Anorexia nervosa
DefinitionAnorexia nervosa is an eating disorder that involves
self-imposed starvation. The individual is obsessed
with becoming increasingly thinner and limits food
intake to the point where health is compromised. Ano-
rexia nervosa can be fatal.
DescriptionAnorexia is often thought of as a modern prob-
lem, but the English physician Richard Morton first
described it in 1689. In the twenty-first century ano-
rexia nervosa is recognized as a psychiatric disorder in
theDiagnostic and Statistical Manual for Mental Dis-
orders Fourth Edition (DSM-IV-TR)published by the
American Psychiatric Association.
Individuals with anorexia are on an irrational,
unrelenting quest to lose weight, and no matter how
much they lose and how much their health is compro-
mised, they want to lose more weight. Recognizing the
development of anorexia can be difficult, especially in a
society that values and glamorizes thinness. Dieting is
often the trigger that starts a person down the road to
anorexia. The future anorectic may begin by skipping
meals or taking only tiny portions. She (most anorectics
are female) always has an excuse for why she does not
want to eat, whether it is not feeling hungry, feeling ill,
having just eaten with someone else, or not liking the
food served. She also begins to read food labels and
knows exactly how many calories and how much fat are
in everything she eats. Many anorectics practically
eliminate fat and sugar from their diets and seem to
live on diet soda and lettuce. Some future anorectics
begin to exercise compulsively to burn extra calories.
Eventually these practices have serious health conse-
quences. At some point, the line between problem eat-
ing and an eating disorder is crossed.
Anorexia nervosa is diagnosed when most of the
following conditions are present:
an overriding obsession with food and thinness that
controls activities and eating patterns every hour of
every day
the individual weighs less than 85% of the average
weight for his or her age and height group and will-
fully and intentionally refuses to maintain an appro-
priate body weight
extreme fear of gaining weight or becoming fat, even
when the individual is significantly underweight.
a distorted self-image that fuels a refusal to admit to
being underweight, even when this is demonstrably
true
refusal to admit that being severely underweight is
dangerous to health
for women, three missed menstrual periods in a row
after menstruation has been established
Anorectics spend a lot of time looking in the mir-
ror, obsessing about clothing size, and practicing neg-
ative self-talk about their bodies. Some are secretive
about eating and will avoid eating in front of other
people. They may develop strange eating habits such as
chewing their food and then spitting it out, or they may
have rigid ideas about ‘‘good’’ and ‘‘bad’’ food. Ano-
rectics will lie about their eating habits and their weight
to friends, family, and healthcare providers. Many
anorectics experience depression and anxiety disorders.
There are two major subtypes of anorectics.
Restrictive anorectics control their weight by rigor-
ously limiting the amount of calories they eat or by
fasting. They may exercise excessively or abuse drugs
or herbal remedies claim to increase the rate at which
the body burns calories. Purge-type anorectics eat and
then get rid of the calories and weight by self-induced
vomiting, excessive laxative use, and abuse ofdiu-
reticsor enemas.Demographics
Anorexia is a disorder of industrialized countries
where food is abundant and the culture values a thin
appearance. About 1% of Americans are anorectic
and female anorectics outnumber males 10:1. In men,
the disorder is more often diagnosed in homosexuals
than in heterosexuals. Some experts believe that num-
ber of diagnosed anorectics represents only the most
severe cases, and that many more people have ano-
rexic tendencies, but their symptoms do not rise to the
level needed for a medical diagnosis.
Anorexia has been characterized as a ‘‘rich white
girl’’ disorder. Most anorectics are white, and about
three-quarters of them come from households at the
middle income level or above. However, in the 2000s,
the number of blacks and Hispanics diagnosed with
anorexia has increased. Competitive athletes of all
races have an increased risk of developing anorexia
nervosa, especially in sports where weight it tied to
performance. Jockeys, wrestlers, figure skaters, cross-
country runners, and gymnasts (especially female
gymnasts) have higher than average rates of anorexia.
People such as actors, models, cheerleaders, and
dancers (especially ballet dancers) who are judged
mainly on their appearance are also at high risk of
developing the disorder.Anorexia nervosa