Anorexia Nervosa Introduction & Overview - OmniMedicalSearch.com, by Lindsey Ricciardi, Ph.D

Conditions & Diseases: Eating & Weight Disorders

Anorexia Nervosa

Introduction & Overview:

Anorexia Nervosa (AN) is characterized by a relentless pursuit of thinness and a refusal to maintain a healthy weight range despite dire medical and psychosocial consequences. This potentially life threatening disease is insidious in nature and typically starts with dieting. In time, “normal” dieting becomes pathological dieting. This shift from normal to pathological dieting is often reinforced by increased attention from others in the form of praise for or expressed concern about weight loss. Additionally, a greater sense of control experienced by the dieter can reinforce further dieting. The dieting may take the form of putting off eating as long as possible, cutting out major food groups and types, and limiting overall caloric consumption. Eventually, the pathological dieting and its’ accompanying weight loss spiral out of control. The person restricts their intake to the point of self-starvation. This self-starvation may also be accompanied by dangerous attempts to rid the body of any calories consumed by engaging in compulsive over-exercising and/or purging through vomiting, diuretics, and/or laxatives. The term anorexia, which technically means a loss of appetite, is actually a misnomer because in the case of Anorexia Nervosa there is often intense hunger, appetite, and food cravings but the body is deliberately denied its need for food.

Currently, it is estimated that .05 to.01% of young women meet full criteria for Anorexia Nervosa. But these numbers paint a more optimistic picture than is actually the case given that the majority of AN cases are considered “sublinical,” “subthreshold,” or “partial” AN. Ultimately, this means that for every 1 person diagnosed with full-blown AN, there are 2 other persons who clinically meet the Anorexia Nervosa picture but do not fit perfectly into all diagnostic criteria. These cases are generally no less severe or dangerous. For example, a client may be marginally underweight yet diet constantly, abuse laxatives, and obsess over food, shape, and weight. Because the weight criterion is not met, this individual is likely to receive a diagnosis of Eating Disorder Not Otherwise Specified rather than Anorexia Nervosa.

The prevalence of Anorexia Nervosa is significantly greater for those who participate in activities that value thinness such as dance, modeling, cheerleading, figure skating, and track. Several notable celebrities have died due to complications of Anorexia Nervosa. In 1983, Karen Carpenter, singer and drummer of the famous musical duo the Carpenters, died suddenly at age 32 of cardiac abnormalities associated with Anorexia Nervosa. In 1994, gymnast Christy Henrich, who placed #2 in the United States Nationals, died at age 22 from complications of Anorexia Nervosa weighing a ghastly 60 pounds. Most recently in 2006, Brazilian model Ana Carolina Reston, died at age 21 of multiple organ failure caused by Anorexia Nervosa. At the time of her death, she was 5’ 7” and weighed 88 pounds.

While there have been mentions of Anorexia Nervosa throughout history, the disease has undoubtedly increased dramatically since the 1960's. This sudden increase in prevalence highlights the importance of sociocultural factors in the etiology (cause) of Anorexia Nervosa. Fueled by the boom of television and mass media, the 60's marked an introduction of the infamous Barbie Doll by Mattel and the waif-thin model Twiggy. Ideals of women’s bodies have become increasingly thinner and thinner. This finding is supported by measurement data of Ms. America pageant contestants and Olympic gymnasts since that time. The 1960's were also a time in history when gender roles, particularly those of women, began to change dramatically. Concurrently, the thin feminine body became a commodity in mainstream media. Although controversial, it is worth noting that some feminist theorists argue that the increasing objectification of women in the mass media developed as a hegemonic attempt to prevent gender equality by suppressing women. One byproduct of this attempt at suppression has been the development of Anorexia Nervosa.

It comes as little surprise that more than 90% of all cases of Anorexia Nervosa occur in females. Clearly, the societal pressures to be thin have been much greater for women than for men. Anorexia Nervosa is also far more prevalent in industrialized societies where food is plentiful and thinness is associated with attractiveness. According to the American Psychiatric Association, Anorexia Nervosa is most common in the US, Canada, Europe, Australia, Japan, New Zealand, and South Africa.

In the past, Anorexia Nervosa had not been reported in areas in which food was scarce. It seems that where there is a shortage of food, there is not the same value placed upon thinness. In fact, what we see is quite the opposite in that carrying excess weight is seen as a sign of status or wealth. However, in recent decades with the influx of Western ideals through mass media, the internet, commercialism, etc., we now see cases of eating disorders in places with no previous Anorexia Nervosa reported, such as India and Africa. We are also increasingly seeing Anorexia Nervosa among ethnic groups other than Caucasian.

Such findings challenge the previous notion of Anorexia Nervosa being a “culture bound” illness. Anorexia Nervosa in other cultures may also have greater emphasis placed on somatization where the fear of eating is attributed to stomach discomfort or pain rather than fear of fatness. When determining risk for Anorexia Nervosa, the degree of acculturation to mainstream Western ideals of beauty becomes an important variable. Ethnic minorities who are not greatly acculturated and who are part of a social network that includes members of their identified ethnic group seem to be more protected from the development of Anorexia Nervosa.

Article by Lindsey Ricciardi, Ph.D
Licensed Clinical Psychologist &
Eating Disorders & Obesity Specialist

Lindsey Ricciardi, Ph.D., is a licensed clinical psychologist specializing in eating disorders and obesity. She is the Behavioral Services Director of MindBody Bariatrics and the Clinical Director for Center for Change, both in Las Vegas, NV. She has recently co-authored a book, Obesity Surgery: Stories of Altered Lives, with Marta Meana, Ph.D.