Dr. Randi Fredricks, Ph.D. is a therapist, researcher and author with a Ph.D. in Psychology and a Doctorate in Naturopathy. Dr. Fredricks works
Of all the eating disorders and disordered patterns of eating, none is so closely related to fasting as anorexia nervosa. An estimated 14% of U.S. adults have admitted using fasting as a means to control their weight. An unknown percentage of these people have anorexia, compulsively fasting to drop weight they cannot afford to lose.
Anorexia typically begins in early adolescence, mainly among girls, though the numbers of boys developing this condition is increasing. Between 0.3 and 1% of young women have anorexia nervosa, which makes anorexia as common as autism.
The following are key diagnostic features for anorexia nervosa, guidelines that mental health professionals follow in order to make a formal diagnosis:
1. Self imposed weight loss due to dieting, vomiting, or other means (i.e. fasting) leading to less than 85% of expected weight or a body mass index of less than 17.5.
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2. Abnormal attitudes to food and weight. Preoccupation with the desire to be thinner. Feeling fat even though underweight. In the DSM-5, this criteria was expanded to include not only overtly expressed fear of weight gain but also persistent behavior that interferes with weight gain.
3. Amenorrhea (absence of menstruation) in females, unless taking contraceptives.
The DSM-5 differentiates between two sub-types of anorexia nervosa. The first, restricting type, denotes individuals who lose weight primarily by reducing their overall food intake through dieting, exercising excessively, and/or fasting. The second type, binge-eating/purging type, describes those who regularly binge (consume large amounts of food over short periods of time), and purge through self-induced vomiting, excessive exercise, the abuse of diuretics, laxatives, enemas, and/or fasting. In this context, fasting is defined as voluntary abstinence from food for a discrete period of time.
Anorexia nervosa has one of the highest overall mortality rates and the highest suicide rate of any psychiatric disorder. The risk of death is 3 times higher than in depression, schizophrenia, or alcoholism, and 12 times higher than in the general population. Around 10% of women who have anorexia nervosa die due to anorexia-related causes, mainly from suicide or from complications secondary to starvation after long periods of fasting.
Anorectics use fasting to control their weight. However, what anorectics call fasting eventually turns into starvation once their bodies begin to metabolize essential tissue for fuel and this continues over an extended period of time. This reliance on essential tissue, such as heart tissue, is what determines when starvation is occurring in addition to fasting.
It is significant that the anorectic cannot differentiate fasting from starvation. This is largely to the fact that anorectics almost always suffer from body dysmorphic disorder, meaning that no matter how thin they get, they look at their reflection in the mirror and see themselves as being considerably larger then they really are. Research has shown that body dissatisfaction predicts the use of extreme weight loss behaviors, such as calorie restriction, purging, and excessive fasting.
The anorectic generally engages in starving or restricted eating to the point of becoming malnourished and developing nutrient deficiencies. However, it is important to note that the anorexic often has a religious or spiritual justification for fasting, in addition to weight loss. Because of this, psychologists have suggested that the religious and spiritual beliefs of the anorectic should be thoroughly examined and taken into consideration in the development of a treatment plan.
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