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Anorexia Nervosa: More than Simple Starvation

Clinical definition

Anorexia nervosa is characterized by dramatic weight loss and/or restricted food intake coupled with a great disturbance in body image. The DSM-IV suggests that a person be at least 15% below their normal expected body weight (factoring in age, height, and body frame), but that is only a guideline. In women, the DSM-IV criteria also requires amenorrhea, or cessation of the menstrual cycle, for an "official" diagnosis. (I personally don't agree with this portion of diagnostic criteria, but I didn't write the manual.) Many women with anorexia begin menstruating again just because the body can figure out how to "adapt," even if health and weight are not restored.

If a person is anorexic and still has regular menses, or has lost a great deal of weight yet still is of "normal" or borderline weight, most therapists would have to officially classify this as an eating disorder not otherwise specified, but effectively, this is still anorexia.

There are two subtypes of anorexia: the restricting type, and the purging type.

It's not about not eating

"I eat too much to be anorexic" is an all-too-common defense. The fact is, people with anorexia do eat at least periodically, but greatly restrict food intake. Food restriction may consist of allowing only a certain number of calories per day, or to only certain "safe" foods. (What is "safe" may greatly vary from person to person, and "safe" foods can sometimes change on an almost daily basis.)

Some people with anorexia may restrict for periods of time, and later binge and often subsequently purge; these behaviors are also seen in bulimia nervosa, although a person with anorexia generally restricts overall food intake more than one with bulimia. Others with anorexia may purge after eating normal or very small amounts of food, especially when made to eat with family members. This is how the two "subtypes" of anorexia come into play.

Repeatedly chewing food and spitting it out without swallowing is also sometimes seen...another behavior that therapists may instead classify as "ED-NOS," unless the patient meets all other criteria of anorexia. Excessive exercise, use of diet pills, laxatives and/or diuretics are also very common as well. Anything to manipulate that number on the scale.

It's not vanity or a "diet"

Although going on a "diet" often precedes an eating disorder, there is much more to anorexia than an overzealous attempt at dieting. There is a greatly disturbed body image which causes the anoretic to have a perception (albeit distorted) of being "fat." An entire self-worth based on the number on the scale, the size of their clothes, or their perceived size in relationship to those around them, perhaps because they don't feel they can "measure up" any other way, so to speak. And there are deep psychological issues, most often a low level of self-esteem and a high level of self-hatred. The wish to "fade into nothing" is a common expression with people suffering from this disease.

As far as dispeling the vanity myth, anorexia is hardly a beautiful thing. Women who were sexually abused may use weight loss to make their breasts smaller, so they will be sexually unattractive (the same rational through the opposite means is sometimes seen in binge-eating disorder). An eating disorder is also often a way to numb out, an issue of control (e.g. "the only thing I can control in my life is what goes in or out of my body"), or as a coping mechanism to deal with problems in life. Some researchers classify eating disorders as "addictions," and indeed, some people with anorexia do report feelings of euphoria during long periods of fasting or restricting. Not unlike the "runners high" that occurs from exercise, this "high" occurs for the same reason: the body produces endorphins to mask the pain of starvation. This is why recovery from anorexia is more complicated than a simple "Just Eat."

This disease knows no bounds

Another common myth is that only teenage girls develope anorexia. The fact is, anorexia in young adults, middle-aged women, and even the elderly, is on the rise. Many adults have faced anorexia (or other eating disorders) for many years; others do not develop their eating disordered behaviors until well into adulthood.

It should also be emphasized that anorexia is not a disease only for girls and omwn. Statistics show that about one in ten anoretics is male. The fact that the disorder is more commonly seen in females is partly due to the fact that society sends different messages to males and females about what their bodies should look like, but the fact that there are males with the disorder should prove my point that anorexia is more than just an overzealous bout of dieting.

Anorexia isn't a "white" thing, either. Rates of eating disorders among African-Americans, Hispanics, and Asians are also on the rise, although researchers have not focused on these groups for study until fairly recently.

"But you don't LOOK anorexic..."

For one thing, it's very easy to hide weight loss under baggy clothes. And sadly, today's society has become somewhat distorted as to what they perceive as "too thin," particularly in the skating world. I had been told (by two non-skaters) that my weight loss wasn't that bad, because figure skaters are supposed to be thin anyway.

For some reason, many individuals have the notion that if a person does not look like he or she just stepped out of a concentration camp, then that person cannot be anorexic. This is an extremely dangerous belief. NOT all anoretics look like skeletons; in fact, very few do. But just because a person is not completely emaciated doesn't mean that they do not have anorexia. Conversely, not every single person who is underweight necessarily suffers from an eating disorder. Remember: an eating disorder is about behavior and thought patterns... not how much one weighs.

Evan Keraminas

Links specific to anorexia

"I'm not a child and I'm so afraid..." (adult anorexia)
Sports Medicine Advisor: Anorexia Nervosa link fixed
What people with anorexia nervosa need to know about osteoporosis
Anorexia from the Something Fishy website
What is anorexia nervosa? from NAMI Anorexia FAQ
Anorexia fact sheet

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Anorexia Nervosa Bulimia Nervosa ED "Not Otherwise Specified"Binge Eating Disorder
Causes of eating disorders Physical and emotional effectsSigns and symptoms Getting help/Recovery
Why figure skaters? ED questionnaireBooks on eating disorders Eating disorder links
Issues of diagnosisSubmission formHealthy coping skillsBody image links
Healthy eating/Nutrition Self-injury

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