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Anorexia Nervosa

What constitutes "anorexia nervosa?"

Anorexia nervosa involves self-imposed starvation to maintain a lower than normal body weight. Anorexia is defined as weighing 85% or less than what is expected for age and height, or having a body mass index (BMI) of 17.5 or less. (Click here to determine your BMI.) In adult women, menstrual periods stop or become irregular, and in men sex hormone levels fall. Young girls who are anorexic may fail to begin menstruation at an age-appropriate time, or their menstruation may be erratic. Those who are anorexic are terrified of becoming fat and see themselves as fat, even when they are dangerously thin. They may even starve themselves to death. Anorexics use various rituals to resist the overwhelming hunger they feel, and they obsess about food and eating. About half of all anorexics periodically lose control and binge; then they compensate by more restricting. Anorexics are always seriously underweight and have a poor body image. Anorexia affects about 1 to 3 million Americans, mostly females in late adolescence or early adulthood. This equates to 0.5 to 2% of the general population.

Is excessive exercise ever a problem with those who are anorexic?

Both anorexics and those with other disordered eating patterns can have a problem with exercising too much. A subset of anorexics engage in excessive exercise as a primary means of losing or maintaining a lower than healthy weight. This variation on anorexia is called exercise anorexia or activity anorexia. About 75% of anorexics engage in harsh and excessive exercise, even in the face of injuries, as a means of purging calories and maintaining a low weight, often stealing time to exercise from work, school, and relationships. Excessive exercise becomes the drug that temporarily blots out painful self-awareness. Generally speaking, exceeding more than about 3500 calories burned in a given week is considered excessive. After that point, the health benefits of exercise decrease and the risk of injury increases.

Like anorexics and other who have disordered eating behavior, "obligatory exercisers" are preoccupied with food and weight, and define many foods as forbidden. Performance of exercise becomes a means of defining self-worth-being able to run longer or faster, swim under challenging conditions, or bicycle long distances-but victory typically is not savored. Rather, they grimly push on to the next challenge. Often the obligatory exerciser has participated in sports or physical activities since childhood.

How is anorexia nervosa treated?

Often those with anorexia avoid treatment because they fear they will have to gain weight. Although they may know at some level of their consciousness that they are very thin, having anorexia can become a part of their self-definition and a source of pride. Others who don't recognize that these people have an eating disorder may actually complement them on looking good! Anorexics refuse emotional nourishment and often deprive themselves of pleasure and satisfaction in love and work. Therapy focuses on changing self-concept and finding other ways of defining the Self so that deprivation is no longer the keystone of the personality.

Dr. Joyce Nash, PhD    (650) 329-1000