Eating-Disorders are a serious psychological problem. My goal for the website has been to provide some basic information on psychological issues. My hope has been that somebody could wind up here and at least get their questions answered, maybe browse through the different topics and find something meaningful.

I know there are many sites which provide information on various psychological topics,and probably do a much more extensive job providing information than I do. So my philosophy has been to just share from my own practice and experience what I can. Hopefully, it will be helpful.

When trying to decide what information to provide on eating-disorders, I was suddenly overwhelmed by the amount of resources already available about the subject. I know it wasn't that long ago that nobody had ever even heard of eating-disorders. I’m just a little suspicious about this whole weight/body/ eating thing, and why all the “help” available? I can honestly say there probably has not been a woman client entering my office that doesn’t have some kind of eating issue, or weight problem. I just can’t figure out how much of that is because of cultural messages. So, I’m not going to be another “authority” on eating-disorders. I’ll leave that to Dr. Phil.

What I would like to do is refer you to some sites that can provide extensive, quality information above and beyond what I’m doing here, and maybe recommend some books that I think are good. This whole weight thing is big business, and I’m going to just stay clear of it. However, Eating-Disorders are extremely serious and very dangerous because women die from them. These are the cases that I may see in my practice (and many are hospitalized).

I’m going to concentrate on the psychological definition of an eating-disorder straight out of the Diagnostic Criteria Manual. These are the types of serious mental health conditions that are life threatening and need extensive psychiatric and psychological treatment. I’m thinking if I stick to this approach, it will help somebody decide that they need treatment…or not.

Anorexia Nervosa

By definition it is the refusal of a person to maintain a body weight that is minimally “normal”. The criteria used is a body weight less than 85% of the expected weight based on an accepted weight chart. (like the ones in the doctor’s office).

Intense fear of gaining weight or becoming fat, even though underweight.

Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. In other words, obsessed with weight and body image and denying there is a problem.

The absence of at least three consecutive menstrual cycles.

Notice that these criteria have to do with concrete measurable criteria. This is helpful because so many people, women especially, are obsessed with food, eating, dieting, weight, being fat, how they look, body image, thinness, external beauty, etc. etc.

If you read that your weight is 85% below the expected weight by weight chart and haven’t had a period in awhile, it’s kind of hard to deny there’s a problem. Also, you may see that furry hair all over your body that comes with very low weight.

From there, you can specify a type of Anorexia Nervosa:

Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Bulimia Nervosa

Recurrent episodes of binge eating. An episode of binge eating is characterized by:
1) eating, in a discrete period of time (for example within any 2-hour period), an amount of food that is definitely larger than most people would eat.
2) a sense of lack of control over eating during the episode.

Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting; or excessive exercise.

The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or misuse of substances mentioned above.

Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exersize, but has not regularly engaged in self-induced vomiting or misuse of substances.


Eating-Disorder Not Otherwise Specified

The Eating-Disorder Not Otherwise Specified category is for disorders of eating that do not fit the criteria for specific Eating-Disorders.

1. For females, all criteria for Anorexia Nervosa are met, except the individual still menstruates.

2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range.

3. All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory activities occur less frequently than twice a week or haven’t lasted for 3 months.

4. The regular use of inappropriate compensatory behaviors by an individual of normal body weight after eating small amounts of food (for example, vomiting after eating two cookies).

5. Repeatedly chewing and spitting out, but not swallowing large amounts of food.

6. Binge-eating disorder: recurrent episodes of binge eating without purging in some way.


Body Dysmorphic Disorder

I want to mention Body Dysmorphic Disorder briefly here. It is a Somatoform Disorder (which is a physical condition which results from a psychological source)

Body Dysmorphic Disorder is not an Eating-Disorder, but the dissatisfaction with body shape and size with this disorder is similar to that in Anorexia Nervosa.

Body Dysmorphic Disorder is a preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.

The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The preoccupation is not due to Anorexia Nervosa.

You've seen these people on talk shows who just keep going back to cosmetic surgeons, are never satisfied with their appearance, and are miserable. In other instances, these individuals are so preoccupied with their perceived "flaws" that they can't date, go to work, or attend college. It is a very serious problem.


Book Recommendations

Insatiable: The Compelling Story of Four Teens, Food and Its Power by Eve Eliot, HCITeen Publisher.

This book tells the stories of four teenagers who have eating-disorders. Samantha is silent and non-feeling and perfect and controlling. Hannah is experiencing a debilitating grief, Jessica has had to grow up too fast and be too responsible, and Phoebe is numbing her pain with food.

Teenage girls with eating-disorders can be difficult clients. This book is written for adolescents and speaks directly to them through the stories of these four peers. I recommend it.

Wasted: A Memoir of Anorexia and Bulimia by Marya Hornbacher, Harper Publishers.

I really like this book. It also speaks to the experience of the teen and young woman from a first-person perspective. Marya Hornbacher is witty and honest. She talks about her therapy and how she manipulates the psychologist, she lets us in on the control issues involved. She also speaks to the cultural component of eating-disorders, but also emphasizes the seriousness of the condition. She is not unlike some of the young women I’ve worked with who are creative and smart and yet totally out of control. She shares her inner world of eating-disordered thinking and perceiving and it’s fascinating, sometimes even funny. Her language is real and candid. I highly recommend this novel.

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