The Broader Context of the Diagnosis of Anorexia Nervosa

The diagnosis of Anorexia Nervosa has morphed in recent years into a broader understanding of the illness. However, some of my posts about anorexia don’t always take these changes into account. I’d like to clarify the transformation of the diagnosis.

Anorexia Nervosa originally reflected only the restrictive disease and specific weight criteria without any compensatory behaviors like purging or over-exercise. Over time the diagnosis included subtypes of other behaviors and, only recently, has eliminated the strict weight element of the diagnosis.

The changes are important in order to include all people with the diagnosis and ensure sufficient treatment for everyone. These changes allow that the psychological manifestations of the illness are the same across the board even if behaviors and weight aren’t the same in each case.

The new criteria also merit conversation about varied treatment for the subtypes.

People with anorexia who also are not B at extremely low weights tend to have a more hopeful course. In addition, those people with compensatory behaviors often need treatment that is behaviorally oriented in order to address the compulsive nature of their eating behaviors. Education around these subtypes of anorexia must focus on being malnourished and the effects on organ function and cognition while encompassing body image into the overall recovery.

The original anorexia diagnosis describes a very specific type of eating disorder. These people only restrict, maintain very low weights, tend to feel overweight even when shockingly emaciated and often experience the eating disorder as a loud, demanding voice in their head which they must obey.

This subtype tends to be very difficult to treat and leads to a high likelihood of limited ability to expand their life and early medical consequences. The cause of this subtype appears to be a specific genetic predisposition to prolonged starvation.

When I wrote about anorexia in the recent past, I have called this subtype of anorexia the only type that exists without explicitly naming it as a subtype. The changes in classification necessitate that I differentiate between the types of anorexia.

In the next posts, I will talk more about the varied subtypes and the ways each type is treated similarly and differently.