What Is Anorexia?

Learn what anorexia is and what makes a person anorexic from Allegra Broft, M.D. in this Howcast video about eating disorders.


I'm going to tell you about kind of the key features of Anorexia nervosa. Actually, what I'm going to tell you are the four diagnostic criteria that are currently in the diagnostic manual used by the majority of mental health providers in the United States, and used by psychiatrists. That's the manual called the DSM-IV. So the diagnostic criteria for Anorexia nervosa is first a refusal, or maybe a better word is really sort of an inability, to maintain body weight at a minimally medically appropriate place for one's age and height. The DSM suggests that that minimal medical criterion be around 85 percent of ideal body weight.

So that's criterion number one, and there's really sort of a relentlessness to a person's drive to maintain this thin place that is so characteristic or core to anorexia nervosa. The number two feature is intense fear of gaining weight, even though underweight. Number three is a disturbance in the way one's body shape or weight is experienced. It could also be a denial of the seriousness of the underweight condition. "Oh, there's nothing wrong with this, there's no medical compromise," that type of thing. The fourth cardinal feature of anorexia nervosa which is currently a diagnostic criterion is that a starvation has gone on long enough and has become serious enough that the body is starting to shut down, and how this is manifested in women is by the absence of menstrual cycles.

So if you see, due to underweight, the absence of three or more consecutive menstrual cycles, that is call amenorrhea and that's currently another diagnostic criterion of anorexia nervosa. In fact, as professionals, even though this is on the list of diagnostic criteria for anorexia nervosa, we often see folks that meet all the other feature cores of anorexia nervosa but don't have the absence of menstrual cycles for whatever reason. Maybe their body just hasn't quite shut down yet, or maybe they're on birth control pills and they're still getting their period even though their body is in general in a very starved state.

We also see male patients of anorexia nervosa. While they're the minority of folks suffering from anorexia nervosa, males do also get this illness, and obviously males can't lose their menstrual cycle, but there are men out there that meet all these other core criteria of the illness and we would call those men as having anorexia nervosa. So those are some of the core features. There are lots of other signs and symptoms that go along with anorexia nervosa. There can be a lot of medical consequences, and if I haven't emphasized this until now, anorexia nervosa in particular can get quite severe. It really has a high morbidity and even mortality rate. It's got among the highest mortality rates of all psychiatric illnesses, with a mortality rate of five percent per decade of unremitted anorexia nervosa.

People can become quite medically ill and even die from things like cardiac causes and electrolyte imbalances, as well as from psychological complications of the illness like severe depression and suicidal urges and tendencies. So, a lot of other things that you can see with anorexia nervosa. There's a lot of ritual that goes into the eating associated with anorexia nervosa. People that cut up their food into lots of little bites, strict regimens of calories. Perhaps you only have five or seven hundred calories a day, or maybe even less. That's characteristic of this illness. You can also see binge eating and purging behavior going on in anorexia nervosa as well. So a lot of different things that can be present in this illness, and it's very complicated to treat. Definitely if someone is struggling with this, if you're struggling with it, reaching out to an expert in this area, a treatment center that has experience with anorexia nervosa, is essential for moving through the anorexia nervosa and into the process of recovery.

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