Identifying Anorexia Nervosa
(Definition: lack of appetite)
The definition of Anorexia Nervosa of lack of appetite is deceptive. Anorexia Nervosa has little to do with a lack of appetite. Individuals with anorexia nervosa are hungry, but they switch off their internal signals. Unfortunately this problem is often approached as an illness from the medical model perspective. It can certainly create illness or disease but I prefer to find the person behind the presentation.
If you suffer from Anorexia Nervosa, or if think someone in your family does, medical, psychiatric and psychological professionals would use the following diagnostic criteria to classify the problem. While I have listed the criteria below a diagnosis is not based only on whether a person meets the criteria. Sometimes there are other factors that could be involved which would mean that the diagnosis would not be applied. For example, someone may have lost an enormous amount of weight due to a significant loss or event and may be suffering from depression, a mood disorder which can result in weight loss. A range of factors would be used to make a diagnosis. A diagnostic category or label is a communication tool used by professionals to understand an individual and to devise treatment plans and care packages. Unfortunately, some people internalise labels and then live up to them. Use the following criteria as a guideline to understand the problem rather than to label someone. If you, or someone you know manifests with the following symptoms, try and encourage hin/her to seek professional help. Please remember never to diagnose yourself or someone else! Always speak to a professional specialised in diagnosing and working with eating disorders.
1. There is a refusal to maintain body weight at the accepted normal body weight ratio. Usually the amount of weight that has been lost is more than 25% of the original healthy body weight. (See the Body Mass Index table (BMI) to determine your height and weight ratio). For example, someone who is 1,57 tall and who used to weigh 55 kgs but who now weighs 40 kgs, has lost 27.3% of her original body weight and in terms of the BMI table, is now underweight.
2. There is an intense fear of gaining weight or becoming fat, even though underweight. Every thought is focussed around weight and food.
3. There is a disturbed body image and a relentless pursuit of thinness often to the point of starvation. When an anorexic looks in the mirror, she does not see her body as it is but as she perceives it to be. Say she weighs 32 kilograms. When she looks in the mirror and sees her hips sticking out, and her knobbly knees, she will see these as manifestations of being fat and not as the reality that she is skeletal.
The above are set criteria. Only three of these have to be present for the person to be diagnosed as anorexic.
4. There are two types of anorexics:
1. The restricting type: They restrict their food intake.
They do not binge, nor do they overeat or purge.
This person simply does not eat and can reach a dangerously low weight.
2. Binge-eating / Purging Type: This person regularly engages in purging of different sorts. They vomit up their food, use laxatives, enemas, diuretics and excessive exercise. Any of these methods can be used in isolation or can be combined. Please note that certain foods, such as high-grained cereals have the same effect as a laxative.
If you or anyone manifests with the above symptoms, please do not delay. Seek help immediately. Anorexia nervosa is life-threatening!
Information based on the Diagnostic and Statistical Manual (Fifth Edition) and the ICD-9 and IC-10 criteria.