• Generally, individuals with anorexia are compliant.  Sometime, they are overly compliant, to the extent that they lack adequate self-perception.  They usually do well in school and may often overextend themselves in a variety of activities.  The families of anorexics often appear to be “perfect.”  Physical appearances are important to them.  Performance in other areas is stressed as well, and they are often high achievers.
• While control and perfection are critical issues for individuals with anorexia, aspects of their life other than their eating habits are often found to be out of control as well.  Many have, or have had at some point in their lives, addictions to alcohol, drugs, or gambling.  Compulsions involving sex, exercising, housework, and shopping are not uncommon.  In particular, people with anorexia often exercise compulsively to speed the weight-loss process.

All of these features can negatively affect one’s daily activities.  Diminished interest in previously preferred activities can result.  Some individuals also have symptoms that meet the diagnostic criteria for a major depressive disorder.

Anorexia can have dangerous psychological and behavioral effects on all aspects of an individual’s life and can affect other family members as well. Signs and symptoms include:

• The individual can become seriously underweight, which can lead to depression and social withdrawal.
• The individual can become irritable and easily upset and have difficulty interacting with others.
• Sleep can become disrupted and lead to fatigue during the day.
• Attention and concentration can decrease.
• Most individuals with anorexia become obsessed with food and thoughts of food.  They think about it constantly and become compulsive about eating rituals.  They may collect recipes, cut their food into tiny pieces, prepare elaborate calorie-laden meals for other people, or hoard food.  Additionally, they may exhibit other obsessions and/or compulsions related to food, weight, or body shape that meet the diagnostic criteria for an obsessive compulsive disorder.
• Other psychiatric problems are also common in people with anorexia nervosa, including affective (mood) disorders, anxiety disorders, and personality disorders.  (to be continued next week)

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.  Body weight less than 85% of the expected weight is considered minimal.
2. An intense fear of gaining weight or becoming fat, even though the person is underweight.
3. Self-perception that is grossly distorted and weight loss that is not acknowledged.
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 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 engage in the behaviors seen in the binge eating type.

Anorexia nervosa is a complicated disorder to diagnose.  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 there are other medical complications.  The individual is often brought to the attention of a professional by family members only after  a marked weight loss has occurred.  When anorexia finally comes to the attention of the health 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 or other family members in order to evaluate the degree of weight loss and extent of the disorder.

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