436 CHAPTER 10
Many people in Western culture try to attain or maintain a particular weight by
dieting, exercising, or monitoring their food intake. Some of those people have—
or will have—an eating disorder. An eating disorder is characterized by abnormal
eating and a preoccupation with body image. Females make up 90% of those diag-
nosed with an eating disorder, and so in this chapter, we will refer to an individual
with an eating disorder as “she” or “her;” however, the number of males with eat-
ing disorders has been slowly increasing (Hudson et al., 2007).
DSM-IV-TR lists two specifi c eating disorders: anorexia nervosa and bulimia
nervosa. In this chapter, we examine the criteria for and the medical effects of these
two disorders, and consider the criticisms of the criteria used to diagnose them. We
also discuss research fi ndings that can illuminate why eating disorders arise and the
various methods used to treat them.Anorexia Nervosa
After years of struggling with bulimia, Marya Hornbacher began “inching” toward
anorexia; she gradually became signifi cantly underweight by severely restricting her
food intake, refusing to eat enough to obtain a healthy weight:
Anorexia started slowly. It took time to work myself into the frenzy that the disease
demands. There were an incredible number of painfully thin girls at [school], danc-
ers mostly. The obsession with weight seemed nearly universal. Whispers and longing
stares followed the ones who were visibly anorexic. We sat at our cafeteria tables,
passionately discussing the calories of lettuce, celery, a dinner roll, rice. We moved be-
tween two worlds. When we pushed back our chairs and scattered to our departments,
we transformed. I would watch girls who’d just been near tears in the dorm-room mir-
rors suddenly become rapt with life, fi ngers fl ying over a harp, a violin, bodies elastic
with motion, voices strolling through Shakespeare’s forest of words.
(Hornbacher, 1998, p. 102).
Hornbacher wanted to be thin, to be in control of her eating, and to feel more in
control of herself generally. She began to eat less and less, to the point where she
began to pass out at school.
Let’s investigate anorexia nervosa in more detail. In this section we discuss the
specifi c DSM-IV-TR criteria for anorexia nervosa and its subtypes, the various med-
ical consequences of the disorder, and criticisms of the DSM-IV-TR defi nition of
anorexia nervosa.What Is Anorexia Nervosa?
A key feature ofanorexia nervosa (often referred to simply as anorexia) is that
the person will not maintain at least a low normal weight and employs various
methods to prevent weight gain (American Psychiatric Association, 2000). Despite
medical and psychological consequences of a low weight, those with anorexia ner-
vosa continue to pursue extreme thinness. Unfortunately, anorexia has a high risk
of death, though not all by suicide: About 10–15% of people hospitalized with an-
orexia eventually die as a direct or indirect consequence of the disorder (American
Psychiatric Association, 2000; Zipfel et al., 2000).Anorexia Nervosa According to DSM-IV-TR
To be diagnosed with anorexia nervosa according to DSM-IV-TR, symptoms must
meet four criteria:1.A refusal to obtain or maintain a healthy weight (at least 85% of expected body
weight, based on age and height).2.An intense fear of becoming fat or gaining weight, despite being signifi cantly
underweight. This fear is often the primary reason that the person refuses to
attain a healthy weight. Those who have anorexia are obsessed with their bodyIndividuals with anorexia nervosa have a very
low weight and, despite medical consequences,
refuse to maintain a healthy weight. This young
woman had been on her college swim team when
she suffered a heart attack; her anorexia per-
sisted and she was considered to be a danger to
herself and banned from campus.AP Photo/Ed Andrieski
Eating disorders
A category of psychological disorders
characterized by abnormal eating and a
preoccupation with body image.