ANOREXIA
1. Listen to the podcast What is anorexia? and complete the text:
I'm going to tell you about kind of the key features of Anorexia nervosa.
Actually, what I'm going to tell you are the four diagnostic criteria that are
currently in the diagnostic manual used by the majority of mental health
providers in the United States, and used by psychiatrists. That's the manual
called the DSM-IV. So the diagnostic criteria for Anorexia nervosa is first a
refusal, or maybe a better word is really sort of an inability, to maintain body
weight at a minimally medically appropriate place for one's age and height.
The DSM suggests that that minimal medical criterion be around 85 percent
of ideal body weight.
So that's criterion number one, and there's really sort of a relentlessness to
a person's drive to maintain this thin place that is so characteristic or core to
anorexia nervosa. The number two feature is intense fear of gaining weight,
even though underweight. Number three is a disturbance in the way one's
body shape or weight is experienced. It could also be a denial of the
seriousness of the underweight condition. "Oh, there's nothing wrong with
this, there's no medical compromise," that type of thing. The fourth cardinal
feature of anorexia nervosa which is currently a diagnostic criterion is that a
starvation has gone on long enough and has become serious enough that
the body is starting to shut down, and how this is manifested in women is by
the absence of menstrual cycles.
So if you see, due to underweight, the absence of three or more consecutive
menstrual cycles, that is call amenorrhea and that's currently another
diagnostic criterion of anorexia nervosa. In fact, as professionals, even
though this is on the list of diagnostic criteria for anorexia nervosa, we often
see folks that meet all the other feature cores of anorexia nervosa but don't
have the absence of menstrual cycles for whatever reason. Maybe their
body just hasn't quite shut down yet, or maybe they're on birth control pills
and they're still getting their period even though their body is in general in a
very starved state.
We also see male patients of anorexia nervosa. While they're the minority of
folks suffering from anorexia nervosa, males do also get this illness, and
obviously males can't lose their menstrual cycle, but there are men out
there that meet all these other core criteria of the illness and we would call
those men as having anorexia nervosa. So those are some of the core
features. There are lots of other signs and symptoms that go along with
anorexia nervosa. There can be a lot of medical consequences, and if I
haven't emphasized this until now, anorexia nervosa in particular can get
quite severe. It really has a high morbidity and even mortality rate. It's got
among the highest mortality rates of all psychiatric illnesses, with a mortality
rate of five percent per decade of unremitted anorexia nervosa.
People can become quite medically ill and even die from things like cardiac
causes and electrolyte imbalances, as well as from psychological
complications of the illness like severe depression and suicidal urges and
tendencies. So, a lot of other things that you can see with anorexia nervosa.
There's a lot of ritual that goes into the eating associated with anorexia
nervosa. People that cut up their food into lots of little bites, strict regimens
of calories. Perhaps you only have five or seven hundred calories a day, or
maybe even less. That's characteristic of this illness. You can also see binge
eating and purging behavior going on in anorexia nervosa as well. So a lot of
different things that can be present in this illness, and it's very complicated
to treat. Definitely if someone is struggling with this, if you're struggling with
it, reaching out to an expert in this area, a treatment center that has
experience with anorexia nervosa, is essential for moving through the
anorexia nervosa and into the process of recovery.
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All About Anorexia
Anorexia Nervosa is a mental health condition not just the desire to be slim.
It can endure for a lifetime and there are people who manage to escape
from it but trying to get better is much harder than staying in the illness.
When it enters the life of a family it changes everything, not only for the
sufferer but for those around them. Anorexia is a need, akin to a
compulsion, to achieve a low body weight by avoiding food or avoiding
certain foods that are believed to be fattening. It is maintained by the
sufferer believing that they are fat no matter how thin they are.
What also keeps people stuck is a deep fear of change and terror of being at
a normal weight as well as feeling special and in control. Anorexia has costs
but it also has benefits. This is what makes it an illness of contradictions.
Most people would be worried by low weight or emaciation but people with
anorexia seem proud of their bony appearance. They may insist, despite the
concern and alarm of others, that they are perfectly OK. This sense of being
able to survive with very little food can persist even when they are in a
dangerous state of health and even at risk of losing life.
Anorexia needs to be understood in order for us to help someone to
overcome it. It is described as an illness which is an attempt to feel better
on the inside by focusing on what is on the outside (citing McCabe 2003 in
Whitehead 2007). While this may be true of all people who place great
importance on controlling their weight, in anorexia, no matter how much
the outside is controlled, it never seems to be enough.
(http://eating-disorders.org.uk/information/all-about-anorexia/)
The Story Of An Anorexic Girl
Im 15 years old. have an older sister; she is smart and good at everything
and its hard to live up to her. I am close to my mother, shes a housewife,
and my father is a businessman. They get along okay I think, theyre not very
demonstrative.
Ive always done well at school; I suppose the teachers would call me an
ideal pupil not much trouble. Im aiming for As in my GCSEs, because Im
expected to go to University. Everyone says it should be a doddle for me but
I dont have their confidence in myself. God, it would be terrible if I
somehow failed!
It all started when I was 13 and started putting on a bit of weight and it
didnt feel right. When the gym teacher remarked that I was looking a little
podgy I thought right! thats it! and decided to diet there and then. I cut
down on the sweets and stopped eating breakfast. It was a great feeling
when those first few pounds came off and soon I was throwing away my
lunch as well, I wasnt really hungry.
I guess I was always rather shy and not as popular as I wanted to be, so it
was nice when people began to notice that I had lost weight you look
really good theyd say and when are you going to stop?. I suppose you
could say that I enjoyed the attention, and later their concern. Fighting my
hunger pangs at first was not too easy but when I started doing aerobics it
took the edge off my appetite. Now, if I dont exercise I feel anxious and fat.
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I dont honestly remember the point at which I started to be afraid of food.
Everything I eat bloats me out and Im terrified of gaining weight. So long as
I am losing I know Im safe. Of course people are starting to nag me now and
I have become quite clever at pushing food around on my plate or hiding it
in a napkin on my lap. Most of the time I pretend that I have eaten
somewhere else.
Im 40 kg now, but strange, when I look in the mirror I just see an enormous
blob and my stomach feels huge. My Mum cries a lot now and I am sorry
about that, shes threatening to take me to the doctor but I am certainly not
going to let them make me fat again. They cant make me eat.
I am afraid to admit to myself that I am starving all the time and Id love to
let go and sink my teeth into some bread and butter. But when I manage to
resist and I have won, I feel totally in control. Believe me, Im happy just the
way I am and I wish that people would just leave me alone.
What Is Anorexia Nervosa
The word ANOREXIA means appetite loss of nervous origins. It is not the
same as the loss of appetite that comes from overeating, from illness, or
from emotional stress. Some people find that they cannot eat when they are
afraid or depressed but this is not anorexia nervosa. Some people cannot eat
when they have damage to areas of the brain which are associated with
eating. A person may have a mental delusion that food is contaminated and
as a result they stop eating and lose a lot of weight, but this is not anorexia
nervosa either. Anorexia Nervosa is a condition of weight loss which is not
secondary to a physical condition and not just a variant of depression,
anxiety or OCD although anorexia contains features of all of these
psychological conditions.
Nor does anorexia imply lack of hunger. Many sufferers have intense hunger
and yet are able to master it in a way we do not fully understand. They
might do all sorts of things to distract themselves, like chewing gum, sucking
stones and pretending that they have eaten somewhere else.
So anorexia is perhaps incorrectly named. Its main feature is a deep fear of
food and eating, which is as strong as any of the more common phobias such
as fear of heights or fear of flying both of which are irrational but terrifying
to some people none the less.
Anorexia is also a disturbed perception of body size and shape, associated
with a fanatical desperation to avoid being fat. Now, in this day and age few
people want to be overweight and many people say that they would rather
lose a limb than be fat. So, some of these opinions are normal. But the
strength of conviction in a skeletal person of being really fat, and the
desperation to avoid having the slightest bit of fat on the body; this is what
separates the person with anorexia from those of us who would simply like
to be thinner but it is not such a matter of life and death.
Anorexia is only diagnosed when body weight is very low (BMI is less than
17.5 or 10% less than would be expected at their size and age). For
avoidance of doubt, other distinguishing features must be present as well,
such as a very inadequate diet caused by fear of eating and deep fear of
fatness. Not all anorexics are willing to admit their fear of food. As one
person said:
I dont eat carbohydrate or fat because it makes me bloated and I dont eat
meat because I love animals and I run just as much as other people do; it
makes me feel good and I just happened to have lost 20 lbs
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Who Gets Anorexia ? It is common to blame dieting for causing anorexia but most dieters do not
get the illness and cannot wait to start eating properly again when they have
The answer is mostly girls, dieters, and mostly in early adolescence,
lost some weight.
although 1 in every 50 sufferers is male and children as young as 7 suffer
too. Statistics tell us that for every 100,000 people in the community, we can The simple, clear rules of dieting seem to suit the personality of the person
expect that 19 will have anorexia. The average GP will have 1-2 anorexic who will become anorexic. Dieting is one thing they can do really well and
patients in their practice. Untreated, anorexia can last for many years, they can push themselves to do it better than everyone else. Keeping to the
although older people who show signs of the illness have usually suffered rules 100%, and more, helps them to feel secure and successful. They come
from an earlier episode some years ago. to feel that their body is their biggest achievement. They may get approval
from other people at least at first, and the fear of food and eating replaces
While expert accounts of anorexia differ, they do teach us something about
their true fears of life that belong elsewhere.
the inner world of someone with this condition or the person most likely
to get it. The illness is associated with low self-esteem, high levels of Case study
perfectionism, problems coping with the uncertainty in life, and managing
Jane, a 17-year old girl comes to your private practice complaining that she
relationships with other people. The anorexic personality yearns for a simple
thinks she is suffering from anorexia. She started losing weight one month
uncomplicated life, free of mess and unpredictability.
ago when her friends called her a whale. Since then she is not eating
There is no strong relationship between abuse in childhood or unhappy regularly and she is frightened that she might get ill.
experiences and anorexia. But we do have the impression that the sufferer
Tasks:
has been an overly sensitive child growing into a teenager who feels like a
failure no matter how well he or she is doing; someone who feels out of step a. Ask Jane if there is somebody in her family suffering from anorexia.
with everything that is going on in life. b. Tell her about anorexia.
c. Give her a list of foods she should eat in order to gain some weight.
Thus, while expert accounts of the illness vary, everyone agrees that what
d. Write her a menu for one day (breakfast, lunch, dinner)
starts as a simple desire to feel better by losing a little weight, turns into
something very different. We are not sure when exactly a normal diet turns
into anorexia. Some authors believe that anorexia is present from birth,
hiding within and only triggered at a time of stress.