212 Eating Disorders
fear of fatness.” Anorexia has also been described in terms of self-control.
For example, Garfinkel and Garner (1986) suggested that the achievement
of ever-decreasing weight becomes a sign of mastery, control, and virtue.
Crisp, in 1984, likewise compared the anorexic to the ascetic in terms of
his or her “discipline, frugality, abstinence and stifling of the passions”
(p. 210), and analyzed anorexia as resulting from a determination to keep
“the impulse to ingest at bay” and as a consequence of a “never ending
vigilance and denial.” Similarly, Bruch described the anorexic as having an
“aura of special power and super human discipline” (1985).
Currently, the definition of anorexia nervosa most frequently used by
researchers and clinicians is that described in DSM-IV (1994). This states
that anorexia nervosa involves the following factors:
- Refusal to maintain body weight at or above a minimally normal weight
for age and height (e.g., weight loss leading to maintenance of body
weight less than 85 percent of that expected, or failure to make expected
weight gain during period of growth, leading to body weight less than
85 percent of that expected). - Intense fear of gaining weight or becoming fat even though underweight.
- Disturbance in the way in which body weight or shape is experienced,
undue influence of body weight or shape on self-evaluation, or denial
of the current low body weight. - In postmenarcheal females, amenorrhea, that is, the absence of at least
three consecutive menstrual cycles. (A woman is considered to have
amenorrhea if her periods occur only following hormone – e.g., estrogen- administration.)
DSM-IV also describes two types of anorexia nervosa. The first is restricting
anorexia, which involves food restriction and no episodes of bingeing or
purging. The second is binge eating/purging anorexia, which involves both
food restriction and episodes of bingeing or purging through self-induced
vomiting or the misuse of laxatives, diuretics, or enemas.
This classification system can be used for the diagnosis of anorexia ner-
vosa and is currently central to much clinical work and research. It can be
regarded as the medico-clinical approach to the disorder. In contrast,
Brumberg (1988) argued for a more sociocultural approach to understanding
eating disorders, and suggested that the presentation of anorexia nervosa
has and will change according to the social norms of any particular time.
She stated that “we should expect to see anorexia nervosa ‘present’ differently
in terms of both predisposing psychological factors and actual physical