Anorexia As A Disease

What is 'anorexia nervosa'?

Primarily it is a person's drive for thinness and a refusal to maintain weight. Typically, one of the other parts that tends to be present with anorexia nervosa is that there is what we call a body distortion where the person will not see themselves for what their size is. They don't have an accurate perception for their body, so they may be really emaciated but they see themselves as really fat. Another component that defines anorexia nervosa is this obsession with thinness and maintaining a thinner body.

How many people suffer from anorexia?

When we think about prevalence rates, they estimate it to be one percent of the population here in the US. That's all we talk about: one percent of the population. If we break it down, it becomes more understandable for us. If you look at college populations, one out of every four girls in the college population has an eating disorder. It might be anorexia, or it might be bulimia, so it's a fairly high prevalence. Depending on the pockets of who you look at, the prevalence rates can vary.

What percentage of anorexics are male?

So out of every seven people that come forward, one person, typically, out of the seven, will be a male. And what defines the type of eating disorder that that male person would have, what defines it, as to whether it's anorexia or bulemia really kind of depends on their personality type. A lot of people that may be like in sports such as gymnastics, or jockeys or wrestlers, what happens with them is that they'll end up being in a sport that actually supports and condones that behavior and sanctifies the behavior, so for them it's not ego-dystonic. It's more egosyntonic. And what I mean by egosyntonic is that it fits with their view of the world. It feels okay to them; they don't feel distressed about the fact that they're puking their guts out or anything. They're okay with that. So within that male population, we really kind of have to look at the culture that they're in, and work with that.

What are the two categories of anorexia nervosa?

We have two categories of anorexia nervosa, we have anorexia nervosa restrictive type and anorexia nervosa binge purge type. Now the primary component you want to remember is that both of them, by the definition of anorexia nervosa, there's the drive for thinness. So for one person, what they do, the restricting type is they primarily restrict on what they eat so they don't engage in any kind of purgative behaviors such as throwing up or excessive exercise or laxatives or anything like that. And then the binge purge type, they have the drive for thinness, which is what defines it as anorexia nervosa, however within that what they do is they do extreme exercise or they may throw up or they may do laxatives or other kinds of things like that.

What is the difference between anorexia, bulimia and binge eating disorder?

The differences are that with anorexia nervosa, those three, and the fourth one is eating disorder not otherwise specified, EDNOS, which is sort of like for us in many ways, it is sort of like a catch all phrase if you can't fit somebody in any one of those other categories you have the EDNOS. And the binge eating disorder, what it is with a binge eating disorder, what separates it out from anorexia and bulimia, is there generally tends not to be the extremes of behaviors with trying to get rid of the calories. So it could be somebody who eats in response to stress and then doesn't compensate for those behaviors by trying to throw it up or over exercise. And so with a binge eating disorder typically you have people who turn to food for soothing and then kind of push down the feelings, and some of the binge eating disorder people may be normal weight and majority are overweight. So that's sort of like, in terms of body size you'll find, anorexics will be much more on the thin side. Most people with bulimia nervosa tend to be normal body weight and sometimes slightly overweight, just slightly. And the majority of the people with binge eating disorder may be overweight and many can be normal weight as well. So in terms of body sizes too you see a little bit of a difference in the three diagnostic areas.

What is required for a formal diagnosis of anorexia nervosa?

To receive a formal diagnosis of anorexia, one has to be 15% below their ideal body weight. They have to show a loss of menses, and they have to show body image distortion. To receive a formal diagnosis of anorexia, those are some of the components we have to see.

Is an anorexic who binges and purges also considered bulimic?

When we look at giving a person a diagnosis of anorexia nervosa, we're really looking at the drive for thinness and their personality. Typically for many people with anorexia nervosa, they have other diagnoses along with that. They may be very obsessive-compulsive and detail-oriented, and they also tend to be very perfectionist and highly conflict-avoidant. When you have someone who is bulimic, their personality tends to be slightly different in that they're more aggressive and out there with stuff, and they show their feelings more quickly and things like that. You could have somebody who's anorexic. Anorexia is actually defined on criteria more than just their body weight. It's more about their personality, their extreme drive for thinness, their obsessiveness, their detail orientation, and how conflict-avoidant they are. They could be binging and purging, but that doesn't put them in the category of bulimia because for somebody with bulimia it's a different process.

What other behaviors are considered anorexic?

A lot of people don't realize what's occurring within our communities right now. For example, we have this definition of "healthy", and part of that healthy will be the amount of exercise that people do. Many people do not realize that the obsessive amount of exercise that they may be doing is a manifestation of anorexia, and that the reason why they are doing the obsessive exercises is because they want a certain thin, sculpted body. That drive for fitness is really high. There are categories of anorexia that are just not talked about and detected and described as readily as we see. For example, young girls who seem to lose a lot of weight, or college athletes or different things like that.

Is there a specific cause of anorexia?

There isn't a cause; there are multiple factors that come together. And actually we have some very exciting research that occurs here at UCSD. We have Dr. Walter Kaye, who has one of the biggest grants in the field of eating disorders. And he's doing a lot of work on the genetics with eating disorders and what we're finding is that in families where there is - which we've known clinically in our practices - is that you'll find a linkage of some family members with eating disorders. And now he's finding genetic proof of that. So that for somebody with anorexia, for example, there's an eleven times more likelihood of a family member having an eating disorder. And so, when we look at causes, genetics is one big part of it. We look at developmental factors - the onset of puberty, how that person experienced their puberty. We look at family histories of depression or alcoholism or substance abuse. Then we look at family histories of obsessive compulsive disorder - you know, OCD. And it may not even be like classic OCD but just more like somebody who really likes a lot of order and symmetry and things like that. Because the eating disorder serves the function of ordering the person's life - creates order and structure in their life.