What is Anorexia Nervosa (307.1, F50.01 or F50.02)

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

What is

What is Anorexia Nervosa (307.1, F50.01 or F50.02)
Photo courtesy of Pixabay.

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.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Binging on food – Binge Eating

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Food.
Photo courtesy of Pixabay.com

Out of control eating is officially a mental illness.

With the advent of the DSM-5, Binge Eating Disorder (307.51 F50.8), is officially a recognized mental illness. Reading through the description of this newly recognized disorder it occurs to me that this is not what most non-professionals have been thinking of when they talk about people who overeat. What follows is my oversimplified explanation of how I understand this and how it might affect clients I see. For the full official description, you would need to read the APA’s DSM-5 text.

Why does Binge Eating Disorder matter?

Given the APA’s estimates, the number of people in the U. S. who currently have or meet criteria for Binge Eating Disorder would run from 2 ½ to 5 MILLION people. A look at the criteria also indicates this is a lot more serious condition than we might first think. A lot of the criteria remind me of the features we see in alcoholism. This is more than just liking to eat. Binge Eating Disorder goes all the way to losing control.

First, some things that do not appear to be included in the definition of Binge Eating Disorder and then the things that might define the disorder.

What Binge Eating Disorder is not:

Binge Eating disorder is not being overweight or obese.

We think that excess weight is a medical problem. There are a lot of reasons someone could be overweight or even obese that have nothing to do with binge eating. Mental Health and obesity have a lot of connections but Binge Eating Disorder is not the only one. (More on how mental illness may be making you overweight in an upcoming post.)

Binge Eating Disorder is not Holiday Eating.

That Thanksgiving dinner is a good reason to gorge yourself. It is almost Un-American to eat lightly on that holiday. Lots of families have other traditional family or holiday celebrations and the food is a major part of that celebration. We do not count social eating events as Binge Eating Disorder even if after the holidays you find you have packed on some pounds.

Snacking all day is not Binge Eating Disorder.

Some people have told me that eating small amounts of food at many small meals a day is healthier than a few huge ones. I am also told that eating lots of food is healthy if you can do it all day long. (I am skeptical of that argument.) There was a time when low weight people died every winter and a fat baby was considered a healthy baby. Modern healthcare has severed that connection, but I know new parents often worry if their child is not gaining weight as rapidly as they expected.

Eating because you are chronically hungry is about poverty, famine or bad nutrition.

If someone is low in body weight and eats a lot that is probably not Binge Eating Disorder. If they are staying low body weight because they do other “compensating” behaviors that is a different kind of eating disorder most likely Bulimia Nervosa.

Eating frequently because you are growing, expending energy or just plain hungry is not Binge Eating Disorder. Binging is sneakier than that.

What factors do make it Binge Eating Disorder?

 The Binge eater feels bad when they do it.

People with Binge-eating Disorder may eat alone so others do not see how much they eat. This behavior reminds me of the alcoholic sneaking drinks. The Binge Eater does not want others to see them binging. The may eat in solitary, hide the evidence and they feel guilty or ashamed of what they do.

Eventually, that shame and or guilt become a separate problem that needs treatment and may be the thing that keeps the binging behavior going even if they want to stop.

Binge eaters lose control of their eating.

This loss of control takes many forms. The binge eater eats fast, very fast. They eat more than they want. They can’t stop eating even when they are over full. They may keep on eating to the point of feeling sick to their stomach.

One of the defining features of this disorder is the tendency to eat huge amounts of food in a short period of time. A binge eater will eat enough food for two or three people and do it in 2 hours of meal time or less.

Binge Eaters do these behaviors a lot.

This is not something that the binge eater does occasionally. To get this new diagnosis a person would need to binge at least 13 times over a three-month period.

The Binge Eating Disorder diagnosis allows for a range of severity.

The minimum is 13 times in three months. Extreme Binge Eating Disorder is binging two times a day all 7 days a week. To meet the 3-month rule and have extreme Binge Eating Disorder would require over 180 episodes of binging with no compensating efforts to lose the calories.

Emotional Eating does not automatically count as a Binge.

Most counselors have heard clients describe times they “emotionally eat.” You have a fight with your partner and there go the whole two gallons of ice cream. Those uses of food to make yourself feel better are more likely a part of depression, anxiety or that often overlooked but sometimes fatal Adjustment Disorder.

The Binge Eating conclusion?

If you are overweight or obese see your doctor and work on your physical health. If you occasionally use food like a drug to treat your emotional problems work on those problems. But if you find that you or someone you know is repeatedly binging on food, feels shame and guilt about this behavior or has lost control of how much they eat, it is time for some professional help.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Avoidant Restrictive Food Intake Disorder

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Avoidant Restrictive Food Intake Disorder vs. Anorexia and Bulimia.

How is Avoidant Restrictive Food Intake Disorder (ARFIDO) different from all those eating disorders people have come to know? And did we really need another eating disorder diagnosis?

Proposed for the new DSM-5 and looking like a for-sure new recognized eating disorder is ARFIDO.  ARFIDO has some differences from past eating disorders. Given the many possible bad relationships with food people could become involved with, my take is yes this one is different from either Anorexia Nervosa or Bulimia and it has been needed for some time.

The way we have been looking at eating disorders has had some flaws for a while now. McFarland et al in 2008 wrote an interesting article on eating disorder relapse. The topic of relapse and relapse prevention has been an important part of substance abuse treatment for a long time. Recently we have been looking at the issue of relapse related to mental health issues.

In his article, McFarland reported that they ended up including all the people with an eating disorder in the relapse study because people with an eating disorder move between disorders often enough to prevent saying someone has one and only one eating disorder.

We also are told in this article that the majority of people in treatment for an eating disorder, up to 60% of those treated in outpatient, did not meet the criteria for one of the official diagnosis and ended up in the leftover category Eating Disorder Not otherwise specified (NOS).

Creating a new disorder (ARFIDO) is supposed to reduce the number of people who were ending up in that vague NOS land.

People with ARFIDO are different from those with anorexia nervosa or bulimia in several important ways. (I have taken liberties with the new DSM-V criteria here for sake of explanation.)

1. They do not have the characteristic distorted body image.

Ask a person with anorexia what they think about their current weight and they will tell you they are fat. Show them their reflection in the mirror, bones sticking out and all and they will still say they look fat. They see themselves at fat and no facts, not even the scale and the standard weight charts, will change that perception.

People with ARFIDO do not necessarily think they are fat.

They know they are thin, abnormally thin, but they like it that way. They become proud of their ability to stay thinner than most. They will keep up the dieting even when they know they are developing a health problem or nutritional deficiency because they like being one of the thin ones.

2. They don’t especially like food, food is the enemy.

People with ARFIDO will avoid many or all foods. They may need to resort to nutritional supplements to keep their weight above the critical go-to-hospital point.

3. They avoid putting on weight as they grow or in adulthood lose excessive amounts of weight.

They will continue avoiding food even when they know they are making themselves sick by their intentional starvation.  Like Pieter Pan, they do not want to grow up or get larger.

4. This is not the result of starvation or lack of resources. People with ARFIDO do this on purpose. The will harm their health to look thin while living in a home with a full refrigerator.

5. Because they are so good at avoiding eating, people with ARFIDO do not have the need for the extreme measures we see in Anorexia Nervosa or Bulimia.

That is my understanding of this new diagnostic category at the current point in time. The new DSM will be out early next year and we can all get the full details then.

The update I read at the APA site was May 14-2012. They also note that when this is all done they expect there to be three subtypes of ARFIDO, A People who do not eat and are not interested in eating B People who will only eat food with certain sensory characteristics,  C People who won’t eat because of an aversive experience.

Other posts about eating disorders and the new DSM-V proposals will be found at:

Binge Eating Disorder – the other side of Anorexia and Bulimia 

Middle class and starving to death in America – An Eating Disorder called Anorexia

Love Hate relationship with food – Bulimia Nervosa

Eating Disorders and Substance abuse  

So do you think that this creation of ARFIDO will improve recognition of poorly recognized eating disorders? Do you believe you or someone you know has had an episode of Avoidant Restrictive Food Intake Disorder? If you recovering from or have you had a relapse to Avoidant Restrictive Food Intake Disorder would you care to leave a comment?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.