The Clinical DescriptionDiagnostic Criteria for 307.51
1. Refusal to maintain body weight at or above a minimally normal weight for ageand height, e.g. weight loss leading tomaintenance of body weight less than 85%of that expected; or failure to makeexpected weight gain during period ofgrowth, leading to body weight less than85% of that expected.2. Intense fear of gaining weight or becomingfat even though underweight.3. Disturbance in the way in which ones bodyweight or shape is experienced, undueinfluence of body eight or shape on self-evaluation, or denial of the seriousness ofthe current low body weight.4. In post-menarcheal women, amenorrhea,i.e., the absence of at least threeconsecutive menstrual cycles. A woman isconsidered to have amenorrhea if her periods occur only following hormone, e.g.,estrogen, administration.
(DSM-IV-TR, American Psychiatric Association, 2000)
To this basic outline can be added a series ofother characteristics, which may accompanythe most central features of anorexia:restricting type or binge eating/purging type.Hair loss, growth of lanugo - (fine hair growingall over the body, including on the face),lowered body temperature and heart rate,low blood pressure, feeling cold, poor circulation, dry skin, brittle nails, insomnia,excessive exercising directed to weight loss,obsessional focus on food and calories,loneliness, social isolation, withdrawnbehavior, loss of the ability to concentrate onanything else, low self-esteem, and selfhatred.Just as it is easier to deal with physical illnesssooner rather than later, so it is easier to helpsomeone with anorexia when they have anearly form of the illness rather than when theobsessions and phobias have become a wayof life.
EATING PATTERNS IN ANOREXIA
Anorexia develops over a period of time. Theanorexic becomes very restrictive with foods.Some come to enjoy the feeling of hunger.Sometimes it starts with cutting out food that isconsidered fattening. Many anorexics eatmostly fruits and vegetables, neglecting thenutritional need for fat, protein andcarbohydrates. Anorexics deny the constanttug-of-war that goes on. Their bodies ravefood, but their minds will not allow them toeat. One way or another, by degrees, theanorexic person becomes increasinglypreoccupied with food, weight, shape andsize, and less and less available for ordinarylife. She withdraws more and more from socialinteraction and spends increasingly largeamounts of time on her own thinking abouthow much she has eaten, how much she willeat, how she can limit her intake further andso on. This preoccupation with food is notunusual for someone who is starving; what isstrange is that the anorexic starves while foodis all around her. The stress and conflictcreated by her biological need to eat and her psychological fear of doing so uses up most ofher time and energy.
POWER AND PERFECTION
Those around the anorexic often becomefrantic, angry and frustrated, as she withdrawsfrom ordinary life and ordinary relationships.Families and friends become distraught asthey see the one they love disappearing rightbefore their eyes. They cannot understandhow she can deny ordinary needs for foodand rest, for companionship and comfort.Irritation and anger often accompany their incomprehension. They are powerless over the anorexic and feel controlled andoutwitted. As the anorexic becomesphysically weaker, their anger is replaced byfear. The anorexic's behavior can end indeath or permanent damage to the mindand body.In contrast to those around her, the anorexicusually stays perfectly calm and somewhatremote. She may continue to insist that she isfat even when she is dangerouslyemaciated, and the thinner she gets themore irrational she becomes. Starvationaffects a
person’s capacity to think properly;
the starving anorexic certainly shows no signof being able to grasp the danger she is in. Infact, she often feels fine. She feels powerful,triumphant, excited. Her bid for power over herself and her needs has succeeded. She ison the way to perfection. She often feelscontempt for ordinary mortals who need todo things like eat and rest. She is not like that;she is in control.
FEELINGS WITH NO NAME
Usually, the anorexic grew up in anenvironment where her feelings could not beexpressed freely. She did not learn how toidentify and talk about feelings; in fact, shehas come to believe that she does not havethem. She may find it extremely difficult toaccept that she has feelings (especiallydifficult or negative ones) at all. The
anorexic’s denial of her feelings in
generalmakes it more possible for her to deny her feelings of hunger. An anorexic does notknow she is hungry, and does not know if sheis angry or sad or disappointed. When shestarts to eat more normally, her recovery isonly beginning. She requires education toidentify and express feelings, and to believethat it is valid and important to experiencethem.