Expert: Jeanne Rust, PhD - 9/19/2011

Question
what are the symptoms and causes of anorexia? how many symptoms do you have to have to be anorexic? if my friend is indeed anorexic, how can i help without telling or should i tell?

Answer
Dear Lucy,

I'll give you all of the symptoms of anorexia.  It's difficult to make an accurate diagnosis without all of the information.  Is your friend extremely thin?  This is what people usually "see" at first.

Whether to tell or not tell is a big question.  Have you asked your friend if she's interested in seeing a therapist?  If she looks like she's getting worse, then you might talk to a school counselor or to your friend's mom.  Your friend might be furious with you but you could end up saving her life because of your caring!


Table A1
Summary of Diagnostic Criteria for Anorexia Nervosa, DSM IV

1.   Refusal to maintain minimal body weight at or above a minimally normal weight
2.   Intense fear of weight gain, even though underweight (< 85% of normal weight)
3.   Body-image disturbance, including denial of the seriousness of the current low  body weight
4.   Amenorrhea of 3 consecutive cycles
5.   Restricting type: During current episode person does not engage in binge eating or purging.
6.   Binge eating/purging type: During episode person engages in binge eating and purging

More info:

The most prominent feature of anorexia nervosa (AN) is an intense fear of “fatness” (Williamson, Cubic & Gleaves, 1993).  It has a 5% to 25% lifetime mortality rate in some studies (Katz, 2003).  It is characterized by major behavioral, psychological and physiological problems, including a body weight that is less than 85% of normal weight, fear of gaining weight even though underweight, preoccupation with food and abnormal consummatory behavior (Williamson, Barker & Norris, 1994; DSM-IV, 1994).
Individuals with AN view themselves as overweight even though they are dangerously thin. The process of eating in and of itself becomes an obsession. Compulsive eating habits predominate, such as avoiding food and meals, picking out a few foods and eating these in small portions, or carefully weighing food. Anorectics may repeatedly check their body weight, and many exercise careful control over weight loss via other techniques, such as intense exercise, or purging by means of vomiting and abuse of laxatives, enemas, and diuretics.
Upon physical examination, individuals with AN exhibit decreased heart rate, blood pressure and overall metabolic rate, as well as increased serum cortisol. They also have profound decreases in estrogen production in females or testosterone in males (Soykan & McCallum, 1998). Over two decades of research, clinical outcome studies indicate that this problem is likely not a result of any single biological or psychological factor, but instead appears to be a product of an interaction of biological, psychological and social influences (Cash & Deagle, 1997; Kipman, Gorwood, Mouren-Simeoni, & Ades, 1999; Wonderlich, Brewerton, Jocic & Dansky, 1997).
Some individuals with AN recover after a single episode, a few have a fluctuating pattern of weight gain and relapse, while many others experience a chronically deteriorating course of illness over many years. The mortality rate among people with anorexia has been estimated at 0.5 percent per year, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population. The most common causes of death are complications of the disorder, such as cardiac arrest, electrolyte imbalance, or suicide (Nielsen, 2001).  

In regards to helping your friend, go to my blog, www.edrecovery.com.

Let me know what happens with her!

Warmly,
Jeanne Rust, PhD
CEO/Founder
Mirasol, Inc.
888-520-1700
www.mirasol.net
www.edrecovery.com