During the physical exam, Maxwell looked at his doctor in disbelief. She always thought that eating disorders were only for skinny people. “I laughed,” she said. “I don’t use that kind of language anymore, but I told her she was crazy. I told him, ‘No, I have a problem with self-control.’ »
For centuries, the eating disorder that would become known as anorexia nervosa mystified the medical community, which struggled to understand, or even define, an illness that caused people to deliberately starve themselves. As cases increased during the 19th and 20th centuries, anorexia was considered a purely psychological disorder akin to hysteria. Sir William Withey Gull, an English doctor who coined the term “anorexia nervosa” in the late 1800s, called it a perversion of the ego. In 1919, after an autopsy revealed an atrophied pituitary gland, anorexia was considered an endocrinological disease. This theory was later debunked, and in the mid-twentieth century psychoanalytic explanations emerged pointing to sexual and developmental dysfunction and, later, unhealthy family dynamics. More recently, the medical field has come to believe that anorexia may be the product of a constellation of psychological, social, genetic, neurological, and biological factors.
Since anorexia nervosa became the first eating disorder listed in the Diagnostic and Statistical Manual of Mental Disorders in 1952, its criteria have also changed. Initially, anorexia had no weight criteria and was classified as a psychophysiological disorder. In a 1972 paper, a team led by eminent psychiatrist John Feighner suggested using at least 25% weight loss as the standard for research purposes, and in 1980 the DSM introduced this figure into its definition (with a criterion that patients weigh well below “normal” for their age and height, although normal has not been defined). Doctors who relied on this number quickly discovered that patients who had lost at least 25% of their body weight were already seriously ill, so in 1987 the diagnosis was revised to include those who weighed less than 85% of their body weight. their “normal” body weight. (what was considered normal was left to doctors to decide). In the 2013 DSM, the criteria changed again, characterizing those with anorexia as having “significantly low weight”, a description that will also appear in the 2022 edition.
In this 2013 edition, a new diagnosis emerged – atypical anorexia nervosa – after healthcare providers noticed that more patients were presenting for treatment with all but one of the symptoms of anorexia nervosa: a significantly low weight. Doctors have observed that people with atypical anorexia suffer from the same mental and physical symptoms as people with anorexia nervosa, and even life-threatening heart problems and electrolyte imbalances. They intensely restrict calories; being obsessed with food, diet and body image; and see their weight as inextricably linked to their value. They often skip meals, eat in secret, adhere to complex rules about what foods they allow themselves to eat, and create unusual habits like chewing and spitting up food. Others exercise to exhaustion, abuse laxatives or purge their meals. But unlike those diagnosed with anorexia, people with anorexia atypical can lose significant amounts of weight while remaining average or tall in stature. Others, due to their body’s metabolism, hardly lose any weight. To the outside world, they appear “overweight”.
From the mid-2000s, the number of people seeking treatment for the disease increased sharply. It’s unclear whether more people are developing atypical anorexia or seeking treatment — or whether more doctors are acknowledging it — but this group now includes up to half of all patients hospitalized in eating disorder programs . Studies suggest that the same number of people, or even up to three times more, will develop atypical anorexia than traditional anorexia during their lifetime. A high estimate suggests that up to 4.9% of the female population will suffer from the disease. For boys, the number is lower – one estimate was 1.2%. For men it is probably even lower, although little research exists. For non-binary people, the number jumps to 7.5%.
Overall, the pandemic has exacerbated eating disorders, including typical and atypical anorexia, through increased isolation, heightened anxiety, and disrupted routines. Hospitals and outpatient clinics in the United States and abroad have reported the number of consultations and admissions doubling and tripling during Covid shutdowns, and many providers are still overbooked. “Almost all of my colleagues, we’re at capacity,” says Shira Rosenbluth, an eating disorder therapist who treats clients of different sizes and genders. They see clients who practice more extreme dietary restrictions and experience more intense distress around body image and eating habits. “The demand has gone up, the severity level has gone up,” Rosenbluth says. “We have never seen such waiting lists for treatment centers.”