Issues of Diagnosis

If eating disorders are primarily psychological disorders, why is there so much physical criteria for anorexia? Maybe because if the only criteria were the distorted body image (cognitive), fear of being overweight (emotional), and food restriction (behavioral), pretty much every woman on a diet these days would fall into this category. Certainly not every woman on a diet has anorexia, though. The severity of the food restriction and gravity of body image distortion must be taken into account.

Interestingly enough, anorexia is the only eating disorder that has a weight criteria; 85% or less of "normal expected body weight." This brings up the issue of, "Well, what is a normal weight?" Figure skaters and other athletes tend to be very muscular, and may look much lighter than their actual weight since muscle is very dense. Different height-and-weight charts will tell you different things, and BMI doesn't take into account an individual's frame size. Although this is supposed to be a general criteria, some therapists take it very literally. Which means the loss or gain of a single pound can sometimes mean the difference between a diagnosis of anorexia instead of ED-NOS or bulimia. And what about the individual who starves him or herself and loses a drastic amount of weight, but is still not clinically underweight? Surely this is anorexic behavior. But the person does not have the "anoretic body" (emphasis on the quotes).

Amenhorrea is my next rant. First of all, some long-time anoretics will actually begin to menstruate again once the body becomes "used" to the starvation (this does not mean that they are any healthier, though). Also, not everyone loses their period, even if they reach 75% of their expected weight or below. And yet amenhorrea is often the only criteria used to distinguish between the binge/purge type of anorexia, and the purging type of bulimia nervosa (anorexia takes "precedence" over bulimia in diagnosing an eating disorder). Some therapists do take into consideration a person's total food intake and the reason for a binge when making the diagnosis... for example, a person who binges and purges every single day for emotional reasons as opposed to one who occassionally binges out of legitimate hunger after a long period of starvation.

The issue of diagnosis is far from cut-and-dried. Some people believe that eating disorders overlap so much that we should do away with these individual disorders altogether, and just have one "Eating Disorder." After all, eating disorders are, in essence, just the process of using food (or lack thereof) to cope with feelings. Others point to the fact that there are "pure" cases of anorexia and bulimia, and that these should not be all tossed in together in the same diagnosis. I'm somewhat divided on this issue at the moment.

There is no perfect system of classifying eating disorders, or any other mental disorders for that matter. It's not always easy to "label" a person if they lie somewhere in a gray area between two different disorders. But by trying to find ways to improve the diagnosic criteria, maybe we can make it a little bit easier.