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diagnostic criteria for eating disorders
Anorexia Nervosa

The following clinical descriptions are taken from The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

  1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected, or failure to make expected weight gain during period of growth leading to body weight less than 85% of that expected).
  2. Intense fear of gaining weight or becoming fat, even though under-weight.
  3. 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.
  4. In post menarcheal females, amenorrhea,( i.e. absence of at least three consecutive menstrual cycles). A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen administration.

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)

The term anorexia is of Greek origin; an (privation, lack of) and orexis (appetite) thus meaning a lack of desire to eat. It was originally used to describe the loss of appetite caused by some other ailment such as headaches, depression or cancer where the person actually doesn't feel hungry. Normally appetite is like the response to pain, beyond the individual's control. The term anorexia alone is an insufficient label for the eating disorder known commonly by that name. Persons afflicted with this disorder have not just lost their appetite -- in fact, they long to eat, obsess and dream about it, and some of them even break down and eat uncontrollably. Patients report spending 70-85% of each day thinking about food, creating menus, baking and/or feeding others, worrying about what to eat, bingeing on food, and purging to get rid of food eaten. The full clinical term, "anorexia nervosa" (lack of desire to eat due to a mental disorder) is a more appropriate name for the illness.

Individuals with anorexia nervosa may eventually develop a true lack of appetite, but for the most part it is not a loss of appetite but rather a strong desire to control it that is a cardinal feature. Rather than lose their desire to eat, anorexics, while suffering from the disorder, deny their bodies even when driven by hunger pangs and obsess about food all day long. They often want to eat so badly that they cook for and feed others, study menus, read and concoct recipes, go to bed thinking about food, dream about food, and wake up thinking about food. They simply don't allow themselves to have it and, if they do, they relentlessly pursue any means to get rid of it.

People with anorexia are afraid of food and afraid of themselves. What begins as a determination to lose weight, continues and progresses to a morbid fear of gaining any lost weight back, and becomes a relentless pursuit of thinness. These individuals are literally dying to be thin. Being thin, which translates to "being in control", becomes the most important thing in the world.

In the throes of the disorder, those with anorexia are terrified of losing control, terrified of what might happen if they allowed themselves to eat. This would mean a lack of will power, a complete "giving in", and they fear that once they let up on the control they have imposed on themselves, they will never get "in control" again. They are afraid that, if they allow themselves to eat, they will not stop and if they gain one pound today or this week, that they are now "gaining." A pound today means another pound later and then another and another until they are obese. Physiologically speak-ing there is a good reason for this feeling. When a person is starving, the brain is constantly sending impulses to eat. The strength of these impulses to eat is such that the feeling that one may not be able to stop is powerful. Self-induced starvation goes against normal bodily instincts and can rarely be maintained. This is one reason why many anorexics ultimately end up binge eating and purging food to the point where approximately 50% of them develop bulimia nervosa.

Individuals with anorexia fear, as crazy as it may seem when looking at them, they are or will become fat, weak, undisciplined, and unworthy. To them, losing weight is good and gaining weight is bad, period. With the progression of the illness eventually there are no longer fattening foods but simply the dictum that food is fattening. The anorexic mind set works in the be-ginning of a diet when the goal is to lose a few unwanted pounds, but when the dieting itself becomes the goal, there is no way out. The dieting becomes a purpose and what can be referred to as, "a safe place to go." It's a world created to help cope with feelings of meaninglessness, of low self-esteem, of failure, of dissatisfaction, of the need to be unique, the desire to be special, to be a success, to be in control. People with anorexia create a world where they can feel/be "successful", "good" and "safe" if they can deny food, making it through the day eating little if anything at all. They consider it a threat and failure if they break down and eat too much, which for them can be as little as three hundred calories or even less. In fact, for some, eating anything over 100 calories in one item, usually causes great anxiety. The anorexic mind set seems to prefer two digit numbers when it comes to eating and to weight. This kind of over control and exertion of mind over matter goes against our understanding of all normal physiological impulses and instincts for survival. Of the eating disorders, anorexia nervosa is the most rare.
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