Anorexia (not nervosa)

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lauri195
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#1
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#1
Edit: please note when I say anorexia I am referring to a long-term loss of appetite, not to the body-image condition anorexia nervosa

First personal post, please be gentle

So basically, I have serious anxiety problems (generalised anxiety disorder with phobias and panic disorder, with some obsessive symptoms). For the past six months this has been getting worse up until the point where it now affects my whole life. There are lots of different aspects of my anxiety and I'm taking a few tablets and about to start CBT. One particular thing which has become increasingly serious is anorexia.

I have a huge phobia of being sick. A few months ago I started to fear that I would get food poisoning, and I stopped eating all chicken which I hadn't cooked myself. Since then it has become worse - I don't even trust my own cooking of any food, I don't trust sell-by dates and the like, and if I see a tiny speck in my food I won't eat any more. I can eat breakfast fine first thing in the morning (I get about an hour before the phobias kick in) but after that I can barely eat anything at all, all day. When my boyfriend and my parents try to make me eat I refuse or have a panic attack. I know it's ridiculous, and that's why I'm seeking help.

I have dropped almost two dress sizes because of this (large 14 to 10-12). However, because I was somewhat overweight beforehand and my BMI is still 25, both my doctor and my counsellor are not at all concerned about this loss of appetite. My question is - should they be? Not having an appetite is one of the absolute worst things about all that I go through, and it really winds me up that everyone says 'you're losing weight, you should be pleased!' If I had started as a size 10, I would now be almost a size 6, and doubtless people would be focussing on that.

Shouldn't professionals be concerned about such a dramatic change in appetite, regardless of my original size? Surely there are health concerns associated with not eating other than just whether you're underweight or not (and what are they?) I want to try and nip this particular ridiculous obsession in the bud, but it seems in our society being physically attractive is more desirable than being mentally healthy? Or is it truly better from a health perspective that I have a 'normal' BMI, even if it really is achieved by this extreme means?

If you agree with me, please suggest ways in which I can encourage my doctor and counsellor to take this seriously. If you disagree with me please also let me know. If you've suffered from a serious anxiety disorder I would be really interested to hear from you.

Thanks in advance for your help
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rouxboo
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#2
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#2
To me, it looks like you are over evaluating everything and have trouble with coping with stress. Don't worry you are not the only one as I have lost loads of weight while being stressed. However, you shouldn't neglect all types of food because this can do your body much harm in the long run. I suggest you tell your doctor and counselor that because your condition is harming you and you are worried that you view it as hazardous to your health. A responsible Gp would think the same. You might also want to tell your parents or a trusted confidante and get their opinions as well.

Good luck and stay healthy.
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Ronar
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#3
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#3
'physically attractive is more desirable than being mentally healthy'

Honestly, most people really don't think like this! And you have a boyfriend, I'm sure he likes you as you are

I duno what to say, cuppa soups? Does boiling water not sterilize things I don't know i'm rambling and not helping at all. When you feel stressed relax to some mozart

Nothing is good in extremities either! if your really bothered ask your doctor about a healthy eating thing or something

Ah, i'm so crap at this, good luck anyway :hug:
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AnonyMatt
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#4
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#4
Actually, this would be classified as anorexia nervosa, if you had trouble eating breakfast, and you were underweight.

It is a problem, and you need to work through it. Your condition may worsen and you may actually develop anorexia nervosa.

I don't think you are showing the sympton 'anorexia' though. You started off scared about eating, due to your fear of being sick. It's natural to lose your appetite after prolonged episodes of minimal eating.
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lauri195
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#5
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#5
(Original post by AnonyMatt)
Actually, this would be classified as anorexia nervosa, if you had trouble eating breakfast, and you were underweight.

It is a problem, and you need to work through it. Your condition may worsen and you may actually develop anorexia nervosa.

I don't think you are showing the sympton 'anorexia' though. You started off scared about eating, due to your fear of being sick. It's natural to lose your appetite after prolonged episodes of minimal eating.
I am curious because your definitions are the opposite of those I understand.

To the best of my knowledge, anorexia just describes a loss of appetite - regardless of cause. The fear of eating went hand in hand with loss of appetite, I have never denied myself food when I was hungry. I just don't get hungry any more.

Anorexia nervosa, on the other hand (as classified by the DSM) has to by definition involve body image or a fear of gaining weight, and I don't have body image problems.
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missaphrodite
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#6
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#6
(Original post by lauri195)
First personal post, please be gentle

So basically, I have serious anxiety problems (generalised anxiety disorder with phobias and panic disorder, with some obsessive symptoms). For the past six months this has been getting worse up until the point where it now affects my whole life. There are lots of different aspects of my anxiety and I'm taking a few tablets and about to start CBT. One particular thing which has become increasingly serious is anorexia.

I have a huge phobia of being sick. A few months ago I started to fear that I would get food poisoning, and I stopped eating all chicken which I hadn't cooked myself. Since then it has become worse - I don't even trust my own cooking of any food, I don't trust sell-by dates and the like, and if I see a tiny speck in my food I won't eat any more. I can eat breakfast fine first thing in the morning (I get about an hour before the phobias kick in) but after that I can barely eat anything at all, all day. When my boyfriend and my parents try to make me eat I refuse or have a panic attack. I know it's ridiculous, and that's why I'm seeking help.

I have dropped almost two dress sizes because of this (large 14 to 10-12). However, because I was somewhat overweight beforehand and my BMI is still 25, both my doctor and my counsellor are not at all concerned about this loss of appetite. My question is - should they be? Not having an appetite is one of the absolute worst things about all that I go through, and it really winds me up that everyone says 'you're losing weight, you should be pleased!' If I had started as a size 10, I would now be almost a size 6, and doubtless people would be focussing on that.

Shouldn't professionals be concerned about such a dramatic change in appetite, regardless of my original size? Surely there are health concerns associated with not eating other than just whether you're underweight or not (and what are they?) I want to try and nip this particular ridiculous obsession in the bud, but it seems in our society being physically attractive is more desirable than being mentally healthy? Or is it truly better from a health perspective that I have a 'normal' BMI, even if it really is achieved by this extreme means?

If you agree with me, please suggest ways in which I can encourage my doctor and counsellor to take this seriously. If you disagree with me please also let me know. If you've suffered from a serious anxiety disorder I would be really interested to hear from you.

Thanks in advance for your help

Hm well, this doesn't sound like anorexia to me.
Whilst I have been through a period where I was very narrowly avoiding an eating disorder, I have also had anxiety and panic attacks related to a fear of being sick that led me to stop eating, but this was not due to the anorexia. Anorexia is a lot more about body image, and if you're not happy about losing weight, you certainly don't have the typical anorexic mindset- you're just losing weight because you're not eating and you're scared of being sick.
I was really suprised to hear about you actually, a fellow emetophobic I was in exactly the same position as you back when I was 14-15, am on tablets and have just today stopped seeing my psychologist for CBT, so you're welcome to message me with any questions or just generally talk, I know how you're feeling pretty much x
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lauri195
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#7
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#7
(Original post by missaphrodite)
Hm well, this doesn't sound like anorexia to me.
Whilst I have been through a period where I was very narrowly avoiding an eating disorder, I have also had anxiety and panic attacks related to a fear of being sick that led me to stop eating, but this was not due to the anorexia. Anorexia is a lot more about body image, and if you're not happy about losing weight, you certainly don't have the typical anorexic mindset- you're just losing weight because you're not eating and you're scared of being sick.
I was really suprised to hear about you actually, a fellow emetophobic I was in exactly the same position as you back when I was 14-15, am on tablets and have just today stopped seeing my psychologist for CBT, so you're welcome to message me with any questions or just generally talk, I know how you're feeling pretty much x
That's why I called the post 'anorexia (not nervosa)' - I know I don't have the condition anorexia nervosa. I do definitely have the symptom anorexia (loss of appetite).

What tablets are you on? Do you feel the CBT has helped you? Did anything trigger your phobia? Do you have any other anxiety problems too (and do you panic about being sick in public places)? Lots of questions
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missaphrodite
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#8
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#8
(Original post by lauri195)
That's why I called the post 'anorexia (not nervosa)' - I know I don't have the condition anorexia nervosa. I do definitely have the symptom anorexia (loss of appetite).

What tablets are you on? Do you feel the CBT has helped you? Did anything trigger your phobia? Do you have any other anxiety problems too (and do you panic about being sick in public places)? Lots of questions
Haha, that's okay.
I think back when I started panicking though, I lost my appetite because I constantly felt nauseous because I was so uptight and anxious, and it got to the stage where I refused to sit down and eat a meal because I felt trapped and thought I wouldn't be able to manage it all and I'd throw up (lol) so I began so survive on snacks. I think your stomach gradually begins to shrink and you get used to eating less, so it's natural that you lose your appetite- what I'm saying is, I don't think it's to do with your mental health.

I'm on Sertraline (anti depressants) which were prescribed for anxiety, which I always found a bit weird. Hoping to cut down on them soon. I started off on Prozac, but that made me feel extremely nauseous and really didn't help at all.
CBT has most definitely helped me- it changed my life I've been so inspired that I want to become a psychologist myself. I very rarely have panic attacks and if I do have them, 9 times out of 10 I can control them. And I've gone from being agoraphobic to being able to take a coach down to London so yes I would very much recommend it.
Yes I think my problems started from a fear of being sick in public, which I think is basically fear of embarrassment, fear of being disliked if you break it down. I don't know why I have such a phobia of being sick, it's actually ridiculous the lengths that I will go to try and stop myself, haha. (However I will say that recently I was actually sick through illness and it WASN'T that bad, it was horrible for a while when it was fresh in my mind, but even though it was in front of my boyfriend, it wasn't the nightmare I was expecting )

I've got to go now, but feel free to message me and maybe at a later point add me on msn, I'd love to talk to you.
Oh I do love telling my life story openly on TSR! :p:
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AnonyMatt
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#9
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#9
(Original post by lauri195)
I am curious because your definitions are the opposite of those I understand.

To the best of my knowledge, anorexia just describes a loss of appetite - regardless of cause. The fear of eating went hand in hand with loss of appetite, I have never denied myself food when I was hungry. I just don't get hungry any more.

Anorexia nervosa, on the other hand (as classified by the DSM) has to by definition involve body image or a fear of gaining weight, and I don't have body image problems.
You don't need to have problems with body image or gaining weight to be diagnosed with anorexia, it's just a typical observation.

You have an irrational fear of eating.

I didn't say you had anorexia nervosa, but the symptoms you think are just the symptom of anorexia, are actually symptons of anorexia nervosa.

Your 'anorexia' comes from your lack of eating. It happens to everyone.

For what it's worth, I don't agree with the DSM. I think that body image problems and a fear of gaining weight should be part of the diagnostic criteria. I think 'refusal to gain or maintain a certain weight' is part of the criteria, but 'refusal to eat' comes under this (when it shouldn't). There are some people diagnosed with anorexia nervosa that would like to gain weight and be healthy, but they've got food phobias that aren't related to weight. There's a documentary about a boy with 'anorexia nervosa', which I was really keen to watch because they're rare and I'm interested, but he had a fear of eating after 6pm because he thought he would choke in his sleep. I was disappointed!
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lauri195
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#10
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#10
(Original post by missaphrodite)
Haha, that's okay.
I think back when I started panicking though, I lost my appetite because I constantly felt nauseous because I was so uptight and anxious, and it got to the stage where I refused to sit down and eat a meal because I felt trapped and thought I wouldn't be able to manage it all and I'd throw up (lol) so I began so survive on snacks. I think your stomach gradually begins to shrink and you get used to eating less, so it's natural that you lose your appetite- what I'm saying is, I don't think it's to do with your mental health.

I'm on Sertraline (anti depressants) which were prescribed for anxiety, which I always found a bit weird. Hoping to cut down on them soon. I started off on Prozac, but that made me feel extremely nauseous and really didn't help at all.
CBT has most definitely helped me- it changed my life I've been so inspired that I want to become a psychologist myself. I very rarely have panic attacks and if I do have them, 9 times out of 10 I can control them. And I've gone from being agoraphobic to being able to take a coach down to London so yes I would very much recommend it.
Yes I think my problems started from a fear of being sick in public, which I think is basically fear of embarrassment, fear of being disliked if you break it down. I don't know why I have such a phobia of being sick, it's actually ridiculous the lengths that I will go to try and stop myself, haha. (However I will say that recently I was actually sick through illness and it WASN'T that bad, it was horrible for a while when it was fresh in my mind, but even though it was in front of my boyfriend, it wasn't the nightmare I was expecting )

I've got to go now, but feel free to message me and maybe at a later point add me on msn, I'd love to talk to you.
Oh I do love telling my life story openly on TSR! :p:
Thank you, that post is very helpful, we seem to have a lot in common . My doctor tried to prescribe me Sertraline (good for obsessive symptoms apparently) but I told him I was not taking anything where possible side effects were nausea or vomiting, so he gave me a prescription for Citalopram instead as I've taken them before with no nausea, he said that should work as well, but I'm not sure when I'm going to start taking it. Can't wait to start CBT then!, though it looks like I will have to wait until September as I am going home for the summer . Oh well, I know I can get by day-by-day on diazepam and metoclopramide, but I hate treating the symptoms and not the cause. My doctor recommended a good self-help CBT-based anxiety workbook (which you go through and complete yourself) in the meantime so I will have that as summer reading and see how it goes.

I will message you in the morning, would be good to chat
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missaphrodite
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#11
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#11
(Original post by lauri195)
Thank you, that post is very helpful, we seem to have a lot in common . My doctor tried to prescribe me Sertraline (good for obsessive symptoms apparently) but I told him I was not taking anything where possible side effects were nausea or vomiting, so he gave me a prescription for Citalopram instead as I've taken them before with no nausea, he said that should work as well, but I'm not sure when I'm going to start taking it. Can't wait to start CBT then!, though it looks like I will have to wait until September as I am going home for the summer . Oh well, I know I can get by day-by-day on diazepam and metoclopramide, but I hate treating the symptoms and not the cause. My doctor recommended a good self-help CBT-based anxiety workbook (which you go through and complete yourself) in the meantime so I will have that as summer reading and see how it goes.

I will message you in the morning, would be good to chat
Ahhh wish I had some diazepam! Haha, it's good when you're desperate anyway, but from my studies in psychology if nothing else, I know it's only a short term solution and you have to be careful not to get hooked on them, because that's no life. I know those are the possible side effects of Sertaline, but I promise you I have had no problems whatsoever on them, and I felt sick on Prozac but was not physically sick. I think at the end of the day a CBT programme at the same time as taking some tablets is really the most effective way of managing your anxiety, so have a think about being prescribed by a psychiatrist at least. What's the worst that can happen? Yeah, you could throw up, and I know that seems like the worst thing in the world, but actually maybe that would help you- and even if it didn't, it would soon be over and you'd know the tablets weren't right for you. Well anyway, something to consider :p:
I like the sound of the workbook, I also found at the start keeping an anxiety/panic attack diary really helped me, in which you write down the situation, your thoughts, feelings and actions and rate your anxiety on a scale of 1-10, maybe you could try that?
Hope to hear from you soon and all the best x
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generalebriety
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#12
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#12
(Original post by schoolstudent)
Well...personally, my diagnosis would be "wall of text" disorder.

Owing to lack of awareness of the condition, and the limited opportunities to see the symptoms, this problem is something which can go unnoticed in an individual for many years.

When expressing him/herself in written english, the sufferer will shock the reader with what has become known as a "wall of text": a large, concentrated block of writing. On examination, it is normally found that the "wall" is composed mainly of unnecessary comments and questions, and badly phrased, drawn out sentences.
Gosh. Attempted humour.

2/10.
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belis
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#13
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#13
(Original post by lauri195)
[B]
Shouldn't professionals be concerned about such a dramatic change in appetite, regardless of my original size? Surely there are health concerns associated with not eating other than just whether you're underweight or not (and what are they?) I want to try and nip this particular ridiculous obsession in the bud, but it seems in our society being physically attractive is more desirable than being mentally healthy? Or is it truly better from a health perspective that I have a 'normal' BMI, even if it really is achieved by this extreme means?

If you agree with me, please suggest ways in which I can encourage my doctor and counsellor to take this seriously. If you disagree with me please also let me know. If you've suffered from a serious anxiety disorder I would be really interested to hear from you.

Thanks in advance for your help
What do you expect the professionals to do? I understand that you are about to start a course of CBT. As all your eating problems appear to be directly related to your anxiaty and phobias then I don't think it is unreasonable to expect an improvement when those issues are addressed through CBT. In the meantime as you are still very much within what is considrered to be a healthy weight it is not suprising that your doctor is not taking any drastic actions.

There are obviously health concerns associated with not eating such vitamins and minerals deficiencies. However you can help yourself. If you can eat breakfast just fine than make sure that it is a very nutricious and well balanced meal. Have at least 2 portions of fruit at the time and some whole grains and proteins.

If there are foods that feel safe to you try eating those during the day. Try experimenting with single foods at first rather then combinations. Have one thing that appears clean and unthreatening rather then many ingridients all at once. Discourage people from trying to force you to eat as this only fueals the circle of anxiaty. Have you got problems with drinking? If not than juicies, smoothies and milkshakes could sustain you quite well through the day and give you extra vitamins and calcium.

When are you about to start CBT? Let them know that phobias relating to food are a major issue at the moment so that they can focus on those first thing.
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Sephaeii
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#14
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#14
(Original post by AnonyMatt)
You don't need to have problems with body image or gaining weight to be diagnosed with anorexia, it's just a typical observation.
Actually, you do, (assuming you're referring to anorexia nervosa). In order to be diagnosed as 'anorexic' a patient must fulfil three conditions; a refusal to maintain a healthy weight due to an intense fear of being fat, a BMI of under 17.5, and the loss of periods for 3 consecutive months (if a female).

Unless a person has all of those, they would not be classed as anorexic.
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Nambi
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#15
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#15
Sounds like OCD to me
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AnonyMatt
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#16
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#16
(Original post by Sephaeii)
Actually, you do, (assuming you're referring to anorexia nervosa). In order to be diagnosed as 'anorexic' a patient must fulfil three conditions; a refusal to maintain a healthy weight due to an intense fear of being fat, a BMI of under 17.5, and the loss of periods for 3 consecutive months (if a female).

Unless a person has all of those, they would not be classed as anorexic.
I was sure that the 'refusal to maintain a healthy weight' did not have to be due to a fear of being/getting fat.

But whatever it is, it's irrelevant. The OP clearly has a problem, which isn't anorexia nervosa, but still needs to be sorted, preferably by professionals. Go, OP, go!
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Magic Dust
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#17
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#17
If you are really worried, you should keep a food diary for a week or two and take it to your GP and show them, that might make them see
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xbutterfly
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#18
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#18
Hi
I can relate to you on your fear of being sick and also to a great extent on anxiety.

I've been absolutely terrified of being sick since I was about 9 after an unsettling school move (long, boring story). After that, I started having panic attacks, fearing that I would be unwell. The anxiety made me feel ill, I'd always have stomach pains which would make me panic even more Understandably, the "new me" lost a few friends! At that age I couldn't really explain it to them in a way that they'd understand or tolerate. If someone around me had been ill, I'd avoid them for a couple of days as I was frightened I'd catch it.

I must admit, sometimes I still do that ;D Although now, I can reason that a lot of my friends may have been sick for different reasons such as consuming too much alcohol (which is something they probably wouldn't have done when they were nine! )

I'd also obsess over food! I was forever checking the use-by dates on everything.
I'd be wary when eating chicken and ask my mum about any pink parts as I worried about food poisoning. That was very awkward when someone else was cooking as I didn't want to be rude or offensive by being picky about their food. I have never eaten something I've cooked which made Home-ec quite tough (I ended up dropping that anyway). I find that odd as surely I should trust my own cooking more than somebody elses. I guess that shows what little confidence I have in myself

Anyway, over time I have improved somewhat. In fact, I rarely look at use-by dates. At least, I remember looking at them once and don't feel the need to obsessively check each time. I used to react badly as soon as someone said something like "I feel sick" but I guess I almost became desensitised to that in a way as in school, people seem to say they feel sick all the time and nothing happens (usually!) :rolleyes:

I've never even considered any medication although it's been suggested a couple of times. The side-effects put me off, no matter how unlikely they are. I rarely take any ordinary medicines like painkillers and I can't swallow pills =(

I'm relieved to find two other people here who can understand to an extent I clicked on this thread expecting something totally different and then I suddenly started nodding at everything I'm glad you posted! I wish you all the best with CBT and everything else :]

OP, if your loss of appetite is concerning you, I would ask them about it. When I had difficulties eating for a short while a few years back, they focused entirely on that itself which honestly, I did not find helpful as I needed help with what was causing my loss of appetite: the anxiety.
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la fille danse
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#19
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#19
(Original post by AnonyMatt)
You don't need to have problems with body image or gaining weight to be diagnosed with anorexia, it's just a typical observation.

You have an irrational fear of eating.

I didn't say you had anorexia nervosa, but the symptoms you think are just the symptom of anorexia, are actually symptons of anorexia nervosa.

Your 'anorexia' comes from your lack of eating. It happens to everyone.

For what it's worth, I don't agree with the DSM. I think that body image problems and a fear of gaining weight should be part of the diagnostic criteria. I think 'refusal to gain or maintain a certain weight' is part of the criteria, but 'refusal to eat' comes under this (when it shouldn't). There are some people diagnosed with anorexia nervosa that would like to gain weight and be healthy, but they've got food phobias that aren't related to weight. There's a documentary about a boy with 'anorexia nervosa', which I was really keen to watch because they're rare and I'm interested, but he had a fear of eating after 6pm because he thought he would choke in his sleep. I was disappointed!

To be diagnosed as having anorexia nervosa, according to the DSM-IV-TR, a person must display:
  1. 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).
  2. Intense fear of gaining weight or becoming obese
  3. 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.
  1. The absence of at least three consecutive menstrual cycles (amenorrhea) in women who have had their first menstrual period but have not yet gone through menopause (postmenarcheal, premenopausal females).


To our knowledge, the OP doesn't meet any of the diagnostic criteria...
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InnocentEyes
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#20
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#20
technically speaking, there is such a thing as 'atypical anorexia nervosa' which can occur in patients who don't display body image distortion, particularly if they are phobic about vomiting or food poisoning etc.
but really diagnosing you is not the point here - I think your GP should definitely be concerned whatever your bmi is because if these problems aren't resolved you are going to continue to lose weight and will end up in an unhealthy bmi category.

negatives consequences of eating very little? vitamin/mineral deficiencies can be very serious, and your energy levels are also likely to suffer. in terms of cognitive function, there's a serious risk that you COULD develop the body image issues associated with 'typical' anorexia nervosa, due to starvation affecting your perceptions. google the 'Keys study' on the effects of starvation on the brain/body if you want to know more.

for the moment, it sounds like you need therapy to address the anxiety and lessen your phobias so you can work up to eating a reasonable amount. have you tried supplement drinks or very calorie dense foods to get your requirements in despite lack of appetite?
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