Click here for DSM IV definition of Anorexia Nervosa
Onset of Anorexia
Anorexia Nervosa usually begins with a desire to lose weight and restricting food intake to foods with high protein and low calories (APA, 1994). Bit by bit other foods join forbidden list until intake is 600 – 800 calories per day. individuals with anorexia gain no pleasure in eating (Simon et al, 1993).
90-95% of sufferers are female. It is usual for individuals with anorexia to start developing symptoms around the ages of 14-18, but can occur at any age (APA, 1994). Stressful events, such as parental separation, moving away from home, or to a new area, or personal failure often trigger the disorder. 5 – 18% of sufferers die, usually because of associated medical complications.
Crisp (1964) described anorexia as a “Weight Phobia” because one major characteristic is a morbid fear of becoming overweight or giving in to hunger.
Preoccupation with food
Individuals with anorexia, while they focus on restricting their food intake, are preoccupied with food. They think about food constantly, read about food and plan their meals (King et al, 1991). Many individuals with anorexia report that their dreams are filled with images of food and eating (Frayn, 1991). However, this may be a result of food deprivation, rather than a cause of the disorder (Yates, 1989).
It has been demonstrated that non-anorexics can develop a preoccupation with food after significant deprivation: Keys et al (1950), for example, put 36 participants, who opted to take part in the study instead of military service, on a semi-starvation diet for 6 months. They became preoccupied with food, meticulously planned their tiny meals, talked almost constantly about food, dawdled over their meals and had vivid dreams of food.
Distorted Body Image
Anorexia sufferers have a low opinion of their body shape and feel unattractive (Heilbrun & Witt, 1990). Despite being incredibly emaciated they overestimate their bodily proportions and consider themselves fat. This motivates them to lose more weight.
Laboratory studies have tested the anorexic perception of body image. Using apparatus where participants can be asked to look at a photograph of themselves through a special lens which is adjustable such that they can alter the image from 20% thinner than they actually are to 20% larger than their actual size, Garner et al (1976) found that over half of anorexic participants overestimated their body size, whereas normal participants underestimated their body size.
Maladaptive attitudes are common in anorexia nervosa. For example:
- “I must be perfect in every way.”
- “Self control and self discipline must be perfect in life.”
- “Weight and shape are the most important criteria for inferring one’s own worth.”
- “I will become a better person if I deprive myself”
- “I can avoid guilt by not eating.”
Personality and Mood problems are also a characteristic feature including:
Mild depression and low self esteem:
- Anxiety other than fears about body weight such as extreme indecisiveness.
- Lack of concentration.
- Obsessive-compulsive patterns of behaviour (APA, 1994).
- These can include rigid rules for food preparation or cutting food into specific shapes.
- Common for obsessions other than those that involve food.
- Solyom et al. (1982): OCD sufferers and individuals with anorexia scored equally on obsessiveness and compulsiveness scale
