Dieting Disorders in Depth

Body Image

A person's body image is their perception of their physical appearance. It is more than what a person thinks they will see in a mirror, but is inextricably tied to their self-esteem and acceptance by peers. A person with a poor body image will perceive their own body as being unattractive or even repulsive to others.

While a person with good body image, or positive "body acceptance," will either see themselves as attractive to others, or will at least accept it as is. Body image is most strongly affected during puberty, and is influenced by peers, parents, teachers and mentors, and commercial advertising (i.e. Barbie dolls).

In the United States, poor body image is widespread, especially (but not exclusively) among women, and often leads to a variety of eating disorders, including anorexia nervosa, bulimia, and binge eating disorder. Other possible effects of the cultural obsession with looking thin may include binge exercising, fad diets, and multiple cases of suing fast food chains.

Body dysmorphic disorders cover a range of personality disorders where a person is dissatisfied with one's own body. When a person is dissatisfied with their own body, they often resort to drastic measures to alter it and, most often, this takes the form of eating disorders or cosmetic surgery. At this site, we are going to discuss the most common forms of eating disorders, in particular, Anorexia Nervosa, Bulima and Binge Eating Disorder.

Anorectics

Anorectics, anorexigenics or appetite suppressants, are substances which reduce the desire to eat ("anorectic," from the Greek an = "not" and oreg = "extend, reach").

Used on a short term basis clinically to treat obesity, some appetite suppressants are also available over the counter. Drugs of this class are frequently stimulants of the phenethylamine family, related to amphetamine (speed). Indeed, amphetamine itself was sold commercially as an appetite suppressant until it was outlawed in most parts of the world in the late 1950s due to increasing exploitation of its stimulant properties ("abuse"). Many amphetamines produce side effects including addiction, tachycardia and hypertension, making prolonged unsupervised use dangerous.

Epidemics of fatal pulmonary hypertension and heart valve damage associated with anorectic agents have led to the withdrawal of products from the market. This was the case with aminorex in the 1960s, and again in the 1990s with fenfluramine (see: Fen-phen). Likewise, association of the related appetite suppressant phenylpropanolamine with hemorrhagic stroke led the FDA to request its withdrawal from the market in the United States in 2000, and similar concerns regarding ephedrine resulted in an FDA ban on its inclusion in dietary supplements, in 2004.

In spite of these precedents, numerous related compounds are still marketed today as appetite suppressants. These include phentermine (Fastin®, Adipex®, Ionamin® and others), diethylpropion (Tenuate®), phendimetrazine (Prelu-2®), benzphetamine (Didrex®) and others. Sibutramine (Medaria®, Reductil®) is a recent addition, which is used with orlistat by doctors to control obesity. The new cannabinoid receptor antagonist Rimonabant (Acomplia®) will be available in 2006.

Anorexia Nervosa 

Anorexia nervosa (commonly shortened to anorexia) is an eating disorder characterised by voluntary starvation and exercise stress. Anorexia nervosa is a complex disease, involving psychological, sociological and physiological components. A person who is suffering from anorexia is known as an anorectic (although the spellings anorexic and anoretic also exist).

Anorexia also refers to loss of appetite, usually considered as a medical symptom.

Clinical definition of Anorexia

The following is considered the "textbook" definition of anorexia nervosa to assist doctors in making a clinical diagnosis. It is in no way representative of what a sufferer feels or experiences in living with the illness. It is important to note that an individual can still suffer from anorexia even if one of the below signs is not present. In other words, it is dangerous to read the diagnostic criteria and think either oneself or others must not be anorectic because one or more of the symptoms listed are not present.

• Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).

• Maintaining excessive physical activity.

• Intense fear of gaining weight or becoming fat, even though underweight.

• Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

• In postmenarcheal females (women who have not yet gone through menopause), amenorrhea (the absence of at least three consecutive menstrual cycles).

Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Click here to learn more about Anorexia Nervosa.