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The following is a petition that we have been circulating, which will be sent along with a review of current research, to the American Psychiatric Association, for consideration. We hope that our concerns will not fall on deaf ears.
To the American Psychiatric Association
Anorexia Nervosa has a morbidity rate of nearly 10%- higher than any other mental illness. We believe that changing the diagnostic criteria, as defined by the American Psychological Association in their Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) could lead to earlier intervention, and consequently, better recovery rates for those who are afflicted by the disorder. The current criteria are as follows:
- 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).
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which oneís 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, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g. estrogen, administration).
The diagnosis of anorexia is additionally identified as either Restricting Type or Binge-Eating/Purging Type.
If a person meets some, but not all, of the criteria, they are classified under the large category of Eating Disorder- Not Otherwise Specified (EDNOS).
The practitioner uses the diagnostic criteria to determine which treatment strategies would be most effective for that particular patient. However, we believe that by including physical characteristics such as weight below 85% of that expected, and absence of three or more menstrual cycles, many patients are excluded from a diagnosis of Anorexia Nervosa, regardless of the severity of their actual mental state. As a result, they are often diagnosed as EDNOS.
EDNOS is commonly considered to be a ëless severeí form of either AN or Bulimia Nervosa. As a result, many patients are denied appropriate treatment until they lose more weight and then meet the criteria for AN, or they suffer a medical emergency that requires hospitalization.
It is a well-known fact that the longer a patient suffers with an eating disorder before receiving treatment, the poorer the prognosis for recovery. By requiring that a patient weighs less than 85% of expected weight, this means two people who exhibited the same behaviors, the same amount of weight loss, and the same mental issues could receive differing diagnoses, based on their original ëhealthyí weight. For example, if individual A weighed 120 lbs at the onset of their illness, and person B weighed 250 lbs, and both lost weight at the same rate over the same period of time, person A would receive the diagnosis of AN much sooner than person B. So, by the time person B appears to be ëanorexicí, by these standards, they have already suffered much longer than person A. In addition, due to a lack of in-depth education of general medical professionals, person B is actually likely to be prescribed a DIET plan if they do choose to seek treatment.
Most eating-disordered patients will be seen by general medical practitioners for various problems before ever seeking help from a specialist. However, the great majority of GPs have little knowledge about eating disorders, other than the common belief that people with EDs are often emaciated. Sadly, a great majority of eating disordered patients have been told by their doctor that they donít have an eating disorder because they are ënot thin enoughí, and that they wonít worry about them until they lose more weight. This tends to invalidate the patientís suffering, and it encourages them to lose more weight in order to receive treatment for their illness. And since people with EDs tend to believe that they are never thin enough, a statement like the one above, from a medical professional offers justification for their disordered thinking.
People with EDs tend to be very competitive and perfectionistic. They tend to desire to have control over their habits. It is common for people with EDs to believe that if they are diagnosed as EDNOS, they are not a ëgoodí anorectic. They use their diagnosis as motivation to further their quest for self-destruction, until they can be considered a ërealí anorectic.
Another sad trend is that the general public- particularly young girls- are fascinated with Anorexia. Our society places tremendous emphasis on "thinness" and control over eating habits. If we were to change the definition of Anorexia, and separate its association with the achievement of extremely low body weight, we could potentially help the general population to understand that eating disorders do not always lead to extreme thinness. If it was well-known that only a small percentage of people with EDs actually become the 60-pound anorexic that is so often portrayed in the media, and that the majority suffer for years without achieving the outward thin appearance, perhaps young girls would hesitate before embarking on extreme dieting regimens.
Another problem is that not all of the criteria actually apply to men. Only females menstruate. Also, healthy levels of body fat as well as body mass index for males and females differ. The criteria do not reflect these differences.
There are many common symptoms of prolonged starvation. One of those is amenorrhea. Others are slow heart rate, low body temperature, an lanugo. However, not all of these symptoms are present in every individual, even at very low weights. Since every patientís body reacts to starvation differently, we do not believe that physical criteria are reliable indicators of mental illness.
We firmly believe that the weight requirement and requirement for amenorrhea should be deleted. Instead, they should be changed to reflect the mental aspects of this mental illness. Criteria such as amount of time per day the patient spends thinking about food and weight, and withdrawal from social situations due to increased focus on food and weight are more indicative of a patientís actual mental state.
Please join us in our petition to the American Psychiatric Association, so that eating disorders can be more correctly identified, and treatment programs can be changed to focus on restoring mental health, as opposed to merely adding weight to a patientís physical body.
Sincerely,
The Undersigned
You can sign our petition at http://www.petitiononline.com/dsm01apa
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