Imagine a 20-year-old woman who refuses to eat anything except carrots and toast because she is afraid of gaining weight, even though she is 5-foot-8 and weighs only 99 pounds. She exercises to the point of exhaustion five mornings a week because, though she is bone-thin, she thinks her thighs are too flabby. Her periods are irregular, but she has never gone more than three months without menstruating.My court-appointed psychologist thinks that I have a "vegetable of the month" disorder. I don't see it listed in the manuals anywhere.
Another woman, who is also 20 and also 5-foot-8, has an opposite eating pattern. She goes without eating all day, and starting at 6 p.m. she eats nonstop, whatever she can get her hands on. Her favorite pastime is to sit in front of the television with a gallon of mocha-chip ice cream. She maintains a normal weight of 130 by occasionally forcing herself to vomit. But purging is not always easy in her college dormitory, with four young women sharing a single bathroom, so she ends up vomiting, on average, about once a week.
Everyone can agree that these women have some sort of disordered eating.
But psychiatrists would say that neither one falls into the strict definition of anorexia nervosa, the most severe eating disorder, or its relative, bulimia nervosa. According to the bible of psychiatric diagnosis, the American Psychiatric Association's Diagnostic and Statistical Manual, anorexia must be accompanied by cessation of menstrual periods for at least three months in a row, and bulimia must involve vomiting or other forms of purging at least two times a week, on average.
Instead these women, and thousands like them, would fall into a category that doctors have been relying on for years, a vague nondiagnosis known by the acronym Ednos: eating disorder not otherwise specified.
Wednesday, December 01, 2004
Defining eating disorders
This NY Times article describes how wacky psychologists struggle with definitions of eating disorders: