By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER CAN’T SELF-DIAGNOSE ANOREXIA, NEEDS TO SEE DOCTOR

Question: I have begun to wonder if I have anorexia. I am just not interested in food. Many people think I am too thin, but I think I am just about the right size. I don’t throw up after I eat. How would I know if I have anorexia?

Answer: Anorexia nervosa is an eating disorder that is also a psychological problem. People with anorexia are overly obsessed with losing weight and dieting. It can lead to starvation and death. People who need to be thin for their profession, like dancers and models, are at greater risk for developing anorexia nervosa. Most people with anorexia are female, and it usually begins in adolescence but can even start in childhood. It is also more common in upper and middle socioeconomic classes. About 10 percent of all adolescent girls have this problem.

The cause is not known, but that doesn’t keep us doct ors from speculating and developing many theories to try to explain this complex disorder. Most of the current theories revolve around self-image problems and family dysfunction. Researchers are trying to determine if there’s a genetic component to anorexia and if it might be due to a chemical imbalance in the brain.

Your question seems quite straightforward. You are simply asking how the disorder is diagnosed. Unfortunately, the answer is more convoluted than your question because the diagnosis is not simple.

First off, it’s almost impossible to self-diagnose anorexia. This is because one of the hallmarks of this disorder is a distorted body image. You may think you are overweight or “just right” but an objective observer may correctly see you as extremely thin and emaciated. Though your friends and relatives have noticed your thinness, this is not true in many cases. This is because many people try to hide their thinness with bulky clothing or pretending to eat. Often girls and young women with anorexia are not diagnosed until they become medically ill with a complication from excessive weight loss.

According to the American Psychiatric Association, the four basic criteria for diagnosis are:

• Refusal to maintain body weight at or above 85 percent of normal weight for age and height;
• Intense fear of gaining weight or becoming fat, even when underweight;
• Self-perception that is grossly distorted and weight loss that is not acknowledged; and
• For women who have started their menstrual cycle, missing as least three consecutive periods or only having periods after being given hormones.

Some people with anorexia also vomit after eating and use laxatives, but this doesn’t happen in all cases. Other symptoms of anorexia are depression, irritability, fatigue, lack of concentration, food obsession and perfectionism. Advanced anorexia leads to starvation, which can cause life-threatening heart problems, stomach problems, osteoporosis, electrolyte imbalances and anemia.

Your level of self-awareness in asking this question is to be commended. Since you have these concerns, I urge you to see your primary care physician as soon as possible and honestly discuss them with him or her.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.