Eating Disorder Treatment of Anorexia and Bulimia

Eating Disorder Referral and Information Center

International Eating Disorder Referral Organization

Anorexia Nervosa

 

Defining characteristics of Anorexia Nervosa:

Individuals with anorexia nervosa are unwilling or unable to maintain a body weight that is normal or expectable for their age and height (most clinicians use 85% of normal weight as a guide). Individuals with anorexia nervosa typically display a pronounced fear of weight gain and a dread of becoming fat although they are dramatically underweight. Concerns and perceptions about their weight have a extremely powerful influence and impact on their self-evaluation. The seriousness of the weight loss and its physical effects is minimized or denied  (women with the diagnosis of anorexia nervosa have missed at least three consecutive menstrual cycles).

Diagnostic criteria of anorexia nervosa include two subtypes of the disorder that describe two distinct behavioral patterns. Individuals with the Restricting Type maintain their low body weight purely by restricting food intake and increased activity (i.e. compulsive exercise). Those with the Binge-Eating/Purging Type usually restrict their food intake but also regularly engage in binge eating and/or purging behaviors (i.e. self-induced vomiting or the misuse of laxatives, diuretics or enemas). Binge-Eating/Purging Type of Anorexia Nervosa is also frequently associated with other impulse control problems and mood disorders. 

People who suffer from anorexia often have low self-esteem and a tremendous need to control their surroundings and emotions. The eating disorder is often a reaction to external and internal conflicts (i.e. anxiety, stress, and unhappiness can be leading factors).

 

Profile: Anorexia Nervosa

The person suffering Anorexia is generally extremely sensitive about being fat, or has an intense fear of becoming fat, and of losing control over the amount of food he/she eats.  This hyper-sensitivity is accompanied by the desire to control his/her emotions and reactions to these emotions. Low self-esteem and the constant need for acceptance leads to obsessive dieting and starvation as a way to control not only weight, but also feelings and actions regarding their emotions. Many anorexics feel they are not deserving of life's gifts and pleasures.  They often deprive themselves of situations that offer pleasure. Starvation or restriction, obsessive exercise, calorie counting, a constant obsession with food and health issues, self-induced vomiting, the use of excessive amounts of laxative, diuretics, and/or diet pills, and a persistent concern with body image can all be some of the physical indications that someone suffers from Anorexia Nervosa. People suffering with Anorexia may also go through periods of Bulimia (binging and purging) as well.

There are numerous ways a person with Anorexia can exhibit their disorder. The anorexic attempts to maintain strict control over food/caloric intake. Periods of starvation, obsessive counting of calories, compulsive exercising, and/or purging after meals are among the most common symptoms. In some cases, an anorexic will seem to eat normal meals with only periods of restriction. They use diet pills to control their appetite, or laxatives to attempt to rid their body of food, both of which are dangerous and useless in producing weight loss results. Anorexics will deny hunger, make excuses to avoid eating, will often hide food they claim to have eaten, or attempt to purge the food away with self-induced vomiting, or by taking laxatives.

 

Diagnostic Criteria: Anorexia Nervosa

The following definition of Anorexia Nervosa is used to assist mental health professionals in making a clinical diagnosis. The clinical criteria is not always representative of what one living with anorexia feels. Please note, you can still suffer from Anorexia even if one of the below signs is not present. One can not simply read the criteria and think "I don't have one of the symptoms, so I am not Anorexic" or "I don't have a problem with food."

1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).

2. Intense fear of gaining weight or becoming fat, even though underweight.

3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

4. In postmenarcheal females (the absence of at least three consecutive menstrual cycles.

Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Binge-Eating Type or Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating OR purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

 

Definition/Review of Anorexia Nervosa:

Anorexia Nervosa is an eating disorder effected by a complex mixture of social, psychological and physical problems.

Characteristics are:

A. An intense drive for thinness

B. An intense fear of gaining weight or becoming fat

C. A disturbance in body image

D. In women- a cessation of the menstrual cycle for at least three months

E. In men- a decreased sexual drive

 

Facts About Anorexia Nervosa:

A. There are two types of Anorexia Nervosa:

1. Restrictive type

2. Binge eating/purging type.

B. 90-95% of individuals with Anorexia Nervosa are female.

C. It affects about 1 in 2400 adolescents.

D. It typically develops in early to mid-adolescents.

E. Psychological problems are displaced onto food.

F. It is usually preceded by dieting behavior.

G. Unusual food behaviors are practiced.

H. Need to vicariously enjoy food by cooking it, serving it, or being around it is common.

I. Preoccupation with body weight and image.

J. Dieting becomes increasingly important.

K. Denial of the condition can be extreme.

L. Body image disturbance (misperception of body size and shape) is common.

M. Pronounced emotional changes are common.

N. One-third of anorexics subsequently develop Bulimia Nervosa.

 

Common purging behaviors include:

A. Self-induced vomiting

B. Diuretic abuse

C. Laxative abuse

D. Emetic abuse

E. Excessive exercise

F. Fasting

 

Both Anorexia and Bulimia:

Eating disorders are very complex emotional issues. Though they may seem to be nothing but a dangerously obsessive dietary concern on the surface, for most men and women suffering with an eating disorder there are deeper emotional conflicts to be resolved.

 

Things that can increase your chances of getting anorexia are called risk factors. Here's a list of some of them. (From the British Medical Journal)

Being female. Ten women get anorexia for every one man who gets it.[1]
Having mental health problems that affect your mood, such as depression and anxiety (intense worry) or obsessive-compulsive disorder.[1] [2] [3] [4]
Having a job or hobby that makes you feel you have to be thin. Ballet dancers, gymnasts and models are under a lot of pressure to be thin.[1] [2] [3] [4] For men, sports like bodybuilding and wrestling increase their risk of getting anorexia.[3]
Having low self-esteem. Thinking you're no good at anything or won't amount to anything increases your chances of getting anorexia.[1]
Wanting to be perfect and accepting nothing less.[2] [4] [5]
Being unhappy with your weight and shape.[1]
Getting teased by others about your body.[3] [5]
Being white and financially well off.[3]
Feeling grief or deep sadness that you can't get over, about something bad that happened.[1]
Being sexually abused as a child.[1]
Having had problems digesting food and eating as a child.[1]
Inheriting certain genes.[1] [3] Having a female relative with anorexia in your immediate family, especially an identical twin, increases your chance of getting anorexia.[3]

 

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Sources:

American Psychiatric Association  (1998), Eating Disorders.

ANRED, www.anred.com

Dept. of Health and Human Services (1987, 1995). Anorexia Nervosa and Bulimia.

Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC: American Psychological Association, 1994.

 

*We cannot diagnose or treat eating disorders by email, but we can send you information and assist you in finding resources. Information provided by the Eating Disorder Referral and Information Center is not a substitute for medical treatment or psychological care.  It is vital that you talk with your physician and a qualified mental health professional regarding eating disorder symptoms and treatment.

 

Anorexia Nervosa

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