Abnormal Psychology

Eating Disorders 439

If, as you read Knapp’s description of her eating ritual, you were reminded of

symptoms of obsessive-compulsive disorder (OCD, see Chapter 7), you’re on to

something. Some symptoms of anorexia overlap with certain symptoms of OCD:

obsessions about symmetry, compulsions to order objects precisely, and hoarding.

However, other symptoms of OCD, such as obsessions about contamination and

checking and cleaning compulsions, do not overlap with those of anorexia (Halmi

et al., 2003).

Two Types of Anorexia Nervosa:

Restricting and Binge-Eating/Purging

People with anorexia become extremely thin and maintain their very low weight

in either of two ways: through restricting what they eat or through binge eating

and then purging. DSM-IV-TR categorizes two types of anorexia based on which

pattern is present:

• Restricting type. Low weight is achieved and maintained through severe undereat-

ing; there is no binge eating or purging. This is the classic type of anorexia, and

Knapp’s description in Case 10.1 illustrates the pattern of eating that is common

among people with the restricting type.

• Binge-eating/purging type. Some people with anorexia may engage in binge

eating—eating much more food at one time than most people would eat in the

same context, for example, a “snack” might consist of a pint or two of ice cream

with a whole jar of hot fudge sauce. Among people with anorexia, binge eating is

followed by purging, which is an attempt to reduce the ingested calories by vomit-

ing or by using diuretics, laxatives, or enemas.

Medical, Psychological, and Social Effects

of Anorexia Nervosa

Anorexia has serious negative effects on many aspects of bodily functioning.

Because of the daily defi cit between calories needed for normal functioning and

calories taken in, the body tries to make do with less. However, this process comes

at a high cost.

Anorexia’s Medical Effects

One possible effect of anorexia is that the heart muscle becomes

thinner as the body, searching for an energy source to meet the

its caloric demands, cannibalizes muscle generally, and the heart

muscle in particular. Muscle wasting is the term used when the

body breaks down muscle in order to obtain needed calories.

When people with anorexia exercise, they are not building mus-

cle but losing it, especially heart muscle—which can be fatal.

Excessive exercise is actively discouraged in people with an-

orexia, and even modest exercise may be discouraged, depend-

ing on the person’s weight and medical status.

A physical examination and lab tests are likely to reveal

other medical effects of anorexia, which arise through the

body’s adjustments to conserve energy. These include low heart

rate and blood pressure, abdominal bloating or discomfort,

constipation, loss of bone density (leading to osteoporosis and

easily fractured bones), and a slower metabolism (which leads

to lower body temperature, diffi culty tolerating cold tempera-

tures, and downy hairs forming on the body to provide in-

sulation). More visible effects include dry and yellow-orange

skin, brittle nails, and loss of hair on the scalp. Symptoms that

Binge eating

Eating much more food at one time than most

people would eat in the same context.

Purging

Attempting to reduce calories that have

already been consumed by vomiting or using

diuretics, laxatives, or enemas.

Underweight people may develop lanugo hair—

fi ne downy hair similar to that of newborns—on

the abdomen, back, and face. Lanugo disappears

when normal weight is attained.

C. Laird Birmingham, MD