What the professionals say
Anorexia, or anorexia nervosa – to give it it’s proper name, is a serious mental illness in which sufferers intentionally achieve and maintain a low body weight by restricting calorie intake. They may also vomit after eating, use laxatives, and exercise to excess.
Professionals use diagnostic tools, such as the ICD-10, to determine whether someone has anorexia nervosa. According to the ICD-10 criteria, for a definite diagnosis of Anorexia Nervosa, all the following are required:
- Body weight is maintained at least 15% below that expected (either lost or never achieved), or Body Mass Index (BMI) is 17.5 or less. Pre-pubertal patients may show failure to make the expected weight gain during the period of growth.
- The weight loss is self-induced by avoidance of ‘fattening foods’ and one or more of the following: self-induced vomiting; self-induced purging; excessive exercise; use of appetite suppressants and/or diuretics.
- There is body-image distortion in the form of a specific psychopathology whereby a dread of fatness persists as an intrusive, overvalued idea and the patient imposes a low weight threshold on himself or herself.
- There is endocrine disorder, manifesting in women as loss of periods (amenorrhoea) and in men as a loss of sexual interest and potency.
- If onset is pre-pubertal, the sequence of pubertal events is delayed or even arrested (growth ceases; in girls the breasts do not develop and the onset of periods is delayed; in boys the genitals remain juvenile). With recovery, puberty is often completed normally, but the menarche is late.
Another diagnostic tool, the DSM-V, similarly says that to be diagnosed as having Anorexia Nervosa a person must display:
- Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health) .
- Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight).
- Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Professionals seem to agree that there are two main sub-types of anorexia:
Restricting type, whereby a person severely restricts their food choices and/ or calorie intake. Sufferers may follow obsessive and rigid rules relating to their food, it’s preparation, and eating practices.
Binge-eating or purging type, (sometimes referred to as ‘anorexia with bulimic tendencies’) in which a person restricts their intake as above, but also engages in binge-eating and / or purging behaviour.
Signs and symptoms may also include:
Appearance of lanugo: soft, fine hair growing over the face and body
Obsessive counting of calories and monitoring contents of food.
Preoccupation with food, recipes, or cooking meals for others to consume
Rituals around food, such as cutting food into tiny pieces.
Hiding or discarding of food.
Excessive exercise may including micro-exercising, such as finger tapping or leg swinging
Intolerance to cold and frequent complaints of being cold.
Low blood pressure or orthostatic hypotension.
Slow heart rate (Bradycardia) or tachycardia (increased heart rate)
Low mood and / or anxiety
Avoidance of friends and family, becoming more withdrawn and secretive.
Halitosis (bad breath) from vomiting or starvation-induced ketosis.
Dry hair and skin, as well as hair thinning.
Rapid mood swings.
Having feet discoloration causing an orange appearance.
Seeming on edge more often than usual.
Evidence/habits of self harming or self loathing.
Admiration of thinner people.
The other side of anorexia
Whilst diagnostic tools and the like help professionals to recognise and diagnose illnesses, they also tend to ‘lump’ everyone onto the same category. An eminent psychiatrist, an ‘expert’ in eating disorders, once said to me “you anorexics all want to be different, but anorexia makes you all the same!” I disagreed with him at the time (silently of course!) and I still disagree with him now. Everyone is unique, and everyone deserves to have their own story of anorexia heard. There is also a tendency to focus on the physical symptoms of anorexia, which are visible and also life threatening, but this is most definitely a mental illness. Here are some definitions of anorexia from sufferers – there will be some similarities and some differences. Such is life..
“What is anorexia? For me, it is an all consuming, destructive mental illness, characterised by a drive for perfection, a manifestation of self-loathing, a desire to disappear and a need to control.”
“As an anorexic, I didn’t want to be seen, heard or noticed. I wanted to blend into the background and preferably, disappear. All this time, my eating disorder was becoming more powerful; I was becoming more ‘anorexia’ and less ‘me’. Anorexia takes over your life; the element of choice people often associate with the illness becomes completely lost. Anorexia controls your every waking, and sleeping, thought. You become locked in…….anorexia becomes a safety blanket despite the constant insults and hate filled messages it continually throws at you.”
Read more about Katie’s experience of anorexia
“Anorexia for me was a hellish existence. I wasn’t living life – I was in limbo. Everyone was concerned about my weight, but the torture of anorexia was going on in my head. Every rational thought I had was immediately countered by an irrational one, and I was dealing with an internal dialogue – an argument with myself basically, for every waking minute of every day, week after week, month after month, year after year. Of course, it was all about food and weight, but it certainly wasn’t vanity. I wasn’t interested in looking good. Far from it – I was full of self loathing, and had a belief that I shouldn’t exist. I truly believed that I was rubbish at everything except starving myself, which I did better than anyone I knew. I was so desperate to be good at something, even this, and I was terrified to let go.”