I'm going to tell you are the four diagnostic criteria that are currently in the diagnostic

manual used by the majority of mental health providers in the United States, and used by

psychiatrists. That's the manual called the DSM-IV. So the diagnostic criteria for Anorexia

nervosa is first a refusal, or maybe a better word is really sort of an inability, to maintain

body weight at a minimally medically appropriate place for one's age and height. The DSM suggests

that that minimal medical criterion be around 85 percent of ideal body weight.

So that's criterion number one, and there's really sort of a relentlessness to a person's

drive to maintain this thin place that is so characteristic or core to anorexia nervosa.

The number two feature is intense fear of gaining weight, even though underweight. Number

three is a disturbance in the way one's body shape or weight is experienced. It could also

be a denial of the seriousness of the underweight condition. "Oh, there's nothing wrong with

this, there's no medical compromise," that type of thing. The fourth cardinal feature

of anorexia nervosa which is currently a diagnostic criterion is that a starvation has gone on

long enough and has become serious enough that the body is starting to shut down, and

how this is manifested in women is by the absence of menstrual cycles.

So if you see, due to underweight, the absence of three or more consecutive menstrual cycles,

that is call amenorrhea and that's currently another diagnostic criterion of anorexia nervosa.

In fact, as professionals, even though this is on the list of diagnostic criteria for

anorexia nervosa, we often see folks that meet all the other feature cores of anorexia

nervosa but don't have the absence of menstrual cycles for whatever reason. Maybe their body

just hasn't quite shut down yet, or maybe they're on birth control pills and they're

still getting their period even though their body is in general in a very starved state.

We also see male patients of anorexia nervosa. While they're the minority of folks suffering

from anorexia nervosa, males do also get this illness, and obviously males can't lose their

menstrual cycle, but there are men out there that meet all these other core criteria of

the illness and we would call those men as having anorexia nervosa. So those are some

of the core features. There are lots of other signs and symptoms that go along with anorexia

nervosa. There can be a lot of medical consequences, and if I haven't emphasized this until now,

anorexia nervosa in particular can get quite severe. It really has a high morbidity and

even mortality rate. It's got among the highest mortality rates of all psychiatric illnesses,

with a mortality rate of five percent per decade of unremitted anorexia nervosa.

People can become quite medically ill and even die from things like cardiac causes and

electrolyte imbalances, as well as from psychological complications of the illness like severe depression

and suicidal urges and tendencies. So, a lot of other things that you can see with anorexia

nervosa. There's a lot of ritual that goes into the eating associated with anorexia nervosa.

People that cut up their food into lots of little bites, strict regimens of calories.

Perhaps you only have five or seven hundred calories a day, or maybe even less. That's

characteristic of this illness. You can also see binge eating and purging behavior going

on in anorexia nervosa as well. So a lot of different things that can be present in this

illness, and it's very complicated to treat. Definitely if someone is struggling with this,

if you're struggling with it, reaching out to an expert in this area, a treatment center

that has experience with anorexia nervosa, is essential for moving through the anorexia

nervosa and into the process of recovery.