Handbook of Eating Disorders: Physiology, Psychology, and Treatment of Obesity, Anorexia, and Bulimia

By Kelly D. Brownell; John P. Foreyt | Go to book overview

14
Anorexia Nervosa :
Diagnostic
Conceptualizations

Paul E. Garfinkel

Allan S. Kaplan


Introduction

Anorexia nervosa is an increasingly common and complex disorder; it is characterized by an all-consuming pursuit of thinness8 that overrides the patient's physical and psychological well-being. The person begins to diet ostensibly to alter her weight, but this desire is often a screen that masks a pervasive sense of helplessness.8 Pursuing a thin body becomes an isolated area of control in a world in which the individual feels ineffective; the dieting provides an artificially dangerous sense of mastery and control. As the weight loss progresses, a starvation state ensues, which eventually develops a life of its own, leading to the features of anorexia nervosa.

Diagnostic thinking about the illness has passed through several phases (see chapter 12). It has been considered entirely somatic and entirely psychological. It was first described by Gull36 and Lasegue48 as a psychological disorder with physical manifestations. For the first quarter of this century, conceptualization of anorexia nervosa was greatly influenced by Simmonds'67 description of pituitary insufficiency. More recently there has been a clearer distinction made between the biological and psychological nature of the illness. This chapter will review changes in the diagnostic understanding of anorexia nervosa.

____________________
The authors are grateful to Velma Varey for her valuable assistance in the preparation of the manuscript. Our work was supported by grants from the Ontario Mental Health Foundation and the Medical Research Council of Canada.

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