By Lindsey Hall & Monika Ostroff
Anorexia nervosa, in the most simple terms, is self-starvation. Anorexics (anorectic is also correct usage) are typically described as "walking skeletons", a graphic image that depicts the pallor and frailty of these struggling individuals. Anorexics are also often characterized as stubborn, vain, appearance-obsessed people who simply do not know when to stop dieting. But anorexia nervosa is much more than just a diet gone awry, and the sufferer more than an obstinate, skinny person refusing to eat. It is a complex problem with intricate roots that often begins as a creative and reasonable solution to difficult circumstances, and is thus a way to cope.
Anorexia is Greek word meaning "loss of appetite," which is misleading because only in the late stages of starvation do people in fact lose their appetites. Instead, an intense fear of weight gain leads anorexics to routinely and vehemently deny their hunger. In order to formally diagnose an individual with anorexia nervosa, clinicians turn to the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 1994). The DSM-IV lists four criteria that an individual must meet in order to be diagnosed as anorexic, generalized as follows:
A. The individual maintains a body weight that is about 15% below normal for age, height, and body type.
B. The individual has an intense fear of gaining weight or becoming fat, even though they are underweight. Paradoxically, losing weight can make the fear of gaining even worse.
C. The individual has a distorted body image. Some may feel fat all over, others recognize that they are generally thin but see specific body parts (particularly the stomach and thighs) as being too fat. Their self-worth is based on their body size and shape. They deny that their low body weight is serious cause for concern.
D. In women, there is an absence of at least three consecutive menstrual cycles. A woman also meets this criteria if her period occurs only while she is taking a hormone pill (including, but not limited to, oral contraceptives).
The DSM-IV also differentiates between two specific types of anorexia nervosa. "Restricting Type" denotes individuals who lose weight primarily by reducing their overall food intake through dieting, fasting and/or exercising excessively. "Binge-Eating/Purging Type" describes those who regularly binge (consume large amounts of food in short periods of time), and purge through self-induced vomiting, excessive exercise, fasting, the abuse of diuretics, laxatives, and enemas, or any combination of these measures.
