Talk:Anorexia nervosa/Archive 3

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Archive 2

Archive 3

Archive 4

Statistics?

Are there absolutely NO statistics about how many cases by country and over time? CDC? US gov statisticians? Hans Rosling? -- Michael Janich (talk) 02:10, 5 June 2009 (UTC)

Prposed external link: Archive of Resitance - Anti-Anorexia/Anti-Bulimia

Hi all, I'd like to propose we add the following link to the 'External links' section: Archive of Resitance - Anti-Anorexia/Anti-Bulimia. While the website design is a little basic, the Archive has existed for more than 20 years, and has been referenced in many professional publications, including peer-reviewed journals. It contains resources for and by people dealing with anorexia, as well as professionals in the field. Material posted on the site is edited / vetted, so it's not a site for 'anything goes'. The founder of the archive, David Epston, is highly regarded in the field, and has pioneered non-pathologising therapeutic approaches to dealing with anorexia and bulimia. I will also try to reference his work in the main entry at a later date. Annarean7 (talk) 12:09, 5 May 2008 (UTC)

picture was tasteless, removed —Preceding unsigned comment added by 121.44.128.94 (talk) 18:20, 4 February 2009 (UTC)

History of Anorexia in U.S.

When was anorexia introduced to the U.S.? —Preceding unsigned comment added by 204.156.113.111 (talk) 20:46, 11 May 2008 (UTC)

Anorexia nervosa and sport

In my opionion, bodybuilding is a treatment for Anorexia nervosa. Light bodybuilding with 3 kg weights and small situps produces a nice hunger feeling. Even if you hate all kind of food, you will get stimulate to eat.

I have googled to find medical papers to support this thesis, but i didn't found anything. So my questions:

  1. Is my thesis right? 
  2. Are scientific papers availible to support this thesis? 

--80.78.168.2 (talk) 08:33, 6 October 2008 (UTC)

Excessive exercise is one of the very common methods anorexics (and those with other eating disorders) use to lose and keep off weight, and this definitely includes body building. Link to supporting abstract. So I do not think you will find much support for your thesis. --Danae00 (talk) 20:03, 13 July 2009 (UTC)

Calling Bodybuilding A treatment is probably a tad extreme. At the time of treatment patients are usually too weak and life-threatened for physical exercise to be a good idea. But to include bodybuilding in a long term plan may be a good idea, not least because metabolism with these patients have become permanently unstable leaning towards the low end and that means weight gain can become a problem in itself. However, few facilities work with long term treatment that goes beyond the point of having achieved normal weight - in part because treatment is mostly payed by the patients themselves, and where the state is involved costs are kept as low as possible.

A variant of anorexia is anorexia athletica, includes compulsive exercise (which can include weightlifting) so no, unfortunately I don't think weight lifting is a treatment. Anorexia is not caused by not feeling hungry, the hunger stimulated by exercise will be resisted by the anorexic and provides them with the satisfaction of resisting and exercising their will and control. I used to be anorexic, and it was for me about controlling aspects of my life such as food intake etc. It is a mental illness, not a physical one.

Possible vandalism?

Under the section "interpersonal and social", is inserted the line "Viva la Nation". I can't imagine why that means anything where it is, so... I wanted to leave it so that the guru's can decide if it's a repeat offender, et c. I just thought I'd bring some attention to it. Of course, if that means something to anorexia nervosa specialists, then perhaps we could include a short explanation... Gaedheal (talk) 22:33, 4 December 2008 (UTC)

Possible Pro-Ana Photograph

The photo on the main anorexia page could be seen as appealing to those who consider themselves Pro-ana Hrmg (talk) 13:49, 22 January 2009 (UTC)

I do understand your concern!

However, it is important to not present a standpoint for or against a specific phenomenon or group of people, regardless of their views. Any picture uploaded in connection to an article should have the purpose only to clarify, exemplify, and/or enhance, the text and subject of the article. Whether certain individuals will otherwise see the picture in a certain way or not has to be left out of the overall consideration, simply because the nature and purpose of a Wikipedia article is to inform, and to do so as correctly as possible. AmaDraque (talk) 23:34, 2 November 2010 (UTC) Tues. Nov. 2010.

picture

the picture was tasteless and didn't add any value to the article so it was removed —Preceding unsigned comment added by 121.44.128.94 (talk) 18:21, 4 February 2009 (UTC)

athletes live near

many pro-athletes suffer from eating disorders and are near anorexic "if they miss one meal or eat too much they could end up in a hospital and can even die" yet there is no mention of this. many pro-sports are very unhealthy and reduce the average life expectancy quite a bit. Markthemac (talk) 04:04, 23 February 2009 (UTC)

This would need a citation, as I would say that it's not that they starve themselves, just that they exercise so much they need the calorie intake. For example, a professional swimmer swims for their whole day burning thousands of calories. They need to take in around 8,000 calories or else their body will not have enough energy to support itself. This does not make them anorexic. yes (talk) 01:36, 17 December 2009 (UTC)

Indeed. However anorexia is common amongst gymnasts and jockeys, and dancers - any athletic pursuit where weight (such as horse racing) and aesthetics (such as ballet and gymnastics) are important. — Preceding unsigned comment added by 89.145.252.66 (talk) 09:46, 17 August 2011 (UTC)

Reply to 'athletes'

I think with the athletes your on about,it's a different scenario, it's not the amount they're eating that's the problem, it's the amount of exercise, they're doing so much they can't possibly eat enough to sustain themselves, they get in a scenario where if they eat any less they become very ill becuase they have no energy, if they eat any more they become very ill becuase it's physically impossible for them to eat so much, they're eating as much as they possibly can eat, but it's still not enough, they need to learn to slow down a bit. —Preceding unsigned comment added by 92.1.190.142 (talk) 11:34, 18 May 2009 (UTC)

Maudsley Approach section

This section has been recently added by User:Jneher99. Just glancing at it with comments such as without question and the results are clear -- and without the refs needed for the statements made, this does not seem to be WP:NPOV, and some of it e.g Still others remain skeptical of the role of parents in the treatment consists of weasel words. I've removed an inappropriate resources section. Edgepedia (talk) 14:07, 11 June 2009 (UTC)

---

jneher----

I've edited in response to your concerns

A comment in passing: While this section clearly needs some copyediting, it may be neutral for the purposes of complying with WP:NPOV. This recent news article describes the Maudsley method as "the only therapy that has proved effective in controlled trials" and says a number of other positive things about it. This assessment seems to be fairly typical of mainstream news sources. I believe therefore that a "positive" section is actually necessary to be "neutral", because NPOV defines neutrality as accurately reflecting the views of the reliable sources, not being even-handed. WhatamIdoing (talk) 02:59, 20 June 2009 (UTC)

Note: Just because it is cited in "mainstream" news media does not prove validation. Also, it is necessary to cite the age and severity of the test population to add perspective to the posting.

I've just done some pruning on the Maudsley section,,took out vague unsourced material, deleted repetition and just some general tidying up. This was taking up way too much space on the main article. I'll go through the rest and check sources when i've got time. StevieNic (talk) 09:49, 13 November 2009 (UTC)

Proposed external link

http://www.everyone-else-is-taken.com

It looks like someone's blog, and as such it is not appropriate, in my opinion. Dawn Bard (talk) 17:14, 25 June 2009 (UTC)

Autism and Anorexia Nervosa Section

The section is right now preliminary and rough, I intend to improve it. I was contacted by a woman with autism and anorexia who encouraged me to add this information to the article. I have more references that I was given, I'll have a look though them and see what else can be added. The idea that autism maybe a cognitive phenotype underlying anorexia is a Swedish-European thing, and seems to be gaining at least local popularity. --Diamonddavej (talk) 16:54, 25 September 2009 (UTC)

I am very unhappy with the autism and anorexia section. Seems someone displaying weak central cohearance got disproportionately over-focused on the word Empathy. I'll remove the reference to empathy rather than risk an dispute, as I am not happy that half the Autism and Anorexia section is now given over to attempting explain the meaning of empathy rather then sticking to the subject at hand. If the editor who made the changes in question would like to read a philosophical exploration of the conspicuous morality displayed in autism and Aspergers syndrome, here is an excellent paper - Autism, Empathy and Moral Agency by Jeanette Kennett.[1] It is argued that autistic people follow a Kantian moral agency. --Diamonddavej (talk) 16:49, 26 September 2009 (UTC)

The section looks allot better now, thanks for improving the readability of the section. --Diamonddavej (talk) 17:03, 26 September 2009 (UTC)

No Picture?

I'm surprised, tbh. I understand that a section above mentions that one was removed for being tasteless, but a picture of someone (preferably a girl, seeing as they suffer form the disorder more often than guys) with the disorder (not nude, but at least with arms and rib cage visible) would definitely improve the article. MichaelExe (talk) 22:24, 14 November 2009 (UTC)

Agree Doc James (talk · contribs · email) 23:00, 16 January 2010 (UTC)

Why do you what a picture? A starving women (or man) looks the same whether that is due to a mental illness or lack of availablity of food. Starvation has a picture of a starved man. Edgepedia (talk) 13:25, 19 January 2010 (UTC)

No ideal but could be used. Not a huge fan however of using images that could have been the disease but are not.Doc James (talk · contribs · email) 19:18, 19 January 2010 (UTC)

Olivia Cohen, whose picture is on the article, is not anorexic. She did the water fasts for spiritual reasons and had no problem to eat after she finished the fasts. You should remove her picture from the article, because it is insulting to her to call her anorexic.Svetoslav80 (talk) 14:45, 18 January 2013 (UTC)

Reinstated Relationship to Autism Section

I have reinstated the relationship to autism section, if anyone is unhappy with its inclusion in the article, let me know why. --Diamonddavej (talk) 17:22, 27 November 2009 (UTC)

Yes, checking cited sources and other medical articles.(google.scholar & pubmed) and there does seem to be credible evidence (as per WP:MEDRS) that supports Family based treatments so this does deserve a mention in the main article. However we must take care not to give 'undue weight' and maintain a NPOV within WP guidelines. There is already mention of family based treatments in the 'Treatments' section.StevieNic (talk) 22:50, 27 November 2009 (UTC)

I was a bit surprised that this article doesn't include much on the social or gender-based factors of anorexia. I couldn't find any relevant and recent reviews about those factors, unfortunately. However, some useful information can be found here:

• PMID 15627053 [Hyperactivity and anorexia nervosa: behavioural and biological perspective]
• PMID 12567214 Risk and protective factors for juvenile eating disorders. "Temperamental factors, eating dysregulation, attachment, deficient self regulation and sociocultural ideals of health and beauty all contribute to pathogenesis." It doesn't get any more specific than this in the abstract, though. >.>

MichaelExe (talk) 18:48, 28 November 2009 (UTC)

There was a section titled "Social and environmental factors" but it was removed another editor, see the article's history. Almost 50% of the article was deleted in the last couple of weeks. It was bloated and in need of a clean up, but I think much relevant material was removed the process. --Diamonddavej (talk) 00:33, 30 November 2009 (UTC)

I think the original article was about 4500 words and I think the current article is about 1700 words so it’s probably more than 50%. The size of the reduction is not important it’s the content. As I’ve already explained most of the article was unsourced POV,anecdotal hearsay and was not really necessary. I suggest you reread the article as it was about a month ago and then read the current version. It’s definitely a big improvement, it’s a lot tighter and reads with a lot more accuracy. To editors in general, please try not to re add material just because it appears, or there are references to it in the popular press. Mainstream newspapers are not reputable sources and therefore citations from them are not suitable to be used in medical encyclopedia articles. Also primary sources or sources affiliated with the subject are generally not sufficient for a Wikipedia article. Only reputable secondary and tertiary reviews from well-respected medical journals should be used. Also remember that not all WP:MEDRS are created equal. PS.. Also I have re added a condensed section from the 'Social and environmental factors' para....Once again Best wishes..StevieNic (talk) 14:54, 30 November 2009 (UTC)

When I say "... much relevant material was removed" I am largely whihc concerned with the The "relationship to autism" section, which I wrote. It originally contained about 20 references from reputable medical journals, 3 references I accept were not appropriate - from Time Magazine, The New York Times and the BBC. After recent editing, the relationship to autism was section deleted and replaced a single sentence that retained only two references. --Diamonddavej (talk) 16:26, 30 November 2009 (UTC)

You are correct, looking back at my editing, I was being rather aggressive with my pruning. I was trying to edit the article to a compendious balanced viewpoint with all the main points covered. When I came to the 'Relationship with Autism' section I thought the whole section could be condensed down to a couple of lines with just a couple of the main references. Just because there are numerous references for a particular treatment or viewpoint it does not necessarily mean that this viewpoint should be given a prominence or an excessive amount of weight.

On a quick perusal of other main Anorexia articles on the web ie. Medline Plus [2], Encyclopedia Britannica [3] , the NHS website [4] and others the subject of autism connection doesn't get that much weight. It is not even mentioned at all in some articles with the most weight being given in Encyclopedia Britannica where it gets a line at most. So therefore I didn't feel it deserved that much prominence so I condensed it down from its original size. StevieNic (talk) 18:10, 30 November 2009 (UTC)

Clarity,order

I hope nobody gets offended about the revisions I made. I'm not sure how to add to the "reflist" I cited the sources but didn't link to them. The co-morbid and prevalence sections can and should be added to as there are studies, one of which went on for 55 years. There are also statistics from various countries. The fact that men can develop anorexia nervosa and certain subgroups of men have a higher prevalence should probably be added as well. 7mike5000 (talk) 11:44, 4 December 2009 (UTC)

I reverted your recent edits. This list is mostly unsourced, and where the sources are quoted they are not suitable for use in a medical encyclopedia article. Please only use sources and peer reviews from well-respected medical journals (as per WP:MEDRS ).StevieNic (talk) 12:34, 4 December 2009 (UTC)

There's something missing from this article

Maybe I missed it? I don't think so, because I've looked ... I don't see any mention in this article of the widespread misuse of the word "anorexic" in the popular press. The misuse of the term is extremely widespread. To bray in the "media" that someone like Keira Knightley (just to name only one example out of a hundred ludicrous examples) is anorexic is not only bald-faced preposterous BS, but it's also an insult to people that truly do have the disease anorexia. It is disrespectful. Anorexia nervosa is a very dangerous and sad disease, and it is rather rare. Almost all of the actresses and models that are "accused" of having "anorexia" in the popular stupid garbage-tabloid-press are perfectly normal women who just happen to be naturally, and quite healthily, thin (including K. Knightley). HAVE YOU ACTUALLY LOOKED AT A PHOTOGRAPH OF A PERSON THAT REALLY IS ANOREXIC? These models and movie stars these people are calling "anorexic" are not anorexic, and in fact they're not even at all underweight. (And yes, you might notice, if you browse for Keira Knightley's "images" in google that some asshole has pasted a picture of a truly sick and dying anorexic's body onto Keira Knightly's face -- this is the kind of BS I'm referring to -- this misrepresentation of anorexia nervosa is a very sick phenomenon on the Internet.)

Wikipedia needs to address this misuse of the word, or else it is not doing its job as the best encyclopedia in the world (which it strives to be).

The U.S. is the "most obese" nation in all of the Western developed nations. Is this fixation on "all these Victoria's Secret models" and "all these actresses" are anorexic, etc. etc. perhaps just jealousy on the part of people that have difficulty keeping their weight naturally under control?

My point is, this article is remiss in not addressing the point that "anorexia" is an frequently and egregiously misused word in much of the popular press. Is Political Correctness so domineering on Wikipedia that this frequent, fundamental fact of misuse of a medical term cannot be addressed, at least in passing, in the article? Worldrimroamer (talk) 05:25, 25 December 2009 (UTC)

If you can find WP:RS feel free to add this.Doc James (talk · contribs · email) 11:43, 18 January 2010 (UTC)

Agree with above comment. If this material can be found anywhere with reliable sources to cite by all means add it.StevieNic (talk) 12:22, 18 January 2010 (UTC)

Epidemiology

The lead is not supposed to contain information that is not present in the rest of the article. see WP:LEAD. Causes encompasses risk factors etc. See WP:MEDMOS.Doc James (talk · contribs · email) 09:50, 18 January 2010 (UTC)

By all means create and expand the section with relevant information cited with reliable sources. But you've just copy-pasted material from the lead, which is superfluous..StevieNic (talk) 11:33, 18 January 2010 (UTC)

The only issue is now the information in the lead is not discussed in the body of the text. I disagree but will leave it at that.Doc James (talk · contribs · email) 11:41, 18 January 2010 (UTC)

I really don't see the problem. Basically it's just a couple of lines that covers prevalence and doesn't really need it's own section. Every topic in the lead does not have to be discussed in the main body of the text. It can be a standalone para with no expansion necessary.StevieNic (talk) 12:15, 18 January 2010 (UTC)

I've added a title to the aforementioned lines so it sort of gets its own section..StevieNic (talk) 12:25, 18 January 2010 (UTC)

Sounds good. Tried to find an image without any luck. This page could use one.Doc James (talk · contribs · email) 12:31, 18 January 2010 (UTC)

Works for me..StevieNic (talk) 12:45, 18 January 2010 (UTC)

Sourced Unsourced Claim

This was the unsourced claim that was removed on Feb 24, 2010:

"Sociocultural studies have highlighted the role of cultural factors, such as the promotion of thinness as the ideal female form in Western industrialized nations, particularly through the media."

It is fact, according to numerous online medical articles. Added reference to support the claim.

Ursa Gamma 23:24, 25 February 2010 (UTC)

Yes but you need to find a reliable source as per WP:MEDRS.The articles you mention or the one you quoted [[5]]are not reliable sources, basically they are medical journalism and do not qualify for medicine related articles. Only use peer reviewed studies that are published in highly respected scientific/medical journals.StevieNic (talk) 12:09, 27 February 2010 (UTC)

On second reading I have reverted my previous edit. Apologies for that,,this piece of unsourced material had been sitting in the article for months without any citation so I just deleted it. The press release by The Royal College of Psychiatrists’ Eating Disorders Section is being reported quite strongly at present so I have reverted the edit and added an aditional source. Once again my apologies for any mistake.StevieNic (talk) 16:10, 27 February 2010 (UTC)

Question of clarity

Under the subheading of Nutrition under Causes, the only line is "Zinc receiving the placebo" sourced to The Journal of Nutrition. Would it be possible to expand upon this statement which seems to make no sense? I am not able to do so at this point but I thought I would bring it to the attention of someone who can. Many thanks. —Preceding unsigned comment added by 155.246.98.61 (talk) 23:27, 10 March 2010 (UTC)

Copyright problems with diagnostic criteria

The American Psychiatric Association has not released its Diagnostic and Statistical Manual of Mental Disorders into public domain, but claims copyright. The Wikimedia Foundation has received a letter of complaint (Ticket:2010030910040817, for those with access) about the use of their diagnostic criteria in this and a number of other articles. Currently, this content is blanked pending investigation, which will last approximately one week. Please feel free to provide input at the copyright problems board listing during that time. Individuals with access to the books would be particularly welcome in helping to conduct the investigation. Assistance developing a plan to prevent misuse of the APA's material on Wikipedia projects would also be welcome. Thank you. Moonriddengirl ^(talk) 14:06, 11 March 2010 (UTC)

I've fixed the problem and put the result at Talk:Anorexia nervosa/Temp. Eubulides (talk) 03:36, 13 March 2010 (UTC)

Sitophobia redirect

I am pretty sure the definition of Sitophobia is: A phobia of eating food, or abnormal fear of eating food. Anorexia is not eating food, Anorexia nervosa is a psychiatric condition that comes with distorted body image. There are clear differences between all of these.

Someone needs to clean this up. At the very least, remove the redirect. —Preceding unsigned comment added by 131.216.14.33 (talk) 02:23, 15 March 2010 (UTC)

I had a quick perusal through PubMed and Google Scholar and the term 'sitophobia' is not used anymore, at least not in a medical sense. Most of this topic is better explained under the Anorexia or Anorexia Nervosa label.StevieNic (talk) 11:19, 15 March 2010 (UTC)

It would seem that, in the UK at least, sitophobia would be treated in a simular way to an eating disorder http://www.patient.co.uk/leaflets/sitophobia.htm Edgepedia (talk) 13:46, 15 March 2010 (UTC)

Indeed, you are correct. It would come under an eating disorder, at least in the UK. I think it's just a matter of which semantic different people use. I think it would be best to leave the redirect as it is, otherwise we just get into different interpretations of what different people and cultures use and things will get very messy. Regards..StevieNic (talk) 15:13, 15 March 2010 (UTC)

I would agree that the redirect needs to be removed. While I would agree that both Sitophobia and Anorexia are eating disorders, sitophobia is actually more closely related to anxiety disorders. The fear of food can be classified in many ways, but not all anorexics fear the food itself: many fear the 'result' of food. Sitophobes fear the actual food itself. I think this is a qualifying difference. If any redirect should be made, it should be to anxiety disorders, with a mention of it on this page.--Chÿna ChÿnaDragön (talk • contribs) 17:25, 19 February 2011 (UTC)

7mike5000 Comments

Relationship to autism: This is hypothesis and not really needed in a medical encyclopaedia article) (undo) (cur) (prev) 08:55, 5 April 2010 StevieNic (talk | contribs) (cur) (prev) 08:49, 5 April 2010 StevieNic (talk | contribs) (33,112 bytes) (→Relationship to autism: condensing ..this article is about primarily about anorexia) (undo)

Whoever wrote that section put effort into. It was informative and was probably the only section that was sufficiently robust in its presentation, including a diagram, unlike the rest of the article that is noted for the paucity of information.

"Such an accumulation of similarities from a great diversity of perspectives suggests that anorexia nervosa might be considered a female variant of the autistic spectrum." Autism and anorexia nervosa: Two facets of the same disease? Odent M.Med Hypotheses. 2010 Feb 20. [Epub ahead of print] PMID 20176449

Things you can't find out in this article.

• What are the signs of anorexia nervosa? e.g. Russell's sign, No tolerance of cold (hypothermia),odd and ritualistic eating habits etc.
• What are the symptoms? lanugo, xerosis etc.
• What are the complications? hypokalemia, anemia etc.
• What's the most efficient treatment for adoloscents? Family treatment with a 75% success rate, 15% intermediate recovery.
• What are the differential medical diagnoses? What are the differential psychiatric diagnoses? Crohn's Disease: "We report three cases of young 18 to 25 year-old girls, initially treated for anorexia nervosa in a psychiatric department. Diagnosis of Crohn's disease was made within 5 to 13 years."(Blanchet C, Luton JP. 2002)"This disease should be diagnostically excluded before accepting anorexia nervosa as final diagnosis". (Wellmann W et al.)[263][264][265][266]
• What's the relationship to body dysmorphic disorder? 39% of anorectics have it.
• What's the proper way to diagnose an eating disorder? Medical tests firsts to rule out organic causes. As per the American Psychiatric Association
• What about neuroimaging? Second, neuroimaging plays an important part in diagnosing early-onset anorexia nervosa, both from a clinical and a research prospective".(O'Brien et al.2001).
• What type of psychological tests are used? Psychometric tests like the Body Attitudes Test etc.
• What type of medical tests are used? ELISA, BUN test, etc.

I could mention more of what's missing but then I would be writing an article on the talk page. I crammed as much information as I could into the article on Eating disorders because it's not here where it should be.

What's not missing is the doom and gloom. Academics don't reference Wikipedia laypersons do. Chances are that someone reading information on anorexia either has it or knows somebody that does. There are kids reading this. The prognosis section mentions; mortality, dying, and the word suicide four times, in one paragraph. How about; with Family therapy the full recovery rate is 75%, the intermediate recovery rate is 15% that's 90% positive results.

This guy is a respected researcher in the field;

I wished that Dr. Steinhausen had been more prudent in his phrasing. In fact, his own data have shown that with increasing duration of follow-up, the rate of recovery can rise to more than 70%. The prognostic picture of anorexia nervosa should include this more optimistic conclusion, in reference to Theander’s wise words, although I do not underestimate the seriousness of the disorder. Walter Vandereycken PMID 12944354

The Slogan is be "Bold" not "Manic" The amount of edits to this article are ridiculous. Every two minutes. I'm adding this, I took out that, I'm adding this, I took out that blah blah blah, maybe that's why professionals don't donate their knowledge and time, because numnutzes will just come along and butcher it.

The article occupies the first position in the search results for anorexia nervosa, it had 120,000 page views in one month. It's about a disabling and for some people deadly condition, mostly kids, and it's a horrible way to die. It's not about Matchbox cars, people that are actively suffering are reading it, an effort should be made to give them something worthwhile to read instead of babbling nonsense like "..., association studies published commonly have problems with low power due to small sample sizes. However, confirmed and consistent...". Even "just a Wikipedia article" can be a source of knowledge,

I have my own malfunctions, eating disorders are not one of them, kids starving themselves to death just bothers me. I forgot to sign my heretofore unsigned comments in the aforementioned Talk page furthermore in a 1994 random double blind double controlled half caf double latte study with low power.....7mike5000 (talk) 09:55, 6 April 2010 (UTC)

Hi Mike, I've reflected long and hard on this all day. Maybe the WP:MEDRS criteria which I am trying to adhere too, are a little too stringent and harsh for this article. All I have tried to do is maintain an article within those guidelines, maintain a NPOV, as any other Wiki medicine related article, and use correct balanced language and try and carve a balanced text. You do appear to be a lot more knowledgeable than I on this subject. I have reverted the article back to where you left it. Feel free to add more information, I won't be editing this page any more barring correcting vandalism I will leave it to more knowledgeable people..I apologise for any problems caused. Peace be with you...regards.....StevieNic (talk) 10:22, 6 April 2010 (UTC)

Um thats very mature of you, I didn't mean to come off like an immature jackass but I kind of am one. I get bent because the mental health field is for the most part a load of sh*t. And people suffer and die because of that, everyday. Nobody should be diagnosed with anything until all medical causes are ruled out thats common sense and pure science. People are in "therapy" for depression and they actually have Lyme disease or some other medical condition. There are psychoanalysts making a fortune spewing pseudoscientific b.s. and their clients wind up jumping off bridges. That's my motivation, if somebody can get positive information even from "just a Wikipedia article" like maybe they don't have anorexia nervosa it's Crohns disease etc.7mike5000 (talk) 10:51, 6 April 2010 (UTC)

Triggering of Anorexia

There has been discussion that seeing an image of an anorexic person may make people anorexic or make mild cases or anorexia more severe. Has anyone come across any evidence to support this idea? As if there is this should be mentioned.Doc James (talk · contribs · email) 07:43, 13 April 2010 (UTC)

These papers finds concerns with ideal media images PMID 17013768 PMID 19227390. This paper looks at internet sites and concludes that they may have negative effects [6] "Users of both pro-eating disorder and pro-recovery sites were hospitalized more than users of neither site" but hardly conclusive. --Doc James (talk · contribs · email) 07:57, 13 April 2010 (UTC)

Picture in the lead

I think the picture of Miss A in the lead is good.Doc James (talk · contribs · email) 16:03, 22 April 2010 (UTC)

Diagnosis section

I have reservations about the way the diagnosis section is structured now. Putting the medical before the psychological section seems silly since AN is an axis I psychological condition according to the DSM-IV-TR; medical conditions that may exacerbate psych conditions are placed on axis III. The medical tests listed should be kept in, but none of them can "diagnose" AN; they can only specify possible medical complications. Currently, the only medical criteria used to diagnose AN are amenorrhea in women (DSM and ICD) and lack of sexual desire in men (ICD).

Also, I think the bit on neuroimaging needs to be rewritten. If a patient has an organic brain lesion that is causing certain symptoms, then that patient may have anorexia, but does not have AN.

This section also needs to be expanded to include discussions of subtypes.

Any thoughts about or objections to these changes? Heresybythought (talk) 04:54, 15 July 2010 (UTC)

While psychological diagnosis are always diagnosis of exclusion after medical causes have been ruled out.Doc James (talk · contribs · email) 04:48, 2 September 2010 (UTC)

Symptoms?

Some symptoms on the page are:

"Russell's sign:[16] scarring of the knuckles from placing fingers down the throat to induce vomiting"

"purging: uses laxatives, diet pills, ipecac syrup, or water pills; may engage in self-induced vomiting; may run to the bathroom after eating in order to vomit and quickly get rid of the calories[19][20]"

"cheeks may become swollen due to enlargement of the salivary glands caused by excessive vomiting[24]"

Aren't these all symptoms of Bulimia nervosa and not of Anorexia nervosa?

Pinexxcone (talk) 03:35, 25 August 2010 (UTC)

The ref says Russell's occurs in 4% but sign do need to be rearranged to list them in the order of frequency of occurrence. Feel free if you wish.Doc James (talk · contribs · email) 04:51, 2 September 2010 (UTC)

Sun. Oct. 31. 2010

An Appeal to the Author of this Wiki "Anorexia_Nervosa":

I think it's a good idea to include a chapter about Bulimia and it's symptoms, but you might consider making it clear that these are two different diagnosis with each their descriptive criteria.

Bulimia does indeed often coincide with Anorexia. But I find it problematic to list Russell's Sign, along with a picture exemplifying this, as the second possible symptom you mention, out of less than 20 in total, and with only one other picture (the picture showing chilblains). Russell's Sign is not a sign of Anorexia ... it's not even a possible sign of Anorexia, but of Bulimia ... so in the form the chapter "Possible signs of anorexia nervosa" now has there is in fact misleading information, and that's a darn shame because you've written a very good article with a lot of sound information.

Lastly I will add that I thought it to be better to address this issue in 'Discussion', to yourself, rather than just go and edit what I think is wrong with your article. This is how I prefer my work to be treated by others, even if it does represent a certain problem when you also have to consider the readers who may go away with, use, and share, incorrect information.

Please do consider my suggestion.

AmaDraque (talk) 04:48, 31 October 2010 (UTC)

I have entered a small line mentioning that some of the signs listed are not signs of Anorexia Nervosa, but of Bulimia. I felt I had to do this since the author hasn't found time to edit the article. AmaDraque (talk) 09:09, 24 November 2010 (UTC).

"Invitation to edit" trial

It has been proposed at Wikipedia talk:Invitation to edit that, because of the relatively high number of IP editors attracted to Anorexia nervosa, it form part of a one month trial of a strategy aimed at improving the quality of new editors' contributions to health-related articles. It would involve placing this:

You can edit this page. Click here to find out how.

at the top of the article, linking to this mini-tutorial about MEDRS sourcing, citing and content, as well as basic procedures, and links to help pages. Your comments regarding the strategy are invited at the project talk page, and comments here, regarding the appropriateness of trialling it on this article, would be appreciated. Anthony (talk) 12:05, 31 August 2010 (UTC)

Yes would support that.Doc James (talk · contribs · email) 16:32, 31 August 2010 (UTC)

The list of articles for the trial is being reconsidered, in light of feedback from editors, and should be ready in a day or two. If you have any thoughts about the Invitation to edit proposal, they would be very welcome at the project talk page. Anthony (talk) 14:48, 2 September 2010 (UTC)

Statistical inconsistencies on M/F incidence

In the third paragraph, it states that the ratio of male to female incidence of anorexia nervosa is 1:1.5, yet in the Epidemiology section it states that approximately 90% of people with anorexia are female. There is a major inconsistency in these two estimates. What is the true figure? --192.149.74.10 (talk) 14:55, 15 November 2010 (UTC) (This edit was me ... my login had expired. --Spiff666 (talk) 18:39, 15 November 2010 (UTC))

Fixed Doc James (talk · contribs · email) 10:23, 24 November 2010 (UTC)

Identification prior to Gull? William Stout Chipley, early psychologist

I was sorting problem articles (unlinked, uncat, etc) and ran across this bio of a mid-1800s psychologist who supposedly first identified AN, calling it "sitomania". Anyone want to check into this and see if it's worth adding to the article? William Stout Chipley. MatthewVanitas (talk) 06:23, 30 December 2010 (UTC)

Chipley wasn't the first to identify AN. The earliest medical descriptions are generally accepted to be the case studies by Richard Morton, in 1689, and Robert Willan, 1790, as described in article History of anorexia nervosa. The History paragraph already references the "History" article - someone may wish to edit it to name Morton and Willan; and edit the History article to include Chipley.Achilver (talk) 18:29, 27 January 2011 (UTC)

Lede Section

There is some information that is in there seemingly for the sole purpose of being politically correct. It says, "However, it can affect men and women of all ages, races, socioeconomic and cultural backgrounds." This is completely irrelevant and is the case for almost every psychiatric problem. I am going to delete this as it is unneccisary and seems to be put there by an oversensitive female who was peeved at the emphasis on the fact that females experience it the most.--Jacksoncw (talk) 15:24, 23 February 2011 (UTC)

It was added by a male editor actually [7] The rationale is that many people assume it's an illness that only afflicts girls and young women. --Anthonyhcole (talk) 16:11, 23 February 2011 (UTC)

Other medical conditions

Mesenteric Ischemia (aswell as a multitude of other gastrointestinal disorders / diseases) can cause a person to develop Sitophobia, to simply redirect Sitophobia to Anorexia nervosa is quite lazy and in the case of this Ischemia (and the other conditions) a bit irrelevant. Please improve :) —Preceding unsigned comment added by 92.236.176.112 (talk) 10:03, 1 March 2011 (UTC)

Fix it yourself. Put in a couple of hours and begin Sitophobia. The volunteers at Wikiproject medicine will help you with formatting. Mainly, cite reliable sources for anything you say, per the WP:MEDRS guideline. --Anthonyhcole (talk) 15:42, 1 March 2011 (UTC)

The article is listing badly

The inclusion of long lists of data and facts makes the article very difficult to read, someone better fix the listing or it will sink. --Diamonddavej (talk) 05:15, 30 April 2011 (UTC)

Could we add a section on Rudolf Bell's work?

There does not seem to be any reference here to the interesting and seminal work of Rudolf Bell, as explained in his book "Holy Anorexia", in which he argues that the likes to Catherine of Sienna may have had a condition not too far removed from that of anorexia nervosa. However, he does clarify in the book that what he terms "holy anorexia" and anorexia nervosa are not the same thing; evidence that Caroline Brumberg, as is evident from her book "Fasting Girls", had not read Bell's book very carefully (if at all), as she says derogatory things there about people like Bell trying to make out that the likes of Karen Carpenter and Catherine of Sienna suffered from the same illness - a claim that Bell never once made in "Fasting Girls"! ACEOREVIVED (talk) 15:18, 8 February 2012 (UTC)

Concerns over length of article

The article reads like a long list. I think it would be better if for example the biological causes section was made into a separate article which can go more in depth about biological causes of AN, since there's a fair bit to say about it. rasppeachberry (talk) —Preceding undated comment added 04:10, 4 April 2012 (UTC).

Blog to help overcoming anorexia nervosa

I had Anorexia Nervosa 17 years ago and now it has been 15 years that I feel recovered and never had any further problems with food specifically. I am not a doctor, but started this blog fightagainstanorexianervosa as my contribution to help people who I believe can fully overcome an eating disorder. I try to describe thinking patterns that I used consciously to avoid negativity after I decided to recover. I wanted to suggest my blog to those who work in the field, who study anorexia and anorexia sufferers. It is one person's viewpoint, but it worked for me. Fightagainstanorexianervosa (talk) 00:49, 1 September 2012 (UTC)

I am happy for you that you feel fully recovered. However, Wikipedia is not the place to announce your blog and another editor, who is more strict than I am, might remove your message. Lova Falk talk 08:20, 1 September 2012 (UTC)

Minor changes to a few sections

I was hoping to add a general overview to the Treatment- Diet section and elaborate on Zinc treatments by providing an explanation of the importance of zinc to patients with Anorexia Nervosa. The prognosis section is a bit too vague and studies show that the prognosis is not always as favorable as this section suggests. The last section I was planning to add to was the topic of relapse in reference to high energy diets. Jberens3826 (talk) 03:39, 14 November 2012 (UTC) — Preceding unsigned comment added by Jberens3826 (talk • contribs) 03:33, 14 November 2012 (UTC)

Men with eating disorders

This article is quite correct to note in the section on epidemiology that anorexia nervosa can affect men. However, it does not point out the problems that men with eating disorders have been claim to have faced - a double problem in having the disorder, and a second problem in having what is more frequently seen as a woman's illness. In fact, there is a book on this them - "Men with Eating Disorders" - those who have read the book and know its contents could add ideas from it to the article. ACEOREVIVED (talk) 16:56, 28 November 2012 (UTC)

You seem to have access to this book, so maybe you could write a few lines? Lova Falk talk 17:02, 28 November 2012 (UTC)

Paragraph 1: Statement that individuals with anorexia nervosa do not lose their appetites is debatable

The statement (and reference to Carlson) that individuals with anorexia nervosa do not lose their appetites is debatable. Once an individual gets to a certain point of starvation, appetite loss is a physiological response that occurs naturally. So while it may be true that in the beginning stages of anorexia a person does not lose her/his appetite, this is likely not the case for individuals in later stages of the disease (i.e. at the point of starvation, which is a necessary criteria in order to qualify for anorexia nervosa according to the DSM IV (i.e. 85% or less of the expected body weight for someone's age and height)).

Additionally, while the distorted body image/fear of gaining weight commonly co-occurs with anorexia, I find it a small bit frustrating that other motivating factors are not as highlighted in the discussion. I.e. many individuals with anorexia may not have a desire for thinness per se, but rather a desire to eat the "perfect amounts" of food (to avoid feeling gluttonous and guilty, but not simply because they're afraid of the end result of gaining extra weight). I think it's important to try to introduce alternative perspectives that do not embolden the stereotype that individuals with anorexia are only concerned about gaining weight, as this is not true... And I think that opening the article with a sentence that includes "irrational fear of gaining weight" may inadvertently set that bias from the beginning.

Thank you for any thoughts/feedback! Gigi13th (talk) 08:18, 17 December 2012 (UTC)Concerned in NYGigi13th (talk) 08:18, 17 December 2012 (UTC)

Hi Gigi13th! In Wikipedia, it is all about sources. Do you have a WP:reliable source that individuals with anorexia nervosa lose their appetites, or for alternative perspectives? If you have, something can be written about it in the article. With friendly regards, Lova Falk talk 08:32, 25 December 2012 (UTC)

New Therapy

Hello!! I am student at the University of Florida and as part of my grade in one of my psychology courses our professor has assigned us to learn and participate in editing a wikipedia page. Because Wikipedia plays a vital role in disseminating psychological science to the masses. I would like to make a new addition in the therapy section of UCAN Uniting Couples Therapy in the Treatment of AN (anorexia Nervosa) based on the studies found in Eating Disorders Review volume 23 Issue 6. Any input or help would be greatly appreciated!! --Anajean93 (talk) 05:05, 2 April 2013 (UTC)

As well as the benefits of adjunctive family therapy in treatment for AN. — Preceding unsigned comment added by Anajean93 (talk • contribs) 05:22, 2 April 2013 (UTC)

First off, you'd need to establish the notability of the therapy by providing a reliable source, which I see you labeled above. When adding the actual information, be sure to use a neutral, encyclopedic tone. If you look under "journals" here (Wikipedia:CT#Examples), you can find the template to add the information for your citation. You can find me on my talk page if you have any questions. Icarus of old (talk) 03:48, 3 April 2013 (UTC)

thank you!! I'm still working on the neutral tone needed for submitting new information. For this specific journal, is the link of the site sufficient or do i need to include both the apa citation and the url? --Anajean93 (talk) 04:27, 3 April 2013 (UTC)

Wikipedia has its own citation guidelines. They even have helpful templates you can copy and fill in the appropriate information. Those templates are located here, and this page also contains useful tips for adding new information. Be sure to check it out. You will need the URL as part of the citation, but you'll also need the title, author, journal name, etc. You'll see what I mean when you visit the page. If you need help, find me on my talk page. Icarus of old (talk) 04:39, 3 April 2013 (UTC)

Cause of Anorexia is Biological

Anorexia is caused by the "sex point" in the hypothalamus in the brain being thrown off its normal setting. The hypothalamus regulates many things--eating, thirst, sleep, blood pressure, body temperature, sex drive (they've found differences in the hypothalamus between straights and gays), digestive secretions, immune activity, etc. It's important for impressionable, insecure young girls (anorexia is most prevalent in young girls aged 12 to 18) to understand that anorexia is NOT THEIR FAULT! What happens is they inadvertently "trigger" anorexia by engaging in, or are subjected to, various behaviours. These include, but are not limited to: STRESS, SMOKING, CRASH DIETING, NERVOUSNESS, DRUGS, LACK OF VITAMIN B1, DEPRESSION, ILLNESS (ESPECIALLY ILLNESS AFFECTING THE LIVER AND KIDNEYS), PARENTS FIGHTING, BRAIN DAMAGE, DISEASE (SUCH AS HERPES), GENETICS, etc. --When one or several of these things are happening to you, you are susceptible to anorexia. These "triggers" send chemicals to the brain, such as serotonin, cortisol, dopamine, epinephrine, norepinephrine, etc. which throw the hypothalamus off its normal "set point". The fashion industry does not cause anorexia because ANIMALS GET ANOREXIA! And animals do not have a fashion industry. TO CURE ANOREXIA, THE PATIENT MUST BE REMOVED FROM THE VARIOUS TRIGGERS MENTIONED ABOVE AND MUST START EATING AGAIN SO THAT THE "SET POINT" RETURNS TO NORMAL. Again, I must stress that anorexia is not psychological in origin, but is biological. However, since it involves the brain, it is incorrectly deemed psychological.****Here's some more information: the PARAVENTRICULAR HYPOTHALAMUS TELLS US WHAT TO EAT, THE LATERAL HYPOTHALAMUS TELLS US TO START EATING, AND THE VENTROMEDIAL HYPOTHALAMUS TELLS US TO STOP EATING. Here are the usual hormones that regulate eating: LEPTIN (released by the fat cells) tells us to stop eating; GHRELIN (released in the stomach) tells us to start eating; OBESTATIN (discovered in 2005 in the stomach and small intestine) tells us to stop eating. DEATH in anorexia is usually caused by an imbalance of salts in the bloodstream (notably potassium) so if you're anorexic at least take your vitamin and mineral pills. Bananas have potassium, as do other foods. Anorexics DENY having anorexia, so denying you have anorexia is a sign that you have it.****Okay, that's a brief summary of what I uncovered researching a hundred sites--books, magazines, Internet, college research papers, etc. I hope it helps people out there with the affliction. I'll provide a bibliography after I get some feedback from Wiki editors. All I did was put the pieces of the puzzle together, others did the research, but I think I'm the first one to co-ordinate the information.63.192.101.175 (talk) 04:51, 27 February 2010 (UTC)mike peters

Please remember when editing WP articles only reputable secondary and tertiary studies that have been peer reviewed and published in well-respected medical journals should be used as per WP:MEDRS for medicine related articles.StevieNic (talk) 12:22, 27 February 2010 (UTC)

Other causes of anorexia nervosa, a I have done a lot of research on for an essay report before, can be from the media and the fashion industry. As well all know,the fashion industry uses stick thin models to show off their fahionable clothes and accessories and the media contributes by exploiting these images to the world. Since sciety has the ideal image of hat most young men and women "should" look like, it drags everyoneto believe that whatevr is in, is beautiful. And if skinny makes me beautiful then I will whatever it takes. First it starts wih excessive excersing, then dieting, slight fasting, and if one has a very poor body image, this insecurity can result to drastic measures like anorexia and starvation...all just to look like the young, beautiful, thin, men and women on tv, in magazines and on posters pictures and billboards everywhere you go. —Preceding unsigned comment added by Danihickethier (talk • contribs) 08:11, 12 March 2010 (UTC)

In my experience, anorexia is more of a control mechanism, a security blanket/OCD response to a life that is unpredictable. This may not be everyone's experience, but sick as it sounds, the fact that 'thin is in' was more of a bonus side effect rather than the cause of the disorder. Although I must admit the desire to be 'perfect' in every aspect of life also seemed to play a role. — Preceding unsigned comment added by 89.145.252.66 (talk) 09:55, 17 August 2011 (UTC)

The whole section on "causes" is misleading in which it divides the "causes" into "biological" and "environmental", "media" and "relationship to autism", as if these were mutually exclusive. I would try to fix it but then people will unfix it. — Preceding unsigned comment added by 90.190.47.64 (talk) 19:36, 15 April 2013 (UTC)

Hypercholesterolemia in patients with anorexia nervosa

Patients with anorexia nervosa present with hypercholesterolemia. More about the aetiology can be found at:

• Ohwada, R (2006 Nov). "Etiology of hypercholesterolemia in patients with anorexia nervosa". The International journal of eating disorders. 39 (7): 598–601. doi:10.1002/eat.20298. PMID 16791856. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Weinbrenner, T (2004 Jun). "Lipoprotein metabolism in patients with anorexia nervosa: a case-control study investigating the mechanisms leading to hypercholesterolaemia". The British journal of nutrition. 91 (6): 959–69. PMID 15182399. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• NESTEL, P. J. (1 February 1974). "Cholesterol Metabolism in Anorexia Nervosa and Hypercholesterolemia". Journal of Clinical Endocrinology & Metabolism. 38 (2): 325–328. doi:10.1210/jcem-38-2-325.

The article can be updated to incorporate this information. Diptanshu^Talk 11:28, 5 July 2013 (UTC)

Impaired glucose tolerance in anorexia nervosa

It seems that the fact of impaired glucose tolerance in anorexia nervosa has not been adequately mentioned in this article. Details of the fact can be found at:

• Kumai, M (1988 Feb). "Glucagon secretion in anorexia nervosa". The American journal of clinical nutrition. 47 (2): 239–42. PMID 3277371. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Yasuhara, D (2005 Jul-Aug). "Glucose tolerance predicts short-term refeeding outcome in females with anorexia nervosa". Psychosomatic medicine. 67 (4): 669–76. PMID 16046386. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Scheen, AJ (1988 Nov). "Insulin sensitivity in anorexia nervosa: a mirror image of obesity?". Diabetes/metabolism reviews. 4 (7): 681–90. doi:10.1002/dmr.5610040705. PMID 3069398. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Casper, RC (1988 Sep). "Eating attitudes and glucose tolerance in anorexia nervosa patients at 8-year followup compared to control subjects". Psychiatry research. 25 (3): 283–99. PMID 3054985. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

The article needs to be updated accordingly. Diptanshu^Talk 12:27, 5 July 2013 (UTC)

Removed text, poorly formatted, undue, copyvio check needed

This text was dropped in here, due weight needs to be evaluated, citations are in the section headings, and hopefully someone with journal access will check for copyvio. SandyGeorgia (Talk) 21:18, 15 November 2013 (UTC)

Evolutionary Theories of Anorexia Nervosa

Threat of Exclusion

The desire to belong to a group has not been documented in directly causing eating disorders, but this desire may contribute to the beginning stages that later trigger other systems. Humans are social animals that have evolved in dangerous environments, where group protection and belonging was vital to survival. While groups provide protection from predators, starvation and other groups, they also create environments of intra-group competition. In human environments, attraction is an element of competition. Humans have ‘social attention holding power’, which they use to gain attention and investment from other group members. This investment from others is critical for an individual’s self-esteem, status within the group social hierarchy and sense of perceived attraction. The threat of being excluded from a group and losing this social attention holding power is a very serious fear that has been ingrained in humans throughout the course of evolution when group exclusion would have led to death or impeded reproduction. An individual’s perceived value to a group is assessed by comparison to other group members, especially from a physical perspective. In modern and industrialized societies, the point of comparison is often the mass media’s portrayal of ideal and attractive bodies. Thus, it has been argued that our evolutionary drive to fit into a group and to be perceived as attractive to members of that group, has played a role in dieting behavior that can often trigger an eating disorder. Gilbert and Meyer (2003) saw that a negative evaluation by an individual’s peers led to subsequent dieting in an attempt to raise status. Additionally, from the perspective of a female adolescent, her primary job is to select the most evolutionarily fit father to enable her to reproduce and produce healthy children. In order to have access to fit mates, females try to make themselves as attractive as possible, when competing with each other for males in the group. Modern day female beauty standards have inspired young women to diet to achieve thin body types, and the high rates of eating disorders that have risen around the world can be attributed to the infiltration of western culture and beauty ideals. While the emphasis on thin bodies as the standard of beauty and attraction is a very new phenomenon in human history, the evolutionary mechanisms that drive our desire to belong to a group and to be perceived as attractive to mates has long existed throughout our evolutionary past.

Adaptive Responses to Starvation; Flee Famine Hypothesis

In response to famine, humans would have had three choices: to hibernate like bears, to stay put in their current environment and wait for the famine to end, or to move from their current environment and seek additional resources elsewhere. Humans do not hibernate, so the second two options were often employed. Increased activity in response to malnutrition would have been evolutionarily adaptive, because it would have increased the chances of an individual finding new sources of food. In order to migrate somewhere where there was potential for new food availability in times of famine, humans would have been selected to discontinue local foraging and feel energized to forage for food elsewhere; this is called the “Adapted to Flee Famine” hypothesis. While conserving energy and staying put to wait out a famine is beneficial because calories are not spent searching for new resources, if human groups were living in completely food depleted areas, it would have been beneficial to move around and seek new resources and food supplies. Additionally, the lethargy and fatigue that accompanies starvation would have prevented humans from foraging and moving beyond resource-depleted areas, and in that circumstance, it would have been maladaptive to feel fatigued and stay in an environment with no resources.

While the specific genes have not yet been identified, this hypothesis assumes that some individuals have inherited genes that allow them to respond to low body weight in specific ways that were once employed to deal with famine. It has been seen that some humans exhibit stress-seeking behavior, and experience a sense of reward from stress. The reward pathway is controlled by dopamine neurons in the brain and when the stress response produces glucocorticoids, they can cause euphoria in some humans. In humans who show this behavior, glucocorticoids produce euphoria, decrease feeding, and increase activity. The levels of this hormone are increased in anorexic individuals, and then return to normal baseline levels once these individuals have restored their weights.

The intent to discontinue local foraging can possibly explain refusal to eat, and the restless feeling can explain the increased activity often seen in anorexic patients. Additionally, it might have been adaptive for humans to take on an ‘optimistic’ view of their bodies, to deny that they were ‘dangerously thin’ so that their bodies could “facilitate such a last-ditch effort”. This may play a role in the inability of anorexic patients to comprehend and see that they are substantially underweight. These adaptations are triggered in people who have the genetic correlates to these behaviors when weight loss occurs, and the body perceives an environment of famine when 15% of body weight is lost. This ancestral reaction is mismatched in our modern environment. There have been instances of pigs that have lost weight because of the stress of maternal separation and then restrict their own intake of food and obsessively move around in their pens. When feeding time is restricted for rat populations in the laboratory, rats will continue to starve themselves and constantly run on their wheels. These conserved behaviors seen in other species supports the theory that there are genetic correlates and inter-species support for the “Adapted to Flee Famine” hypothesis. Although the genetic research is “in its infancy” as far as locating specific genetic markers that are correlated with this behavior, the heritability of these traits and the similar behaviors across species indicate that there is a genetic component. Additionally, these behaviors may have been conserved in human populations because individuals who exhibited these traits may have gained higher status within the groups. Gatward asserts that members of ancient human groups who were better able to tolerate starvation, and who could continue to scavenge for and find food, became valuable members of the group. Individuals who had these traits would have been highly valued and would have likely held high social status in the group. This rise in self-esteem that occurred in the face of starvation in ancient times may be at work in anorexic patients who claim that they are much more confident when they do not eat. Members of the group who exhibited these traits would have better survived famines, and would have been able to reproduce, keeping these genes in the human population.

If the “Adapted to Flee Famine” hypothesis is correct, perhaps anorexic patients who are exposed to an environment that represents an excess of fresh resources, it could provide a trigger to the brain that it is time to start eating again. By introducing foods that would signify the end of a famine, for instance fruit and fresh vegetables to patients recovering from eating disorders, perhaps they would be more likely to perceive those dishes as less of a threat, compared to high calorie foods (like mashed potatoes) that are usually provided to patients in treatment centers. Not only could the type of food provided to patients be important, but the environment in which they eat and spend their time could also have important therapeutic effects. For example, working on artwork that incorporates fruits, nuts, grass, images of herds of antelope and other imagery could be beneficial. If patients with anorexia were exposed to stimuli that represented these new and plentiful environments through a variety of interventions, perhaps recovery could be made easier.

Anorexia Nervosa as an example of Female Intra-Sexual Competition

Throughout evolution, those that could reproduce had much greater fitness than those who could not. One strategy to increase one’s own fitness was to prevent others from reproducing. This is called the ‘adaptive phenotype’, a strategy that an individual can use to manipulate the behavior of a competitor to the advantage of the individual that can provoke the behavior. This evolutionary behavior can be seen in anorexia. Women who exhibit mild symptoms of anorexia and provoke it in other women, may be at a fitness advantage if other women develop severe anorexia, lose their reproductive function and exit the sexual competition. The intense fear of weight gain may be attributed to the intense fear that humans have of social exclusion, and women with eating disorders equate weight gain with social exclusion, perhaps a reason why recovery is so hard to achieve.

Reproductive Suppression in Unfavorable Conditions

In our evolutionary past, there may have been circumstances in which it was favorable to restrict eating to avoid sexual attention of undesirable mates. This may have been a strategy employed by women to avoid harmful mates. The adult female body is an indicator of youth and reproductive potential, and females who wanted to prevent these pubertal changes from occurring, could do so by self-induced starvation. Additionally, these women could stop their menstrual cycles by severe caloric restriction. Severe weight loss to a BMI below 17.5 kg/m^2, would have suppressed the reproductive system. Anorexia may have been adaptive to females attempting to postpone reproduction during unfavorable times, and if this was the case the rise of anorexia in individual females would occur around puberty, which the age breakdown of anorexic patients reflects.

Sources

I'm adding the (correctly formatted) sources here (since they were a mess and missing PMIDs). SandyGeorgia (Talk) 21:39, 15 November 2013 (UTC)

• Fessler DM (2002). "Pseudoparadoxical impulsivity in restrictive anorexia nervosa: a consequence of the logic of scarcity". Int J Eat Disord. 31 (4): 376–88. doi:10.1002/eat.10035. PMID 11948643. {{cite journal}}: Unknown parameter |month= ignored (help)
• Gatward N (2007). "Anorexia nervosa: an evolutionary puzzle". Eur Eat Disord Rev. 15 (1): 1–12. doi:10.1002/erv.718. PMID 17676667. {{cite journal}}: Unknown parameter |month= ignored (help)
• Gilbert P (1992). Depression: The evolution of powerlessness. Hove, East Sussex: Lawrence Erlbaum. page numbers missing
• Gilbert N, Meyer C (2003). "Social anxiety and social comparison: differential links with restrictive and bulimic attitudes among nonclinical women". Eat Behav. 4 (3): 257–64. doi:10.1016/S1471-0153(03)00026-6. PMID 15000969. {{cite journal}}: Unknown parameter |month= ignored (help) primary source
• Guisinger S (2003). "Adapted to flee famine: adding an evolutionary perspective on anorexia nervosa". Psychol Rev. 110 (4): 745–61. doi:10.1037/0033-295X.110.4.745. PMID 14599241. {{cite journal}}: Unknown parameter |month= ignored (help) not a review
• Waller G, Kennerley H (2003). "Cognitive-behavioural treatments". In Treasure J, Schmidt U, Van Furth E (ed.). Handbook of eating disorders (2nd ed.). Chichester: John Wiley & Sons.{{cite book}}: CS1 maint: multiple names: editors list (link) no page numbers
• Not PubMed indexed http://onlinelibrary.wiley.com/doi/10.1002/erv.448/abstract
• Not PubMed indexed, College of St. Benedict, seriously. http://link.springer.com/article/10.1007/s12110-000-1005-3#page-1
• Not PubMed indexed, and not strictly a review: http://www.sciencedirect.com/science/article/pii/0162309589900010

Since the citations are not inline, it is impossible to know what text comes from which source, but many of the sources are not reviews. SandyGeorgia (Talk) 21:57, 15 November 2013 (UTC)

Misdirections

I've begun a new topic for this because I didn't know where best to put it.

'Anoretic' immediately redirects here, even though the two topics really aren't related (save for the obvious fact that those suffering from anorexia nervosa will, almost invariably, employ anoretics as a means to avoid eating).

I'm assuming there IS an article for 'anoretic' (I'm thinking that a search for 'appetite suppressant' will lead there when, strictly, the article OUGHT to be entitled the former as that is the correct medical term).

Edited to add that 'appetite suppressant' DOES lead to 'anoretic' and am now thinking that the misdirection is due to either a typo (omitting the 'x' from 'anorexic') or a user confusing 'anoretic' and 'anorexic'. Either way, the misdirection needs to be corrected (and I'd not have the first clue how to go about editing the link(s)). — Preceding unsigned comment added by Margolotta (talk • contribs) 22:13, 26 November 2013 (UTC)

Hi Margolotta! Welcome to Wikipedia and thank you for telling us. I changed the redirect to Anorectic, which is "a dietary supplement and/or drug which reduces appetite and food consumption." With friendly regards, Lova Falk talk 20:24, 29 December 2013 (UTC)

In use, MEDRS

I've put the article in use to begin repairing extensive problems caused by citing to the laypress and primary sources. Please review WP:MEDRS, WP:NOT (news), WP:RECENTISM, WP:UNDUE and Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches. This article is full of citations to the laypress and primary sources, even though numerous secondary reviews are available.

Please also see WP:LEAD and WP:MEDMOS#Sections for how medical topics are organized. SandyGeorgia (Talk) 23:45, 30 December 2013 (UTC)

There is much too much here to fix in a day, or a week. Undue weight is given to some aspects, and original research results from the over-reliance on primary sources. The article needs to be rewritten to secondary reviews. SandyGeorgia (Talk) 00:14, 31 December 2013 (UTC)

The only way I can see to fix this article is to ruthlessly hack it back to information agreed by major medical organisations. Currently it is full of primary sources being used to justify points of view far away from accepted medical opinion. I'm not saying that these won't turn out to be correct, however Wikipedia is supposed to reflect current mainstream medical opinion. FMMonty (talk) 12:59, 2 February 2014 (UTC)

Ruthless pruning seems the sensible way forward. Another whole bunch of text based on a single primary source has just been added and leaving the article as it is only invites more of the same. A substantial prune to material attributable to secondary and tertiary sources would also provide a robust platform to resist any further single source and primary source additions.  Velella  ^{Velella Talk}   13:30, 2 February 2014 (UTC)

That text was added here, at Bulimia nervosa, Disordered eating and Eating disorder. All of these additions were flagged as minor, and I have removed them for now. FMMonty (talk) 14:34, 2 February 2014 (UTC)

concur with "ruthless pruning" done by anyone who has the time. SandyGeorgia (Talk) 14:39, 2 February 2014 (UTC)

Subtype Edit

The section lacks any form of explanation for the distinction between the two subtypes of anorexia nervosa. I would like to suggest a change by adding a brief definition of each subtype so that readers will have a basic understanding of the difference between the two subtypes:

Subtypes:

Restricting type: Individual does not utilize binge eating nor displays purging behavior as their main strategy for weight loss. Instead, the individual uses diets, fasts, and exercise as a means for losing weight. [2] Binge-eating/purging type: Individual prefers utilizing binge eating or displaying purging behavior as a means for losing weight.[2]

Currently, the subtypes are simply listed with no definition.

Reference: cite book|last=Yale|first=Susan Nolen-Hoeksema,|title=Abnormal psychology|date=2014|publisher=McGraw-Hill Humanities/Social Sciences/Languages|isbn=0078035384|page=339|pages=339|edition=Sixth edition.

Galleogst (talk) 01:22, 8 April 2014 (UTC)

"Media effects" section

The first sentence of #Media effects about there being "no evidence" of the media causing eating disorders seems to be contradicted several sentences later by the discussion of the magazine surveys. Am I missing something? It Is Me Here ^{t / c} 19:14, 13 February 2014 (UTC)

The studies cited in the second paragraph of the section find correlations between media exposure and negative thoughts/behaviors, but do not establish an association between media exposure and the occurrence of clinical eating disorders, including anorexia nervosa. While low self esteem and experimentation with laxatives, diet pills, purging, etc. are disturbing outcomes in themselves, they should not be equated with AN (and they certainly should not be conceptualized as less extreme versions of AN). Anorexia nervosa is not the same thing as an extreme diet, and prevalence of dieting behaviors and poor self image do not necessarily predict prevalence of AN in a particular population. There is still a great deal of work to be done in this area of research. It is certainly possible, for example, that nutritional deficits caused by dieting behaviors could "trigger" the onset of AN in some individuals, possibly leading to higher rates of AN in populations with higher rates of disordered (but not clinically significant) body-focused thoughts and behaviors due to media effects. To my knowledge, however, no study has established this causal link. Additionally, even if a link did exist for some individuals, there is no evidence that it would be significant at an epidemiological level.216.165.95.77 (talk) 23:18, 12 April 2014 (UTC)

User friendly.

Hi there! I propose we add the following content to the genetic section, just after "inheritance rates ranging from 56% to 84%."

Twin studies have shown a heritability rate of 56%. </ref>

It will allow users to draw a better picture of how genes and Anorexia Nervosa are related. It provides a better understanding of the topic with easy to grasp information.
Thank you
Scarlettvichot (talk) 17:43, 18 April 2014 (UTC)

Males and eating disorders

I think it is good that this article states how anorexia is more prevalent among females than males but I thought it needed a little bit more than that statement alone. One of the reasons males are not as prone to eating disorders such as anorexia is due to the fact that males are much more confident with their figures than most woman. Someone reading this article may want to know why males aren't as prone so I think an explanation of some sort was needed. Hannahkbowman (talk) 19:11, 18 April 2014 (UTC)

Signs and Symptoms section

The fourth bullet point up, starting at the bottom of this section, states that one symptom of Anorexia nervosa is

• Hair loss or thinning

I would like to add to this statement. Simply revising it to:

• Dry hair and skin, as well as hair thinning

I believe this simple change identifies another crucial, yet similar, symptom in regards to this disorder (Smith.brooke (talk) 03:47, 19 April 2014 (UTC))

Sorry I edited the page and then realized I should have discussed first so I reverted my edits, and have them below Tovegrant (talk)Tove Here are my changes/additions, what do you think? If you ant to put them back in you can just redo my edits I think.

• Thin appearance including emaciation, may not have visible weight loss [52]
• Refusal to eat and denial of hunger [53], includes excuse for lack of hunger, sickness, use stomach, nervous, anxious, planning of eating later
• Obsession with calories and fat content of food. I'D LIKE TO ADD: Can include fixation on 'health' and 'good' and 'bad' foods. Definition of 'good' foods may be so limited that malnutrition occurs or individuals would rather not eat than eat something less nutritious.
• Eliminating food groups: fats, carbs, sugars, proteins [54]
• Dehydration, a large portion of our daily liquids come from food [56]
• Low electrolytes from drinking too much [57]
• Food rituals, such as cutting food into tiny pieces, refusing to eat around others, or hiding or discarding food
• Eating around others and severely restricting food intake in private
• Loss of hunger, may be psychological or physical in nature. Sometimes caused by hormone depletion. Decreased Leptin levels can result in weight destabilization and how your brain tells your body to start and stop eating or how to burn fat.[58]
• Hypoglycemia or low blood sugar, feelings of fainting [62]
• Image Orientation and seeming preoccupation with aesthetics including clothing or hair. Fixation on types of clothes they will wear, taking the perfect self portrait, posting very thin social media selfies, wearing revealing clothing to exhibit size
• Preoccupation with social acceptance (from friends, family, coworkers, significant other), may include desire to act or dress a certain way, meet image demands or demands for time and energy (work over time, volunteer, conform).
• Secretive behaviors including hiding food, eating and toilet habits or binging and purging actions, wearing baggy clothing to cover weight loss (anorexics may hide or display weight loss depending on motivations)
• Intolerance to cold and frequent complaints of being cold; body temperature may lower (hypothermia) in an effort to conserve energy[63]
• Solitude: EDIT: may avoid friends and family; becomes withdrawn and secretive, unwilling to discuss the disorder. May include loss of friends.
• Abdominal distension or WOULD LIKE TO ADD: seeming weight around the midsection in relation to the rest of the body.
• Dental discoloration, from vomiting or from insufficient food intake to remove the stains caused by dark liquids, especially tea and coffee
• Digestive issues, stomach pains, constipation, diarrhea (made worse by laxatives and purging) [70]
• Low blood pressure [71]
• Irregular heart rhythms [72]
• Trouble sleeping, bags under eyes [73]

http://www.dsm5.org/documents/eating%20disorders%20fact%20sheet.pdf http://www.mayoclinic.org/diseases-conditions/eating-disorders/basics/symptoms/con-20033575 http://eating-disorders.org.uk/information/the-effects-of-under-eating/ http://www.webmd.boots.com/mental-health/anorexia-what-anorexia-can-do-to-your-body

Differential Diagnoses

(I do not wish to change the text. I would like to expand, in a sentence, on one of the main distinctions between binge-purge anorexia and bulimia.)

I would like to state how different physical appearances (weight) are a large factor in separating the two disorders. Binge-purge refers to someone who is clinically underweight. Those classified with bulimia are commonly at a healthy weight, or slightly overweight. (BreeRoth (talk) 20:08, 20 April 2014 (UTC))

Headline on Death Morality rate

Hello everyone, I was reading along the Anorexia nervosa section and found that the morality rate is highest in this mental disorder. I actually found the exact morality rate in the Abnormal Psychology Textbook 6th edition by Susan Nolen-Hokesema. I want to add it in because she wrote that it is "5-9 percent" and I believe that it is an important statistic to back up the fact. What do you guys think?Brickellegarcia (talk) 03:16, 21 April 2014 (UTC)

Severity Levels

I wanted to add a brief section of the few values of body mass index that helps indicate the levels of the severity in anorexia nervosa. --GatorGirlGrowls (talk) 18:45, 20 April 2014 (UTC)

I do not disagree with this in any way; however, I do not see why you couldn't have used an Internet source for this. I have found this information on the Internet before. Melange fiesta (talk) 00:31, 7 May 2014 (UTC)

Why does "cibophobia" redirect here?

Term is not used or explained in the article. 86.159.197.174 (talk) 02:22, 22 August 2014 (UTC)

DSM 5

Would you be ok with adding a clarifying statement?Tovegrant (talk)Tove

Something like this: Criterion focuses on behaviors, like restricting calorie intake, and no longer includes the word “refusal” in terms of weight maintenance since that implies intention on the part of the patient and can be difficult to assess. The DSM-IV Criterion D requiring amenorrhea, or the absence of at least three menstrual cycles, had been deleted. This criterion cannot be applied to males, pre-menarchal females, females taking oral contraceptives and post-menopausal females. In some cases, individuals exhibit all other symptoms and signs of anorexia nervosa but still report some menstrual activity.[14]

This looks good to me, we can wait a few days and see if there is any objection Jinandtonicpark (talk) 14:05, 19 November 2014 (UTC)