Anorexia Nervosa

The diagnosis of anorexia nervosa is made in persons who have lost 15 percent or more of the body weight that is considered normal for their height and age and who have an intense and irrational fear of gaining weight. Even with extreme weight loss, anorexics perceive themselves as overweight. Their attitude toward food and weight control becomes obsessive and they frequently develop bizarre or ritualistic behaviors around food, such as chewing each bite a specific number of times. Anorexics minimize the seriousness of their weight loss and are highly resistant to treatment.

The two basic types of anorexia nervosa are the restricting type and the binge-eating/purging type. The restricting type is characterized by an extremely limited diet, often without carbohydrates or fats. This may be accompanied by excessive exercising or hyperactivity. Up to half of anorexics eventually lose control over their severely restricted dieting and begin to engage in binge eating. They then induce vomiting, use diuretics or laxatives, or exercise excessively to control their weight. People who are in the binge-eating/purging group are at greater risk for medical complications.

As the weight loss in either type reaches starvation proportions, anorexics become more and more preoccupied with food; they may hoard food or steal. They also experience sleep abnormalities, loss of interest in sex, and poor concentration and attention. In addition, they slowly restrict their social contacts and become more and more socially isolated. In general, anorexics of the binge-eating/purging type are likely to have problems with impulse control and may engage in substance abuse, excessive spending, sexual promiscuity, and other forms of compulsive behavior. This group is also more likely to attempt suicide or to hurt themselves than others with eating disorders.

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