Talk:Anorexia nervosa

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Date of review: 20 September 2006

[edit] Old talk

Just wondering if there should be a source cited:

1) not many people carry so many BMI #'s in their head

2) most people just say "depression"; it's the same thing as "unipolar depression"

A different way to spot anorexia: soft, downy fuzz all over a sufferer's body. It's much finer hair than normal leg hair. It's a self-defense mechanism of the body (to try to preserve heat) when there is too little fat in the body.

There are MAJOR differences between anorexia nervosa, the diagnosable disorder, and "pro-ana", the lifestyle choice which refers to anorexia as a lifestyle rather than a disease. The former compells and controls the sufferer; the latter is a conscious choice which is self-regulated and typically the product of intelligent research and experimentation. Frequently, however, eating-disordered-anorexics will claim to be "pro-ana" as part of the defiance component of their psyche, and this causes serious confusion in society between the two. Make no mistake: genuine pro-anas are not eating disordered, and eating disordered persons BY DEFINITION cannot be pro-ana, because they are compelled by a disorder, not self-directed by their own volition.

The key to understanding the difference is, of course, VOLITION. The free agency of the will operating in the human mind makes all the difference in the world.

I was about to ask for a cite on there being two distinct groups, pro-anas who aren't sick and anorectics who are, but that can only lead to one of us sounding like Thomas Szasz, of which good cannot come. I'll just say that its very difficult to determine if another person isn't eating due to mental illness or a lifestyle choice that looks identical to it. Or, for that matter, just not being very hungry. --Calieber 20:31, Oct 27, 2003 (UTC)

I heared that the decline of metabolism is one of symptoms of anorexia nervosa, but the article seems ignoring it at all. Does anyone know about this? -- Taku 04:52 11 Jun 2003 (UTC)

I believe it's related to poor nutrition/starvation, but I don't know enough about that area to add it. It's more a matter that there is alot of information about Anorexia, and that the article does not contain everything, rather than ignoring things. Some areas of Wikipedia aren't very useful because there are too few contributers who have knowledge in that field :]

Should pro-anorexia websites be discussed here? I think there should be some discussion of this disturbing phenomenon, if not here then in its own article. --Daniel C. Boyer 20:43 24 Jul 2003 (UTC)

I think it should have its own article

- important to know however that "pro-ana websites" are not websites that encourage, recruit, proliferate etc anorexia. the term "pro-ana" is misleading.

Anoretic was not listed in my dictionaries and Google gives 708 hits. So I changed it into anorectic (in dictionaries, and 13.600 Google hits). Guaka 15:41, 23 Aug 2003 (UTC)

(trojjer, NSI — 2006/4/22 07:46 BST) What's going on – I always thought that anorexic was the correct adjective (and colloquial noun) to use. It's certainly the most commonplace term amidst Google's index... Is there some Greek grammatical clause that I'm overlooking, that changes the "x" into a "ct"? Sounds pretty feasible – although, despite the fact that I try to uphold British English and, similarly, its classical roots, ahem, anorexic is easier on the tongue. And it's already become so ingrained in media.

I'm curious, this page has a copy & paste of this article, with their own copyright at the bottom, is this the correct way of doing things?

No, they did it all wrong, and their copyright over the work is invalid. I have listed the site at Wikipedia:Sites that use Wikipedia for content, and hopefully someone will deal with it. - Mark Ryan 04:02, 5 Dec 2003 (UTC)

User:67.168.209.242 has deleted alot of content (7 paragraphs) from this article and replaced it with some lines from a text-book definition, shall this be undone? I keep seeing more elaborate forms of vandalism, so I am wondering what this user was thinking... Crusadeonilliteracy 08:15, 13 Dec 2003 (UTC)

Why the category feminism?

-agreed. this is a problem that DOES plague men as well. has little to nothing to do with feminism also.

This lacks any mention of famous people who had Anorexia Nervosa, Of sites that promote Anorexia Nervosa. Dwarf Kirlston 17:50 17 Feb 2005 [Brasilia Time Zone]

In the Risks section, it states

"95% of anorexia nervosa sufferers are females"

Two paragraphs later, there is the statement

"Twenty years ago it was thought that for every 10-15 women with anorexia or bulimia, there was one man. Today researchers find that for every four females with anorexia, there is one male, and for every 8-11 females with bulimia, there is one male."

These are incompatible. I have no expert knowledge of anorexia - I want to find out about it from the Wikipedia. Maybe somebody with some competence in this area can reconcile the two statements?

I agree. I was very surprised to see the radical statement '95% of anorexia nervosa sufferers are females'. I call it a radical statement, because where does it come from? To which countries does it apply? I'm from Spain, and here 4 out of 10 patients (of anorexia nervosa, of course) are men. And I don't think that's an odd number here in Europe. Tomorrow I'll be taking a seminar on the Treatment of anorexia nervosa (that's why I was hanging out here -I'm starting work at a hospital next week and this is the kind of disorder I'll most frequently see, I've been told), and if I get some recent world epidemology figures I'll put them up here. Maria, March 2nd 2006.

Okay, this is what I found. The female-male ratio of Anorexia Nervosa is about 9-10:1, as almost all epidemiological studies state that almost 90% of patients affected by an eating disorder are women, and only about 3-10% would be men. This is from a U.S study by Gambill, 1998. I couldn't get any other recent international results, so perhaps the article should mention that too. Maria, 5 March 2006

I find this arbitrary distinction between anorexic nervosa sufferers and "pro-ANA" types to be ridiculous as a practicing clinician who treats those with this disorder. Most anorexics are choosing to starve. In some cases it can be argued that their fear of being fat is so overwhelming that it restricts their ability to eat normally. However, many anorexics manage to gravitate to "pro-ana" sites to reinforce their starvation behavior. In response to some of the questions above, there was a famous study on starvation done with conscientious objectors during World War II that found that depression was a concomitant of starvation (see Garner Handbook of Eating Disorders). There were also a lot of personality changes such as withdrawal, obsession with thinking about food, changes in eating habits, hoarding behavior that can be connected to the fact that a person is starving. In response to another statement, the percentage of men with eating disorders has been skyrocketing as we become more sedentary a society. It used to be that men would excessively exercise, now dieting is more acceptable for men. There are clearcut cultural factors in the promotion of anorexia nervosa. Prior to Twiggy coming to the United States, anorexia was so rare that each case merited a journal article. After Twiggy, the disorder became incredibly commonplace. We changed the definition of a sexy woman from an hourglass (e.g., Marilyn Monroe) to a tube (e.g. Twiggy) (Again, check out Garner) Finally, most practicing clinicians ignore the loss of period requirements in diagnosing males as it is not relevant. (MJG)

Shouldn't a lot of the general eating disorders information here be under eating disorder? - Chandon 23:01 07 May 2005 [EDT]

Certainly. JFW | T@lk 09:22, 8 May 2005 (UTC)

[edit] Question

Uh, why is there an anorexia page as well as one on anorexia nervosa? Same thing, right? - Nick 11:42, 29 August 2005 (UTC)

Have you read anorexia? JFW | T@lk 22:22, 29 August 2005 (UTC)

[edit] Problems

I have the following critisms of this article and I can work on it over the next few days unless there disagreement ...

(1) Some anorexics know they are overweight, but are still unable to put on weight (or perhaps they are not AN sufferer, but an atypcial ED? .. this is open for debate)

(2) The last paragraph on treatment is the experiance in the US ... in the UK practice is different, with more outpatient treatment.

(3) I feel the 'interacting with sufferers' should be expanded ... to bring up issues like codependency and boundaries etc... 'unconditional love and empathy' without boundaries to guide the sufferer would not help.

--193.132.127.68 16:43, 30 August 2005 (UTC)

Go ahead, I don't think your criticisms are unfounded. Interacting with sufferers (be careful, "sufferer" is a loaded term) is unlikely to be of much benefit. The anas just wind each other up. JFW | T@lk 17:18, 30 August 2005 (UTC)

why do u guys put anorexia and anorexia nervosa like 2gether aren't they the same thing??

Not really. Dorland's medical dictionary defines anorexia as a lack of appetite for food. In the practice of medicine anorexia can be caused by any number of diseases such as Tuberculosis, cancer of all types, over active thyroid disease. The suffix 'nervosa' indicates, correctly, a psychological or psychiatric cause. User:[LMD] Read anorexia. JFW | T@lk 09:39, 11 September 2005 (UTC)

I have a problem with the folowing "However, while very emaciated women will never menstruate ". I think at the very least a 'most' should be inserted if that line isn't delated all together. I don't know what the person who wrote that defines very emaciated to be but I know some women continue to menstruate with bmi's in the 11-12 range without taking hormones and if someone's below that weight amenorrhea is the least of their problems.

[edit] Anorexia vs. Anorexia nervosa

I added "in this article, anorexia will be used synonymously with anorexia nervosa" to the top paragraph, since that is the case. The other alternative would be to change each instance of "anorexia" to "anorexia nervosa", but I think it might be good to reflect the fact that the terms are used synonymously in common language. Thoughts? /Skagedal 12:19, 20 November 2005 (UTC)

NOT just that, but also for brevity's (and its sibling ease of reading's) sake. I changed the article to reflect this. Remember each time you use "anorexia nervosa" when you could be using "anorexia", you are wasting 9 bytes of data.

Hi there, this is my first time posting, so I apologize if I mis-format this blurb. Someone vandalized the phrase "in this article, anorexia will be used synonymously with anorexia nervosa" by replacing the first "anorexia" with "anal leakage." I switched it back to anorexia. Just wanted to let people know, in case any one was wondering why my IP was changing things. —The preceding unsigned comment was added by 72.57.20.92 (talk • contribs) .

Great work! It looks like the vandalism had been in the article for about 3 hours, and that appeared to be the sole vandalism in the article. Keep up the good work. --TeaDrinker 05:57, 1 July 2006 (UTC)

[edit] Weeding "Notable anorectics"

I'm quite sceptic about the existance of this list. There is a great risk that people will be added just because it has been speculated in the press that they might be anorectic, or maybe just because some Wikipedian thinks they're thin. I think that at the very least, if a person is to be in this list, his or her disorder should be mentioned and discussed in that persons article. I have removed a number of people from the list for the following reasons:

Christine Alt - has no article
Fiona Apple - no mention in article
Shane and Sia Barbi - article mentions bulimia, which is something else
Justine Bateman - no mention in article
Victoria Beckham - no mention (except "weight loss")
Courtney Cox - no mention in article
Kate Dillon - has no article
Jamie-Lynn Sigler - article mentions unspecified eating disorder
Karen Elson - no mention in article
Calista Flockhart - article mentions "media speculations"
Jane Fonda - no mention in article
Geri Halliwell - no mention in article
Amy Heckerling - no mention in article
Audrey Hepburn - speculative
Laraine Newman - no mention in article
Carre Otis - no mention in article
Gail Porter - no mention in article
Gilda Radner - no mention in article
Christina Ricci - no mention in article
Richard Simmons - no mention in article
Princess Diana - no mention in article
Billy Bob Thornton - no mention in article
Richey James Edwards (of Manic Street Preachers) - "on the verge of anorexia"
Allegra Versace - speculated
Lara Flynn Boyle - speculated
Whitney Houston - speculated
Nancy Reagan - speculated
Dolly Parton - speculated
Brittany Murphy - speculated

I think there should be an article called Wikipedia:Wikipedia is not a tabloid...

I kept:

Christy Henrich- American gymnast who died from anorexia

although there is no article, because it sounds like a notable case.

I think it would be much better with a piece of text discussing a few notable, verified cases instead of a list. /Skagedal 16:49, 20 November 2005 (UTC)

We went through this discussion on Talk:Pneumonia. I think anorexia is a bit more sensitive than pneumonia; listing someone here would amount to defamation if the claim was untrue, speculative, original research, unverifiable etc. Only those people who are publically well known (e.g. Karen Carpeter) should be listed here. In my personal view, people should only be listed here if they made lasting changes to the public perception of anorexia. This is fairly exclusionist, but keeps out all the dross and speculation. JFW | T@lk 20:53, 20 November 2005 (UTC)

My feeling is that this type of content decreases not only the quality, but the credibility of Wikipedia. A recent survey fo content showed that Wikipedia was statistically and demonstrably as accurate as the Encyclopedia Brittanica. If I wanted to know who was indicated to have suffered from anorexia nervosa, I would look on Page 3 of the Star or Page 6 of the Post...not the Encyclopedia Brittanica, and therefore, by association, not Wikipedia.

I am, therefore, calling for a vote to remove this section completely. Cheers! --Sadhaka 13:06, 10 March 2006 (UTC) ^{Talk to me}

Going once... --Sadhaka 12:13, 11 March 2006 (UTC)

Going twice... --Sadhaka 14:35, 12 March 2006 (UTC)

Gone. --Sadhaka 12:00, 15 March 2006 (UTC)

Retroactive support. JFW | T@lk 12:12, 15 March 2006 (UTC)

[edit] Amenorrhea requirement

The DSM-IV criterium that requires amenhorrea specifies "in postmenarcheal females". So the discussion about "...it makes diagnosis in males problematic" doesn't really apply as stated. However, I can see why the criterium is problematic - if it only applies to women, why have it at all? Someone who knows more about this discussion should modify the paragraph. Also, wouldn't it be best to just list the DSM-IV criteria somewhere? /Skagedal 10:32, 22 November 2005 (UTC)

[edit] Am I anorexic?

I don't see myself as fat, I just hate eating! I am 5'4" and weigh 98 pounds on a good day. It's not that I don't want to gain weight, I just don't want to eat to do it. This has gone on since I was about 13 years old and I am in my 40's now. I have mastered the art of hiding my eating habbits and I can make a full plate look half empty without having to take a bite. If I force myself to eat, I automaticly gag (no control). This is not something I have time for, nor the money to deal with it. My husband would throw a fit, and my children would see nothing but a bad example. How do you know?

confused.

I would certainly not ask a bunch of strangers on Wikipedia. The fact that you have posted here seems to suggest that you are somehow intrigued or worried about it. Your first port of call should still be your family physician; as the consequences of bona fide anorexia are quite significant, I think time and money are only relative. Your weight means little; steadily losing weight would be worrisome. JFW | T@lk 23:41, 30 November 2005 (UTC)

I agree: go see your family physician. it's hard to make a diagnosis based on a short account like that, but to me it sounds more like some sort of maladaptive eating behaviour (food aversion, globus hystericus, functional dysphagia,FAED,...), maybe even coeliac disease, or some other organic disorder. get a thorough check-up, that's my advice. a correct diagnosis & treatment might seriously improve your quality of life. Arhielanto 00:38, 22 May 2006 (UTC)

I don't realy fit All the stuff they say about anorexcia, but there is a lot...I just don't want to set a bad example for my step-children. It's probably nothing! 70.245.29.91 (talk • contribs)

What makes you concerned they are learning anything from you? JFW | T@lk 01:26, 1 December 2005 (UTC)

they are 13 and 14 year old girls, and my husband is a truck driver (hence...never home)they watch my every move doing exactly what I do, last evening my 14 year old mentioned how I sat at the table with everyone and only took two bites of potatoes then pushed my food around so everyone would think I ate...she said "that's what I do in the cafateria at school, so I don't have to eat either" my heart thumped like it never has...almost like...I don't know, someone had learned something bad about me...do you understand what I mean?

Oh, fully. But as you are likely to be thousands of miles away diagnosis and management are a bit of a challenge :-) If it concerns you, I do think that talking to your FP is the most sensible thing to do. JFW | T@lk 02:29, 1 December 2005 (UTC)

thank you, for talking with me...one more thing,if you will just throw your opinion in, I understand it is only an opinion, nothing legal or anything...If it were you, would you mention it to your spouse?

Goodness, I'm being a Wiki-therapist this fine morning. It depends whether you think your other half can take it, I suppose. A good relationship can take a lot. But that is the opinion of a random nobody, not professional or anything, and the general disclaimer applies to these comments :-) JFW | T@lk 02:46, 1 December 2005 (UTC)

LOL..;) I'm sorry...thank you Good Night.

(the opinion of a random nobody, not professional or anything, and the general disclaimer applies to these comments :-)...understood)

[edit] Reducing number of external links

I think it would help this article if we reduced the number of external links. I've included a list of them below to facilitate discussion. Lots of deadlinks, PDF links, commercial sites, and general links to sites having nothing directly to do with anorexia nervosa. The only ones I think that might be worth keeping are numbers 3, 7, 13, 14, and 16 (not that they're perfect, but I think they're better than the rest.) Any opinions/objections? --Arcadian 20:21, 11 December 2005 (UTC)

[edit] Links as of December 11

(Please do not edit the list below; it is meant to be an accurate representation of the links as of this version, with the only change being numbers added to make it easier to discuss.)

1. Eating Disorders
2. Randomized controlled trial of a treatment for anorexia and bulimia nervosa. Karolinska Institutet (Sweden) treatment model focussing on teaching people how to eat again. Supposes that psychiatric conditions could be more symptomatic than causal. Showing remarkably positive results and seeking further replication.
3. The Stockholm solution
4. The Something Fishy Website on Eating Disorders
5. International Eating Disorder Referral and Information Center - EDReferral.com
6. Wasted (ISBN 0-06-018739-5), by Marya Hornbacher, an autobiographical look at her lifetime of Bulimia nervosa and Anorexia nervosa.
7. Dangers of anorexia nervosa
8. The International Eating Disorders Centre
9. Web4health Anorexia nervosa section
10. Eating Disorders Association (EDA)
11. BBC-Mental Health
12. American Psychiatric Association
13. Mental Health Matters: Anorexia
14. Psych Forums: Anorexia Forum
15. Anorexia Blogs
16. The Prehistory of Anorexia

[edit] Adding an external link

Sorry, I'm a bit new to Wikipedia, but I believe that I must post a link here before adding it to the main page.

My link is Somerset & Wessex Eating Disorders Association, I design and manage the site on a volunteer basis (being a recovered sufferer from anorexia and bulimia myself).

Although we are a rather localised charity I would hope that the information provided by the site would be useful to a much wider audience.

Our site address is www.swedauk.org

I appreciate that others may remove the listing if they don't feel that it's appropriate to be included here but I thought that I'd post in up just in case and have also done so in a few other eating disorder related articles.

I hope that this is ok. Feel free to email me if there's a problem (contact details are on the website).

With Kind Regards Paul

[edit] can i develop anorexia nervosa?

my BMI is 35, and i eat under 1500 calories a day, also i'm sedentary, the calorie calculators say that i need 2318 calories a day,and still i'm obeise, and i still don't loose weight, can i gain this problem????

1. No. But you need at least 1200 for your system to work correctly. 2. BMI is not nonsense, as it is used to accurately calculate an anorexics development 3. See a physician, as this is not the proper forum for this type of question.

Mjformica 00:27, 3 February 2006 (UTC)

Ooookay, while I agree this person should see a physician or get some psychological help, I really think you (Mjformica) shouldn't go around saying BMI is nonsense. It's not. It's an indicator, that's all. Perfectly validated and widely used. The problem arises when people want to make a diagnosis of anorexia nervosa, for example, based only on BMI. That's what is wrong, and what is sheer nonsense. Maria, March 2nd 2006.

Maria...my comment was harsh, as is my wont. My apologies, I'm working on it. I have a HUGE problem with BMI because it does not take into account muscle mass, only body mass. I am 5'6". I weigh 180 lbs. Despite a healthy 16% body fat, I look like I weigh about 145 because I am a serious athlete, and muscle is more dense than fat. According to the BMI index (that's redundant), I am morbidly obese. As a medical professional, see my concern? --Mjformica 14:29, 3 March 2006 (UTC)

Hi again Mjformica. Listen, I just calculated your BMI, and from my results you belong to the 'normal' category. Maybe you made some sort of mistake calculating it? I used metres and kg instead of the US standard scale units you gave me, because as far as I know they are the ones the World Health Organisation use. I've rechecked it twice (with the help of the conversion tables at http://convert.french-property.co.uk/index.htm), and I get 23.91 as your BMI. Maria, 5 March 2006

I agree, of course BMI in itself is nonsense. But then a good physician doesn't look at his patient's BMI and says "you're fat. lost some weight"; he looks at BMI, hip/waist ratio, Blood pressure, blood tests (for LDL, HDL, TG, glycemia, liver function), take anamnesis, and only then decides whether or not the patient has a weight-related problem (metabolic, orthopedic, and/or psychological) requiring treatment. The essence is the Clinical aspect, not the statistical (the same goes for anorexia, and medicine in general really). I agree we need a more nuanced depiction of the issue in the news and media, but saying "BMI is nonsense" is just as oversimplified as the current BMI-obsession.

There's the simple fact that a substantial portion of the western population are sedentary fastfood consumers wíth a high BMI, and a high(er) risk of developing cardiovascular disease, diabetes, cancer, lower life expectancy & QOL,... BMI being redundant will change little about that. Ironically, getting these people's BMI down should not be a concern, getting them to excercise and eat healthier (not less) should. So basically, yes, i agree with you, just not with your wont. Arhielanto 00:38, 22 May 2006 (UTC)

BMI is the crudest possible measurement of excess weight. It measures height and weight only. It is linear mass density in different units. People have a range of skeletal builds, muscular masses, etc... BMI attempts to infer information about the contents of a person's body by measuring the outside, for which there is some correlation. I'm technically 20lbs overweight by BMI, which is funny because this fact always surprises pretty much anyone who has ever seen me.--Loodog 03:37, 25 August 2006 (UTC)

[edit] Cleanup

More than anything else, the statistical claims about rates of anorexia, death rates, ethnic and cultural associations and assertions of associations with other psychiatric and physical orders require citations from reputable sources. It's one thing to say that 95% of people with anorexia are female and another to be able to back the claim up.

Some more time might also be given to the changing rates of anorexia nervosa within different ethnic groups, but that's just my opinion.

I agree, the stats probably do need to be re-checked somewhere Handmedown

BMI is should never be dismissed seeing as almost all treatments of eating disoreders require the constant calculation of the clients BMI.

[edit] Removed notables

I removed the "notable anorectics" section, as no one voted to keep it, despite several days of polling, it is fundamentally purient and sensationalist, and it adds no value to the article.

Abraham Lincoln -- depressed
Adolph Hilter -- megalomaniacal paranoid and xenophobe
Carl Jung -- graphomaniac
Sigmund Freud -- cocaine addict
St. Augustine -- alcoholic
St. Francis -- either touched by God, or a somatoform hysteric
Teresa of Avilia -- see above
King George -- syphillitic psychotic
Richard Nixon -- (undiagnosed) paranoid
Joan of Arc -- either touched by God or schizophrenic
Edgar Alan Poe -- alcoholic
Jesus of Nazareth (not Jesus Christ...keep your shirts on) -- either touched by God or a really charismatic schizophrenic
Leonardo Da Vinci -- poster child for ADHD
Mozart -- graphomaniacal compulsive
Siddartha (not Gautama Buddha, again, shirts on) -- masochist
Catherine the Great -- nymphomaniac
Albert Einstein -- OCD, OCD, OCD, OCD...

These are people who shaped our history and contributed to the development of the world as we know it. They are notable. Lindsay Lohan and Karen Carpenter (GRHS) are not notable...they are of current populist focus. My POV, but one I suspect is editorially legitimate. --Sadhaka 12:17, 15 March 2006 (UTC)

[edit] this DOES have to do with feminism, people

Anorexia plagues men as well, but this is a predominantly female affliction to the tune of about 90%. This disease is both a result of, and protest against, a culture that imposes unreasonable standards of thinness upon its female subjects. In regards to the claims that refute the importance of feminism, I encourage the following reads:

Feminist Perspectives on Eating Disorders, ed Fallon The Beauty Myth, Naomi Woolf Backlash, Susan Faludi Fat is a Feminist Issue Appetites, Caroline Knapp

Caroline Knapp, herself a former Anorexia sufferer, writes that "Anorexia is a response to cultural images of the female body--waif-like, angular--that both capitulates to the ideal and mocks it, strips away all the ancillary signs of sexuality..." and continues by explaining that "It's about the anxiety that crops up alongside new, untested freedoms, and the guilt that's aroused when a woman tests old and deeply entrenched rules about gender and femininity. It's about the collision between self and culture, female desire unleashed in a world that's still deeply ambivalent about female power and that manages to whet appetite and shame it in equal measure. It's about the difficulty a woman may have feeling connected to her own body and her own desires in an increasingly visual and commercial world, a place where the female form is so mercilessly externalized and where conceptions of female desire are so narrowly framed. And it's about the durability of traditional psychic and social structures, about how the seeds of self denial are still planted and encouraged in girls, about how forty years of legal and social change have not yet nurtured a truly alternative hybrid, one that would flower into feelings of agency and initiative, into the conviction that one's appetites are good and valid and deserve to be satisfied..."

According to Naomi Woolf, "Dieting and thinness began to be female preoccupations when western women received the vote around 1920; between 1918 and 1925, the rapidity with which the new, linear form replaced the more curvaceous one is startling." Knapp concurs, stating that incidents of eating disorders have increased by 36 percent every five years since the 1950's. Eating disorders have occurred more and more frequently since the beginning of woman's liberation movements; have occurred alongside these movements. The female body is the space upon which a culture contests its conflicting value systems.

Clearly, Anorexia is a feminist issue. The average model weights 23% less than the average woman. Women in this society have to lose an average estimate of 23% of their body fat to be considered comparable to media images. Furthermore, women are confronted by a 33 billion dollar beauty industry, targeting the insecurities of a female demographic. An unhealthy and unreasonable standard has been created to harness women's new purchasing power, in a society which still priviledges the female body over the accomplishments of the mind.

[edit] Coming updates

Hi there,

I'm going to be making some updates to the page shortly as it's a bit chaotic and confused in places, but please feel free to edit as I go.

- Vaughan 13:13, 29 May 2006 (UTC)

There's loads of fantastic information on the page, and I'm currently just in the process of re-organising the format to make a little more sense, as quite a bit of information is repeated in different places and so on. I'm aiming to make it a little more structured (akin to the schizophrenia page).

Feedback always appreciated.

- Vaughan 13:38, 29 May 2006 (UTC)

[edit] Edited text from Presentation section

I've edited the previous text from the presentation section (previous text below) so it reflects features reported in the clinical / scientific literature (see references in new section). Several of the examples given seemed anecdotal and not generally given as common features, although they certainly may be true of some people with anorexia.

Also, some of the text was based on links to newspaper stories, blatantly seemed like a drug or doctor advert (Drs. Jose Yaryura-Tobias and Fugen Neziroglu / Anafranil) or was focused too much on results from single studies.

Hence I've chopped it down and based it on reviews of the anorexia literature which should provide a more representative description.

- Vaughan 14:59, 29 May 2006 (UTC)

Previous text below...

The primary physiological characteristics of anorexia nervosa are:

voluntary starvation
exercise stress
obsessive-compulsive behaviors relating to food, food consumption, or physical activity

Note that these are not diagnostic criteria but are instead characteristics associated with many or most individuals with anorexia nervosa. In addition to the intentional starvation almost always associated with anorexia nervosa, some subjects will also take part in a high level of physical activity.

Anorexia nervosa has a negative impact on the immune system and the central nervous system (CNS). It is also thought to be linked to serotonin and dopamine abnormalities.

Many anorectics are diagnosed with obsessive-compulsive behavior at some point in their lives. Some have an eating-disordered parent, demonstrating a possible genetic link with the disorder. Drs. Jose Yaryura-Tobias and Fugen Neziroglu have demonstrated by their pioneering work in getting FDA approval for American use of the drug Anafranil that obsessive-compulsive aspects of the disease can be alleviated by that drug, generically known as clomipramine. Total cessation of all anorexic disease was reported in one patient in as short as one hour after administration of Anafranil in clinical trials in Manhasset, NY in February 1979. After a one year course of treatment with Anafranil, this patient has lived a normal life except for occasional visual hallucinations caused by underlying paranoid schizophrenia.

In a long-term set of studies done by Wentz Nilsson, Gillberg, Gillberg, and Råstam on fifty-one adolescents with anorexia nervosa, eighteen percent of subjects were consistently diagnosed with some type of autism-like disorder at onset and at five- and ten-year follow-ups [1]. Researchers Christopher Gillberg and Carina Gillberg have noted that a "small but important minority" of young women with anorexia nervosa may be suffering from undetected and underlying autistic disorders. [2].

Anorexic subjects will often go through a cycle of recovery and relapse, unless weight is restored long-term.

[edit] Physical appearance

is too thin and/or appears to have lost weight;
has dry, yellowish skin and thinning hair;
suffers from poor health and sunken eyes;
has grown lanugo, a thin fuzz-like hair that grows all over their body as a natural physiological reaction to severe starvation that serves to keep the body warm in the absence of fat;
has fainting spells or otherwise pass out (an effect of starvation);
has amenorrhea, the absence of menstruation. Currently, the DSM-IV lists amenorrhea as a required characteristic of diagnosis, as it nearly always accompanies anorexia nervosa in females. However, while many emaciated women will never menstruate (unless they use a form of hormonal-replacement therapy), some women cease to have their menses before appreciable weight has been lost. Conversely, a small percentage of women reach weights that are quite low and still manage to menstruate regularly. Further, the eating disorders work group of the DSM is attempting to have the amenorrhea requirement removed as it makes diagnosis in males problematic. Researchers have often pointed to lack of sexual potency in males as the equivalent of female amenorrhea, but there continues to be a lack of consensus regarding this criterion.

[edit] Behavioral

is secretive about their eating and try to not eat when around other people;
eats in a ritualistic manner (this can encompass taking abnormally small bites, cutting food up into abnormally small pieces, being sullen during mealtimes, staring at their food whilst eating, holding cutlery in odd ways or at strange angles at times, or eating slowly, especially when putting food into the mouth);
looks longingly at or pay abnormal attention towards food but not eat it;
cook wonderful meals for others but avoid eating the food they've made themselves;
says that he/she is too fat when he/she is not;
frequently brings up the topic of food and eating in conversation;
plans their meals up to days in advance;
possesses an extensive knowledge about the food energy contents of the different types of food, and the energy-burning effects of each form of exercise. Although anorexics are less likely to choose fattening foods to eat, this is not always so. They may set their food-restriction objectives by food energy (calories) rather than by food type—for example, one may set a goal of 100 calories in a day and the food chosen to attain that number may very well be a cereal bar one day and an apple the next.
abuses laxatives
are perfectionists. A 2003 study by Sutandar-Pinnock and others analyzed the correlation between high perfectionism scores as measured by the Multidimensional Perfectionism Scale (MPS), and anorexia nervosa as measured by the Eating Disorder Inventory (EDI). The control group participated in a family study, and was indirectly involved. The experimental groups were categorized as good outcome patients, who had regained weight after treatment, and poor outcome patients, who did not regain weight after treatment. The mean scores for perfectionism in both good and poor outcome patients were higher than the control group, statistically significant. The perfectionism scores for the poor outcome were statistically significantly higher than the good outcome group in 4/5 categories.
Also frequently hides food.
Wears baggy or oversize clothing.
Has over reactive mood swings.

[edit] Causes section

I note that the causes section is almost completely without referenced sources. I'm about to go through this and re-write it and include references to scientific articles in the field.

This will undoubtedly removing stuff their that's unverified, speculative, or not widely considered to be a major factor (i.e. is unencyclopaedic). However, if I have removed anything that you know a source for, please do add it.

- Vaughan 15:05, 29 May 2006 (UTC)

I added information late 2005, regarding Christopher Gillberg's observations that autism spectrum disorders (ASD's) are common in adolescent onset AN and are a sub-group that are particularly difficult to treat. The information was removed. I would like to see that information reinstated. If not, I would like to know why ASD's should not be included in the AN article. I can provide journal references if required. The occurrence of narrow focused obsessions are an integral element of ASD's; an aspect of behaviour that could cause some with an ASD to obsesses about body image and food.

- Diamond Dave 15/06/2006 13:48 (UT)

Hi there

I can't say I've come across this information in any of the review articles or books on eating disorders, but please do add some references here as I'd be interested to follow it up. From my search on PubMed (click here) I didn't find much in Chris Gilbert's work on this, but I'd be interested in finding out more.

All the best - Vaughan 14:52, 15 June 2006 (UTC)

[edit] Photos needed

This article is in definite need of photos to illustrate the disease.

Whoever chooses the photos should please be careful to not use any which could be triggering to anorexics reading the article. I think it should be possible to illustrate symptoms accurately this way if some thought is put into the picture selection. puppies_fly 17:12, 5 August 2006 (UTC)

Puppies, how do you mean "trigger"? Like, make them jealous of the appearance of the person? I would figure photos would be a more effective deterrant to anorexics because the severity of the disorder would be illustrated more poignantly.--Loodog 03:42, 25 August 2006 (UTC)

Pictures of particularly thin people may make people with anorexia more likely to engage in weight loss behaviour. This is why [[pro-ana] sites have such pictures as 'thinspiration'. I agree that putting such pictures on the page should be avoided. You;ll notice that the majority of anorexia charity websites do not use such images. - Vaughan 07:13, 25 August 2006 (UTC)

[edit] Cibophobia?

The fopllowinmg sentence was deleted from the article.

Sometimes the condition is called variously Cibophobia, Sitophobia, Sitiophobia, translated as "aversion to food".

What is wrong with it? The terms are circulating in the internet, hence heed explanation. `'mikka (t) 18:41, 29 June 2006 (UTC)

[edit] Should there be a history paragraph?

Does there need to be a paragraph on the history of anorexia nervosa, such as Dr. William Gull who first identifed it in the 1880's, and the effect Karen Carpenter's death on Feb. 4, 1983 had on the world as far as making anorexia, and bulimia, internationally known by the average person?204.80.61.10 18:34, 7 July 2006 (UTC)Bennett Turk

Hi Bennet,

I think this is an excellent idea. If you (or anyone else) adds anything, I think it would be a useful addition to the article.

- Vaughan 07:50, 17 July 2006 (UTC)

[edit] Stick skinny

Stick skinny hollywood models seems a bit arbitrary an biased.

[edit] Mortality rate

I corrected the claim that AN has the highest mortality rate of any psychiatric disorder. I've read in a (recent) manual deaths are something like 4% per decade. Will find source and post it.--Loodog 03:39, 25 August 2006 (UTC)

Found it:

"The mortality rate among patients with anorexia nervosa is about 6% per decade. "

From: Cecil Essentials of Medicine. Carpenter, Griggs, and Loscalzo. 5th ed. W.B.Saunders Co: Philadelphia. p519.--Loodog 23:37, 30 August 2006 (UTC)

Also, the article saying that it has the highest mortality rate concedes that this is a disputed fact.--Loodog 02:04, 16 September 2006 (UTC)

Hi there, the scientific article cited to support the 'highest mortality claim' is more recent than the Cecil Essentials of Medicine 5th Edition book, which was published in 2000. The Birmingham et al. (2005) study from which this claim is taken is from contains the most recent and thorough review that seems to exist on this matter and estimates the mortality to be 10%. This Wikipedia article is better based on the most recent scientific evidence from a peer-reviewed journal than a general medical textbook. Hence, I'll restore the original version. However, if you can find any more recent evidence that disputes this, please add it to the article. - Vaughan 15:21, 18 September 2006 (UTC)

Essentials is Dec 2003.

That's probably the reprint date. The publication data is clearly listed as 2000 for the 5th edition. - Vaughan 21:40, 18 September 2006 (UTC)

Notwithstanding that Birmingham et al. makes argument for AN having highest mortality rate, Birmingham et al. also concedes that the fact is disputed.--Loodog 18:55, 18 September 2006 (UTC)

But then goes on to provide the most accurate evidence to date based on all available studies, including the ones that were used to arrive at the 6% estimate. Of course there are differing estimates, but the most important estimate is the one based on the totality of the evidence, not just selective evidence from the past. - Vaughan 21:40, 18 September 2006 (UTC)

[edit] Interesting

Mario Boselli, head of the Italian fashion industry's chamber of commerce, said anorexia was a "rare phenomenon" in the fashion business.

From Reuters

63.226.124.114 01:12, 16 September 2006 (UTC)

[edit] GA nomination is failed

As a non-specialist about this subject, I've made GA assessment of this article per WP:WIAGA:

1. It is well written.

(a) prose & compelling for a non-specialists:

The diagnosis seems to be a collection of fragmented information about the disease, but it has not been written in a complete story.
Prose is needed to be improved to make a smooth transition between section to section.

(b) logical structure & lead section:

The lead section is already good, but much portion is given on symptoms and causes, but not the treatment. I would suggest the lead section can be a summary about a disease, in the following order: what is the disease with a brief of prognosis -> symptoms -> causes -> treatment.

(d) technical terms:

A little bit annoyance about the infobox. What does it mean? Some unexplained codes?
Please state first what does a new abbreviation mean, before highly use it. I have edited the article to clarify what DSM-IV-TR is. More abbreviations occur in the text, without mentioning the meaning. For example: ICD-10,

2. It is factually accurate and verifiable.

(a) references:

Some unsourced statements about facts are found. I've put [citation is needed] notes to verify these. Please update it with inline citation or remove the whole statement, but not remove the tag only.
One section about Diagnostic issues and Controversies requires rigorous inline citations to support that those are facts rather than just rumours. Unfortunately, the section is completely unsourced. I've put a tag there. Please do not consider it as discouraging.

(b) citation style and inline citations:

I found this statement: "The full ICD-10 diagnostic criteria for anorexia nervosa can be found here, and the DSM-IV-TR criteria can be found here." is not a good way to make a citation, per WP:CITE. Try not to put here words, but a direct point (citation) to the source.

(d) no original research: '

In this statement: "Anorexia nervosa is thought to be a complex condition, involving psychological, neurobiological, physiological and sociological components.", it sounds an opinion. Thought by whom? Please supply source to support this.

3. It is broad in its coverage. In this respect :

(a) all major aspects: passes

(b) stay focus: passes

4. It follows the neutral point of view policy.

(a) no bias: passes

(b) all viewpoints: passes

5. It is stable, no edit wars: passes

6. It contains images, where possible, to illustrate the topic.

(a) properly tagged and with captions: passes

(b) lack of images:

Well if there is images to illustrate about this disease, it would be better, but this is not a requirement for GA.

Conclusion: GA is failed. When the above issues are resolved, this article can be renominated again.

Important note: When I was writing this comment, I looked at the history that someone removed the tag I put in the lead section. In the edit summary (s)he said that Remove {{{fact}}} tag from initial summary. This is referenced later in the article (see Prognosis section). References are not included in the initial summary for ease of reading. This is totally wrong as you are the editor and you know where to find the fact. I'm a reader and I read the lead section first, not to jump directly to a specific section. Next, it's up to the reader whether to continue reading or stop. Please read again WP:LS and there is one statement:

The lead should be capable of standing alone as a concise overview of the article, should be written in a clear and accessible style, should be carefully sourced like the rest of the text, and should encourage the reader to read more.

Multiple citation to the same source is not prohibited and it is even suggested. I am going to put the tag again and please put its reference, not just removing the tag.

— Indon (reply) — 15:02, 20 September 2006 (UTC)

Hi there,

The introduction is a summary of the article. If it was referenced, it would contain all the references from the main article, because it is a summary of those references. This would make it virtually unreadable. It would also be pointless just picking out certain facts to be referenced here.

This style is typically not used in academic work, and does not detract from the quality of the article as this information is fully referenced further down. Requiring a single fact to be referenced in the summary is splitting hairs when it is present in the more detailed discussion below.

- Vaughan 15:10, 20 September 2006 (UTC)

Apologies, it looks like the introduction has changed since I originally wrote it to include references. I'll review the format and make appropriate changes. - Vaughan 15:18, 20 September 2006 (UTC)

Ah, I was just sending my comments. No need to apology. I think this article only needs some wording and reshaping. Try to read the whole article as a reader, a non-specialist one. Cheers and happy editing. ;-) — Indon (reply) — 15:28, 20 September 2006 (UTC)

Thanks for your extensive analysis, Indon. =) Powers ^T 00:38, 22 September 2006 (UTC)

[edit] Why are psychological and emotional symptoms separated?

Hi all, I noticed that under the list of the signs and symptoms of anorexia, the psychological symptoms are separated from the emotional ones. I'm not a medical professional, but shouldn't those be grouped together under one category, and if not, then why not? Just asking. Thanks.--Kyok o 13:52, 28 September 2006 (UTC)

Hi there, it's because these categories are the ones commonly used by mental health professionals and are taken from the references sources. - Vaughan 20:12, 28 September 2006 (UTC)

[edit] Disagreement between Wikipedia pages?

This page says the mortality rate for anorexia is 10%, but the Bulimia page says the anorexia mortality rate is 18%. Can someone resolve this conflict? —The preceding unsigned comment was added by 128.61.136.231 (talk • contribs) .

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