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).
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).
Recurrent episodes of binge eating. An episode of binge eating is characterized by:
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.
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
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
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
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.
Wasted: A Memoir of Anorexia and Bulimia by Marya Hornbacher,
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.