CLINICAL ASPECTS OFEATING DISORDERS
anor e xia ner vosa
appetite inducedbynervousness." However,this defini-
tion is something of a misnomer,becauselack of appetite
is not the real problem.Attheheartof anorexia nervosa is
f ear of gaining weight
or becoming fat,com-
bined with a
r e fusalt o maintain even a minimall ylow
bod y weight .
The DSM-IVcriteria for anorexia nervosa
areshown inthe DSM criteria box.
Descriptions of extreme f asting orascetic food ref usal
that were probably signs of anorexianervosacan be found
in the early religious literature(Vandereycken, 2002). The
first known medicalaccountof anorexia nervosa,however,
waspublished in 1689 byRichard Morton(seeSilverman,
1997,foragoodgeneral historical overview). Morton
described twopatients, an 18-year-old girl and a 16-year-old
boywhosufferedf rom a"nervous consumption"that
caused wasting of body tissue. The female patient eventually
died because she ref used treatment. The disorder did not
receive its current name,however,until 1873,whenCharles
Laseguein Paris and SirWilliam Gull inLondon indepen-
dentlydescribed the clinicalsyndrome.In his last publica-
tion on the condition, Gull(1888)describeda14-year-old
girl whobegan"withoutapparent cause,to evince a
repugnance to food;and soon afterwards declined to tak e
~Refusal tomaintain abodyweight that isnormal for the
person'sage and height(i.e., a reduction ofbody weight
to about85 percent of what would normally beexpected).
~ Intense fear of gaining weight or becomingfat, even
~ Distortedperception of body shape and size.
~Absence of atleast threeconsecutivemenstrual periods.
Adap t ed w it h permission from the
Diagnostic andStatisticalManual ofMentalDisorders, Fourth Edition,Text Revision
(Co py ri ght
Am er i c an P syc hi atr ic Associa ti o n .
any whatever, except half a cup of teaor coff ee."After
being prescribed to eat light foodeveryfewhours, the
patient made a good recovery.Gull'sillustrations of the
patient before and aftertreatment appear in Figure 9.1.
Although the DSM-IV criteria for anorexianervosa
requirethat postmenarcheal femalesstop menstruating in
order tobediagnosed with thedisorder,somehave ques-
tioned thevalueof this diagnostic criterion.Studies have
suggested thatwomen who continue to menstruate but
meetall the other diagnostic criteria for anorexianervosa
are just as ill as those who have amenorrhea(Cachelin
Patient s w i t h anor ex ia n e rvosa ma y be ema c i a t e d
y et den y h avi ng an y problem s w ith their w eight .
The y w ill g o to g r e at len gth s t o co n c eal the i r
thinness by wearing baggy c lothe s or drinking
massive amounts of water prior to being weighed (for example, in a hospital setting).Gu l l ' s anorexic patient .(A) Before treatment .(B) After treatment .
Gull ( 1888).