Defining eating disorders
Rita J. Donley and Dominic O. Vachon University Counseling Center
Editor's note: In conjunction with the University Counseling Center, Scene presents a series of five columns this week that will highlight eating concerns in recognition of National Eating Disorders Awareness Week.
It is normal to want to be attractive. It is not normal to let your appearance and eating behaviors control your life. Joan Ebbit, author of "The Eating Illness Workbook," states that "eating disorders exist when a person's use of food and rituals and practices surrounding the use of food cause increasingly serious problems in the major areas of the person's life." Major areas include: emotional health, spirituality, financial/legal, physical health, social life, job/work/academics and family life. The media has highlighted anorexia nervosa and bulimia nervosa, but it is important to focus on a much broader range of eating and body image concerns as well. In addition to anorexia nervosa and bulimia nervosa, individuals struggle with eating concerns that do not meet the full criteria for an eating disorder diagnosis, obesity, binge eating disorder, and body dysmorphic disorder as well.
Professionals use the "Diagnostic and Statistics Manual of Mental Disorders" (DSM-IV) to help them assess and diagnose eating disorders.
Anorexia Nervosa is characterized by a refusal to maintain a minimally normal body weight (e.g. weight loss leading to maintenance of body weight less than 85 percent of that expected); an intense fear of gaining weight or becoming fat, even though underweight; an undue influence of body weight or shape on self-evaluation; and for women, the absence of at least three consecutive menstrual cycles.
Bulimia Nervosa is characterized by recurrent episodes of binge eating (e.g. eating an amount of food that is definitely larger than most people would eat during a two hour period and under similar circumstances and a sense of lack of control over eating during this time period); the use of recurrent inappropriate compensatory behaviors in order to prevent weight gain including self-induced vomiting, misuse of laxatives/diuretics/enemas/medications, and/or excessive exercise; both binge eating and inappropriate compensatory behaviors occur, on average, at least twice a week for three months; and self-evaluation is unduly influenced by body shape and weight.
Some individuals will report many symptoms of an eating disorder but do not meet the diagnostic criteria. These individuals can benefit from intervention and treatment as well.
Simple obesity is considered a general medical condition, but does not appear in DSM-IV because it has not been established that it is consistently associated with a psychological or behavioral syndrome. However, two of the biggest concerns for obese individuals are the fact that they develop diseases at a higher rate than the rest of the population and face discrimination, prejudice and ridicule in the world by others. Those consequences may result in individuals seeking psychological, nutritional and medical assistance. Obesity is defined as individuals who are at least 20 percent overweight with the following distinctions: mild obesity (20-30 percent), moderate obesity (30-60 percent), severe obesity (60-100 percent), morbid obesity (100-150 percent) and super morbid obesity (250 percent or more). Some obese individuals engage in binge eating behaviors, and others do not.
On Frontline's documentary, "Fat," Dr. Rudolph Leibel from Columbia University stated, "From mice and rats, we have learned that there are single genes that can cause profound obesity, and we have found in every instance that there is a corresponding gene in humans. If we went out on the street right now, and I showed you a group of adults ranging from 4 1/2 feet to 6 1/2 feet, you would make no comment about this. It's expected. We all expect to see wide variations in height. We accept that this is due to very strong genetic influences. My perception of this is that there are equally potent genetic influences on body weight as there are on height. But the population, because of our lack of understanding of all the mechanisms, simply has not come to accept this yet."
Binge Eating Disorder is proposed as a new diagnostic category in the research literature. In contrast to Bulimia Nervosa, in which inappropriate compensatory mechanisms are employed to counteract the effects of the binges, no such behavior is regularly employed to compensate for binge eating and binge eating occurs for a longer period of time (e.g. six months or more) than is suggested in the diagnostic criteria for Bulimia Nervosa. Many individuals involved with the 12-step organization, Overeaters Anonymous, refer to themselves as compulsive overeaters and this diagnostic category would be consistent with the ways they would describe their eating behaviors.
Body Dysmorphic Disorder is defined as a preoccupation with an imagined defect in appearance. If a slight physical abnormality is present, the person's concern is markedly excessive. The preoccupation causes clinically significant distress or impairment in social, occupational or other important areas of functioning. In 1998, USA Today published an article entitled, "Bodybuilders' fret `flip side' of anorexia." In this article Smith states, "A condition identified as `muscle dysmorphia' is a preoccupation with muscle development so powerful that those who suffer from it often give up their jobs so they can spend all day at the gym. Many individuals had not eaten in restaurants for years because they could not control the precise carbohydrate and protein content of their food. People with this condition frequently take steroids to build bigger muscles, but they are still disappointed with their bodies."
Preliminary evidence suggests that Body Dysmorphic Disorder is diagnosed with equal frequency in men and women. The other eating conditions mentioned affect both men and women, but women much more frequently.
No one wakes up one morning and says, "Gee, I want to have an eating disorder." Many individuals begin dieting, a widely accepted behavior in our society. The problem is that for some people, their dieting begins a cycle of feeling out of control with food, obsessing about weight and appearance and feeling like this struggle defines who they are. Tomorrow's article will discuss the treatment options available to individuals with eating disorders.
The views expressed in this column are those of the author and not necessarily those of The Observer.
All Scene Stories for Monday, February 14, 2000