By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Anorexia is an eating disorder that is about more than food.
Anorexia Nervosa, Anorexia for short, is one of the Feeding and Eating Disorders that are officially recognized as a mental disorder in the DSM-5. Anorexia has recognized “subtypes.” Like that of many other mental health disorders, these subtypes may over time change enough that a person might get several different diagnoses during their life.
There have been several prominent people who have suffered from Anorexia and death is a possible outcome of this disease. This disorder affects women about ten times as often as it does men. Researchers and writers have compared this disorder to OCD and addiction. Similar pathways in the brain may be affected in all these conditions. More information on the alteration of the brain’s functioning in these disorders is likely to become available in the future.
The big three Anorexia symptoms.
There are three significant symptoms that professionals look for in diagnosing Anorexia. These include how the person with Anorexia sees their body, similar to the distortions we see in Body Dysmorphic Disorder. Also on the symptoms list is how the client feels about their body weight and lastly comes the result of this distorted body image and their altered feelings about body weight. This post as other posts on counselorssoapbox.com is my simplified, common language description. For the full text check out the DSM-5 by the APA.
People with Anorexia think they are fat even when the mirror disagrees.
It is common for those with Anorexia to report they dislike themselves because they are “fat” or overweight. They will persist in believing they are fat even when told by their doctor or other professional that their body weight falls below the minimum needed for health.
When asked about their weight they will often report that they need to lose a few pounds even when they are experiencing medical issues from malnutrition.
Some may only report that one part of their body is too large or misshapen. The solution to this oversized body part in their mind is extreme weight loss.
In Anorexia weight gain is more feared than death.
Someone who has Anorexia will demonstrate an extreme fear of gaining weight. They continue to assert that if they eat they will become “fat” and will go to extreme lengths to avoid weight gain.
A dislike of the self because of this distorted view of their body is common. Even when they know that this self-view is unrealistic they can’t seem to shake the belief that if they could just lose some more weight than they would be acceptable,
Using more calories than you take in is the continual goal.
Someone with Anorexia will attempt to reduce the calories taken in each day below the amount they need to maintain a normal weight. This is done not simply to prevent weight gain but to result in a loss of weight. This is nothing like typical dieting where the goal is to maintain a healthy weight. The goal here, presumably, is to continue to lose weight even when they are already thinner than a healthy weight.
Because of the two criteria above the person with Anorexia continues to think of themselves as fat and to fear any weight gain no matter how low the body weight may go.
In children or young adults, this may manifest more as a failure to grow and put on weight during the growing years rather than a measurable loss of weight.
There are two recognized types of Anorexia, although this may change over time.
Restricting type Anorexia.
In this condition, the person avoids taking in calories as much as possible. They may avoid eating around others, say they are full or not feeling well or otherwise try to avoid even a minimal amount of calories.
Binge eating and purging type Anorexia.
In this subtype of Anorexia Nervosa, the person with Anorexia may give in to the look or taste of food and eat. When they do this it is like the alcoholic who just relapsed. Any food in sight is fair game. But as soon as they have eaten, they are overcome with an intense fear of weight gain and guilt. At this point, they will use extraordinary efforts to get rid of the unwanted calories.
These compensatory efforts may include purging, self-induced vomiting, or the use of laxatives to produce intense diarrhea. Some will resort to strenuous exercise in an effort to atone for the eating binge.
The primary distinction between Anorexia and Bulimia Nervosa is that the person with Bulimia looks like they have a normal body weight. They may even be a few pounds over and they eat well, just they use the compensatory methods to avoid weight gain. Those purging binges can damage their health. In Anorexia the risk is that the damage to health may be more rapid and may result in death. More on Bulimia Nervosa in an upcoming What is. post
Risk factors for developing Anorexia include having currently or in the past had an Anxiety disorder, as well as cultures, occupations or activities that emphasize being thin.
FYI these recent “What is” posts are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. The descriptions are largely my own plain language versions.
For more on this and related topics see – Feeding and Eating Disorders.
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