Rethinking the Classification of Anorexia Nervosa

In the last post I mentioned how social media has increased communication and awareness about eating disorders and has led to new ideas about adjunctive diagnoses and treatment. The broader knowledge has also led people to seek help earlier and had a significant impact on the classification of eating disorders, Anorexia Nervosa specifically.

Years ago, I wrote a series of posts about the difference between acute and chronic Anorexia. At the time, those posts reflected the awareness and stigma about eating disorders, both of which limited early diagnosis and treatment.

Overall knowledge about eating disorders is much more broad now, especially for the younger generation. In addition, this generation is very focused on mental health with much decreased stigma about seeking diagnosis and treatment.

Accordingly, people with eating disorders look for treatment much earlier, often before they meet criteria for a full-fledged disorder. Anorexia in particular is much more easily treated before the eating disorder thoughts blend with a person’s own thoughts and before the behaviors become central to one’s well-being.

People so early in their illness almost never sought diagnosis and treatment so early in the past. As expected, the patients who get help earlier often recover quickly and fully.

In my mind the phenomenon of earlier diagnosis of Anorexia diagnosis points to a new way of classifying this illness into three stages.

Early stage Anorexia Nervosa can denote patients with symptoms for less than two years and whose eating disorder thought processes are not as entrenched. Immediate and intensive treatment can lead to a faster and long-lasting cure.

Middle stage Anorexia Nervosa identifies people with at least two years of illness and much more defined psychological identification with Anorexia. Disentangling eating disorder thoughts and actions is much more complicated and likely needs more time for treatment and recovery.

Late stage Anorexia Nervosa is a small subset of people with minimal or no change over many years of treatment and no interest in recovery. Management of the disorder keeps medical symptoms stable and helps people function as well as possible.

The middle group is still the largest percentage of people and can itself be broken up into several stages. The first group is the newest and represents the most significant change that arises from the increased communication about eating disorders in social media.