The DSM-IV, the diagnostic manual for psychology professionals, defines anorexia nervosa as:
a) Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g. weight loss leading to maintenance of body weight less than 85% of that expected, or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected)
b) Intense fear of gaining weight or becoming fat, even though underweight
c) Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
d) In post-menarchal females, amenorrhoea, i.e. the absence of at least three consecutive menstrual cycles (A woman is considered to have amenorrhoea if her periods occur only following hormone e.g. oestrogen administration)
It further specifies two types of the disease - the restricting type and the binge-eating/purging type.
Restricting: during the current episode of AN, the person has
not regularly engaged in binge-eating or purging
Binge-eating/purging type: during the current episode of AN, the person has
regularly engaged in binge-eating or purging
While these criteria might be of use to medical professionals in terms of recognising the presence of the illness, they only go so far in explaining the nature of the disease and how it affects those who suffer from it.
Low self-esteem is widely recognised as a point of commonality not only amongst anorectics, but among all those afflicted by eating disorders. This diminished sense of self-worth, combined with psychological, emotional, physical and even social issues which the individual finds themselves unable or unwilling to face, can lead to the development of dysfunctional coping mechanisms. Anorexia nervosa is one example of this.
Anorectics avoid facing up to deeper psychological issues by focusing all their attention and energy on weight loss. They obsessively count calories, fat grams, carbohydrates and especially pounds measuring their worth by how low the numbers on the scale are compared to the day before. To many, the pain of hunger is viewed as either a sign of success or a challenge to the power of their will. Compulsive exercise, diet pills, laxatives and even illicit drugs are often used to aid weight loss.
Many anorectics also suffer from distorted body image and view themselves as being fat even when it is obvious to others they are severely underweight. Still others can recognise that they are, quite literally, wasting away but view this as yet another sign of success - as something to be desired. They take pride in prominent collarbones or protruding hip bones often to the point of publicly flaunting them. Some would argue this almost exhibitionist behaviour is a way of asking for help. They hope that someone will see their suffering in their emaciated form.
Statistically, the vast majority of anorectics are female (over 90%) although the incidence of anorexia in males is on the rise. Anorexia is also more prevalent in the middle and upper social classes and almost exclusive to western cultures. That is not to say, however, that ethnic minorities within western societies are not afflicted. On the contrary, in fact, as recent figures demonstrate a rise in the occurrence of anorexia among non-whites in highly industrialised countries.
Anorexia inevitably takes its toll on the body. The medical complications can affect every organ and system in the body causing everything from malnutrition to kidney damage to heart failure and even death. The effects of anorexia are not limited to the physical, however. In fact, the suicide rate among anorectics is higher than in any other mental illness. This is often due to the sense of being trapped with little hope of ever being entirely free of the disease. Those who do recover often report that the anorexic 'voice' never goes away; that they have learned how to live with or, perhaps, in spite of it.