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Anorexia Nervosa: What is an appropriate diagnosis? 

anorexia nervosaThe criteria for anorexia nervosa requires an individual be significantly underweight for their age and height.  Although it may be difficult to set up a single weight loss standard for anorexia nervosa that applies to all individuals, a benchmark of 85% of the weight considered normal for an individuals weight and height is usually used as a guideline.  Although they may be abnormally low in body weight, individuals with anorexia nervosa are intensely afraid of gaining weight and becoming fat, which fear typically intensifies as their weight continues to fall. 

Another criterion that must be met for individuals with anorexia nervosa is that they must have a disturbance in their judgment about their weight or shape.  Although they may be underweight, they frequently view themselves or part of their bodies as being too heavy.  Typically they deny the inherent medical risks involved in their semi starvation and place enormous importance on whether they have gained or lost weight.  An individual with anorexia nervosa may feel intensively distressed if their weight fluctuates by as little as one half of a pound.  Another diagnostic criterion requires that women with anorexia nervosa also be amenorrheic. 

According to the DSM-IV-TR, individuals with anorexia nervosa should be classified according to two variants, either the binge-eating/purging type or the restricting type.  Individuals with the  restricting type of anorexia nervosa do not engage in either binge-eating or purging, and compared with individuals who  binge-eat/purge, are not as likely to abuse alcohol and other drugs. They usually exhibit less intense mood changes and are less active sexually.  It is also recognized among clinicians that the two subtypes may differ in their response to medication interventions. 

 

Anorexia nervosa frequently begins very innocently. Often times, an adolescent or young woman of normal weight or possibly a few pounds overweight may begin a diet.  Initially, the dieting is usually not very different from that pursued by other young women, but as their weight begins to fall the dieting continues to intensify.  The restrictions become much broader and more rigid. For example, they may begin to eliminate all desserts and meat.  Food frequently begins to assume a moral quality with such foods as vegetables being viewed as "good" and meat as "bad".  Individuals with anorexia nervosa may develop rigid rules about such things as exercise that must be done religiously and rigidly defining when, where and how that they may eat. 

Food avoidance and weight loss are seen as significant triumphs by individuals with anorexia nervosa.  Weight gain is frequently seen as a failure or sign of weakness.  Physical activity such as running becomes constant and extreme as the dieting and weight loss continue.  Inactivity and complaints of weakness only develop later as emaciation has become obviously apparent and extreme.  The anorexic may become more serious and devote little effort to anything besides limiting food consumption and exercising.  They frequently become depressed and develop emotional lability, social withdrawal, become secretive and frequently lie about their eating and their weight.  They develop profound disturbances in their view of weight and calorie needs. However, their reality testing remains intact and they may continue to do well in school or at work.  Symptoms of anorexia nervosa usually persist for months or years until typically at the insistence of family or friends the person reluctantly agrees to see a doctor or mental health clinician. 

Some information from DSM-IV-TR Mental Disorders Diagnosis, Etiology and Treatment

Additional information and webpage by Paul Susic  MA Licensed Psychologist   Ph.D. Candidate  (Health and Geriatric Psychologist)

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