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Anorexia Nervosa: What is an
appropriate diagnosis?
 The criteria for anorexia
nervosa requires an individual be significantly underweight for their age and
height. Although it may be difficult to set up a single weight loss standard
for anorexia nervosa that applies to all individuals, a benchmark of 85% of the
weight considered normal for an individuals weight and height is usually used as
a guideline. Although they may be abnormally low in body weight, individuals
with anorexia nervosa are intensely afraid of gaining weight and becoming fat,
which fear typically intensifies as their weight continues to fall.
Another criterion that must be
met for individuals with anorexia nervosa is that they must have a disturbance
in their judgment about their weight or shape. Although they may be
underweight, they frequently view themselves or part of their bodies as being
too heavy. Typically they deny the inherent medical risks involved in their
semi starvation and place enormous importance on whether they have gained or
lost weight. An individual with anorexia nervosa may feel intensively
distressed if their weight fluctuates by as little as one half of a pound.
Another diagnostic criterion requires that women with anorexia nervosa also be
amenorrheic.
According to the DSM-IV-TR,
individuals with anorexia nervosa should be classified according to two
variants, either the binge-eating/purging type or the restricting type.
Individuals with the restricting type of anorexia nervosa do not engage in
either binge-eating or purging, and compared with individuals who
binge-eat/purge, are not as likely to abuse alcohol and other drugs. They
usually exhibit less intense mood changes and are less active sexually. It is
also recognized among clinicians that the two subtypes may differ in their
response to medication interventions.
Anorexia nervosa frequently
begins very innocently. Often times, an adolescent or young woman of normal
weight or possibly a few pounds overweight may begin a diet. Initially, the
dieting is usually not very different from that pursued by other young women,
but as their weight begins to fall the dieting continues to intensify. The
restrictions become much broader and more rigid. For example, they may begin to
eliminate all desserts and meat. Food frequently begins to assume a moral
quality with such foods as vegetables being viewed as "good" and meat as "bad".
Individuals with anorexia nervosa may develop rigid rules about such things as
exercise that must be done religiously and rigidly defining when, where and how
that they may eat.
Food avoidance and weight loss
are seen as significant triumphs by individuals with anorexia nervosa. Weight
gain is frequently seen as a failure or sign of weakness. Physical activity
such as running becomes constant and extreme as the dieting and weight loss
continue. Inactivity and complaints of weakness only develop later as
emaciation has become obviously apparent and extreme. The anorexic may become
more serious and devote little effort to anything besides limiting food
consumption and exercising. They frequently become depressed and develop
emotional lability, social withdrawal, become secretive and frequently lie about
their eating and their weight. They develop profound disturbances in their view
of weight and calorie needs. However, their reality testing remains intact and
they may continue to do well in school or at work. Symptoms of anorexia nervosa
usually persist for months or years until typically at the insistence of family
or friends the person reluctantly agrees to see a doctor or mental health
clinician.
Some information from DSM-IV-TR
Mental Disorders Diagnosis, Etiology and Treatment
Additional information and webpage by
Paul Susic
MA
Licensed Psychologist Ph.D. Candidate
(Health and Geriatric Psychologist)
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