Anorexia Nervosa (cont.)

Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In this Article

• Anorexia nervosa facts
• What is anorexia nervosa?
• Who is at risk for anorexia nervosa?
• What causes anorexia nervosa?
• How is anorexia nervosa diagnosed?
• What are anorexia symptoms and signs (psychological and behavioral)?
• What are anorexia symptoms, signs, and complications (physical)?
• What is the treatment for anorexia nervosa?
• What is the prognosis (outcome) of anorexia nervosa?
• How can anorexia nervosa be prevented?
• The future of anorexia nervosa
• Where can a person get help for anorexia nervosa?
• Patient Comments: Anorexia Nervosa - Treatments
• Patient Comments: Anorexia - Share Your Experience
• Find a local Psychiatrist in your town
• Anorexia Nervosa Index

Anorexia nervosa can be a difficult disorder to diagnose, since individuals with anorexia often attempt to hide the disorder. Denial and secrecy frequently accompany other symptoms. It is unusual for an individual with anorexia to seek professional help because the individual typically does not accept that she or he has a problem (denial). In many cases, the actual diagnosis is not made until medical complications have developed. The individual is often brought to the attention of a professional by family members only after marked weight loss has occurred. When anorexics finally come to the attention of the health care professional, they often lack insight into their problem despite being severely malnourished and may be unreliable in terms of providing accurate information. Therefore, it is often necessary to obtain information from parents, a spouse, or other family members in order to evaluate the degree of weight loss and extent of the disorder. Health professionals will sometimes administer questionnaires for anorexia as part of screening for the disorder.

Warning signs of developing anorexia or one of the other eating disorders include excessive interest in dieting or thinness. One example of such interest includes a movement called "thinspiration," which promotes extreme thinness as a lifestyle choice rather than as a symptom of illness. There are a variety of web sites that attempt to inspire others toward extreme thinness by featuring information on achieving that goal, photos of famous, extremely thin celebrities, and testimonials, as well as before and after pictures of individuals who ascribe to extreme thinness.

The actual criteria for anorexia nervosa are found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).

There are four basic criteria for the diagnosis of anorexia nervosa that are characteristic:

1. The refusal to maintain body weight at or above a minimally normal weight for age and height (maintaining a body weight less than 85% of the expected weight)
2. An intense fear of gaining weight or becoming fat, even though the person is underweight
3. Self-perception that is grossly distorted, excessive emphasis on body weight in self-assessment, and weight loss that is either minimized or not acknowledged completely
4. In women who have already begun their menstrual cycle, at least three consecutive periods are missed (amenorrhea), or menstrual periods occur only after a hormone is administered.

The DSM-IV-TR further identifies two subtypes of anorexia nervosa. In the binge-eating/purging type, the individual regularly engages in binge eating or purging behavior which involves self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode of anorexia. In the restricting type, the individual severely restricts food intake but does not regularly engage in the behaviors seen in the binge-eating type.

In order to diagnose anorexia, the health care professional distinguishes this illness from being a symptom of an underlying medical disorder or of another eating disorder. As a symptom of a medical disorder, the term anorexia (in general, rather than anorexia nervosa, the condition discussed in this article) describes the considerable weight loss that may be the result of serious illness that may afflict terminally ill patients who are receiving hospice care.

Unlike the binge-eating/purging type of anorexia nervosa, bulimia nervosa does not result in weight reduction below the minimal normal weight. Bulimia nervosa is characterized by episodes of eating significantly excessive amounts of food that the individual feels they cannot stop themselves from engaging in (binges), alternating with episodes of attempts to counteract the binges using inappropriate behaviors (purging) like self-induced vomiting, misuse of medications, fasting, and/or excessive exercising. Most individuals with an eating disorder do not fit neatly into either the diagnosis of anorexia or bulimia and are therefore classified as suffering from eating disorder, not otherwise specified (EDNOS). For example, people with binge-eating disorder experience episodes of binge eating but do not regularly engage in purging or restricting behaviors.