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| Thu, 10-23-2003 - 6:41pm |
I have a question for you...Do therapists/psychologists generally stick by the book (DSM-IV) for diagnosis? Why am I asking? Well, I'm currently working on my psych degree, then off to grad school to specialize in treating women w/ eating disorders.
In order to be diagnosed as anorexic, one of the first guidelines is that you must be 85% what is considered "normal" for your weight and height. This rule bothers me.
While in highschool, I starved myself for over a year. (Sorry, I do not want to bring up numbers but I feel this is relavent.) In about 6 months I went from 200 lbs. to 115 lbs. According to the BMI (Body Mass Index) 115 pounds is just below average (for my height). However, I was starving myself, lost my periods, lost hair, grew extremely sensitive to temperature change, etc. (Basically, had all of the symptoms and signs as someone w/ an eating disorder.) I was afraid to talk to a psychologist because I was not a skeleton yet, I didn't look "anorexic." And I did not meet all of the criteria neccessary for diagnosis: I was not yet 85% of a normal weight.
So, what I'm trying to say...Can someone who is at a "healthy" weight be diagnosed as anorexic based on: self starvation, an intense fear of gaining weight, amnnorhea, etc. ? I'm just worried that I won't be able to help people who are hurting inside but do not yet meet the "standards" of anorexia (though they most likely will if they continue to starve and eventually reach that 85% of what is normal).

Hi there Sara!
Although I'm actually a lawyer, I've gone back to school to get my PhD in counseling psychology - so I thought I'd give you my opinion on your question/concern.
First of all, it's my understanding - and experience - that a lot of psychologists never actually crack open the DSM-IV when making a diagnosis. This means that they make their diagnoses not necessarily on the technical criteria as listed in the DSM, but more on their general knowledge of pathology. In other words, I think that someone meeting the criteria you set out in your post would still be diagnosed with anorexia most of the time even though she didn't techinically meet every requirement (such as the 85% rule).
Secondly, a lot of people get treatment for subclinical disorders. And finally, there's always that great "NOS" category - "not otherwise specified" - which is pretty much a catch all for everything that is pathological (disordered) but doesn't fit in one of the other categories.
So, although it may be more difficult in some ways, I think that a lot of people whose eating disorders don't rise to the clinical level can still ask for and receive treatment. But, I'm not sure that having treatment available necessarily gets to the other problem you mentioned - that those with subclinical disorders often don't feel as if they're "worthy" of treatment. "I'm not thin enough to deserve help; My eating disorder's not bad enough for treatment," and so on. In fact, even though my eating disorder clearly meets the diagnostic criteria for B, all of those same thoughts went through my head. I thought, "I'm just a big baby; I need to just get over myself; there are others so much worse off than me, so why will anyone want to take time to help ME?" And actually, I still have those thoughts sometimes, but thankfully have managed to overcome them for the most part and see that *everyone* who is struggling (no matter how much or how little) deserves help and empathy and understanding!!
Take care, and best of luck with your career. You obviously care a lot about people, especially those who struggle with eating disorders, like us.
Grace
Take Care,
Sara Rose
Thank you so much for helping me understand, and for the positive encouragement! I'm sure one day, you'll be able to go back and finish that degree that you've wanted because you seem like a very strong person...and have a beautiful daughter by the way.
Take Care,
Sara Rose