What is Anorexia Nervosa?
The National Institute of Mental Health (2007) described anorexia nervosa as being characterized by emaciation, a relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight, a distortion of body image and intense fear of gaining weight, a lack of menstruation among girls and women, and extremely disturbed eating behavior.
The loss of menstruation must occur for at least three consecutive monthly cycles in order to be attributed to anorexia nervosa (Corcoran & Walsh, 2006). Reduction in food consumption and obsession with caloric intake are the result of an intense fear of weight that is not alleviated by weight loss. People with anorexia view themselves as overweight when others see them as clearly malnourished.
There are two types of the disorder which are restricting and binge-eating/purging. A person with the restricting type mainly loses weight due to dieting, fasting or excessive exercise and does not engage in binge eating/ purging. A person with the binge-eating/ purging type regularly engages in either behavior or both behaviors (APA, 2000).
Purging is done through self-induced vomiting or through the use of laxatives, diuretics or enemas (NIMH, 2007). Purging does not necessarily follow a binge, but rather is done to rid the body of any calories ingested, even if they are minimal. The binge-eating/ purging type of anorexia is different from bulimia because weight is not maintained at or above the minimal level that is considered to be normal.
Anorexia nervosa is the eating disorder characterized by excessive weight loss (NEDA, 2005). The loss of weight is often considered to be a sign of success by the individual due to the self-control that is required to starve one's self. Weight gain is consequently indicative of failure. The American Psychiatric Association (2000), said in the Diagnostic and Statistical Manual of Mental Disorders that some individuals feel globally overweight, while others realize that they are thin but are still overly concerned with certain body parts being too fat. Discontentment with perceived body image results in unhealthy “coping" behaviors.
What Does Anorexia Nervosa Look Like?
What is anorexia nervosa in everyday life? Four Winds Hospital in Saratoga, New York compiled a list of physiological, behavioral, emotional and cognitive characteristics that together portray the eating disorder.
Physiological characteristics include low body weight, slowed heart rate, low blood pressure, reduced body temperature, lowered resistance to infection, muscular weakness, loss of menstruation in women and reduced testosterone levels in men. There are several implications of reduced body temperature including cold hands and feet, sensitivity to cold and growth of body hair. This hair is called lanugo and is described as a downy layer of hair that covers all over the body, even the face, in attempt to keep the body warm (NEDA, 2005).
The behavioral characteristics include excessive dieting, food control, fasting, compulsive exercising, insomnia and early morning awakening, layering of clothing, frequent weighing and tension or refusal to eat at mealtimes (Four Winds). Food control may include ritualistic eating habits which limit intake or severely restrict food types.
The emotional and cognitive characteristics include intense fear of becoming fat, depression, self-centeredness or anti-social tendencies, irritability, distorted body image, perfectionist thinking, difficulty thinking clearly, low sense of self-worth, denial, and an all or nothing perspective (Four Winds). Perfectionist thinking fuels the desire to be the thinnest which is viewed as being the “best." Due to denial, a person with this eating disorder often does not want help, and other inhibited cognitive processes further impede rational thought.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th edition, (DSM-IV-TR). Washington, DC: American Psychiatric Association.
Corcoran, J. & Walsh, J. (2006). Clinical assessment and diagnosis in social work practice. New York: Oxford University Press.
Four Winds Hospital. Anorexia Nervosa. (www.fourwindshospital.com)
National Eating Disorders Association (2005). What is an eating disorder? Some basic facts. (www.NationalEatingDisorders.org)
National Institute of Mental Health (2007). Eating disorders. U. S. Department of Health and Human Services. (www.nimh.nih.gov)