Anorexia nervosa - Fear of Fat

Anorexia nervosa is an eating disorder as classified by DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) and is one of the most dangerous disorders you can be affected by. Often times this disorder is downplayed simply because it affects mostly women and is a psychological disorder, making people believe it to not be as harmful as medical problems like cancer. It is very severe and dangerous because it is directly life threatening. An individual who suffers from this simply refuses to eat, which can lead to malnutrition and eventually death.

The diagnosis of this disorder is directly related to weight. BMI (body mass index) is the main diagnosing sign or symptom for anorexia nervosa and is calculated in weight (kg) and height (cm). The healthy BMI range for adults or adolescents is 18.5 to 24.9 and a BMI below 18.5 is considered anorexic. When it is 25 to 29.9 the individual is considered as overweight. More than 30 and upto 34.9 is obese, while above 35 is extremely obese. In children BMI is given as a percentile and not an absolute number and the percentiles vary for different countries which can use different guidelines. Obesity is not a mental disorder now after revisions in the DSM but it is still a health risk/health hazard.

BMI below 18.5 is considered anorexic and anorexia nervosa is classified into 4 categories based on BMI:
o Mild – BMI is 17 to 18.4 (less than 18.5)
o Moderate – BMI is 16 to 16.99
o Severe – BMI is 15 to 15.99
o Extreme – BMI is less than 15

In this disorder, a person refuses to eat food, but what leads them to such severe limiting of a natural need? Many studies conducted have shown that cultural differences seem to play a major role. This disorder is much like an epidemic in western and industrialized regions with high rates being shown over time. This type of culture which emphasizes or values thinness are more likely to have higher number of individuals diagnosed with anorexia nervosa. Many psychological causes have been identified through counselling sessions of those diagnosed and the main psychological factor seems to be fear. Often anorexia is referred to as the 'fear of fat'. Other related factors are:

1. Intense fear of gaining weight
2. Persistent behaviors that interferes with weight gain (indulge in behaviors that will stop weight gain)
3. Disturbance in self-perceived weight or shape (evaluate themselves – overestimate their shape and weight)

The symptoms based on the 3 factors given above are:
o Restriction of food intake – refusal to eat
o Intense fear of gaining weight
o Disturbance in the way one’s body weight or shape is experienced (negative self-evaluation about body image)
o Lack of recognition of seriousness of the current low body weight

Anorexia nervosa can also be classified into 2 types:
o Restrictive Type – All symptoms above can be considered (specifically restrictive eating).
o Binge-Eating/Purging Type – All symptoms above can be considered. They will eat less, but when they eat, after they will purge it, so digestion doesn’t happen, which is a specific difference from the restrictive type.

In order to diagnose anorexia, their BMI must be below 18.5. They should also exhibit the above symptoms for 3 to 6 months. However, proneness to anorexia can be identified at an earlier stage and prevention techniques can be used to prevent them from being diagnosed.

In current times when keeping ourselves healthy is the best way to survive, eating healthy is an important area that must be focused on. If you feel that some of your eating and thinking habits or those of someone you know are being described in the article above please reach out for help to a therapist.