h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Yes, well, the image of beauty the media presents might be one of the overall triggers of anorexia. One of the drops
I agree not everyone who is bullied commits suicide. Still, bullying is a serious offence. And showing only one image of beauty is a form of bullying as well.

Oh I agree with you on that - after I posted I thought that it might have been more appropriate to say 'many drops in a small glass'.

I think the media enforces and gives direction to self hating feelings which contribute to the feeling of lack of perfection in all aspects of their life - anorexia being the outlet of some.
Another example of such an outlet is self harm (although that can often be an associated negative behaviour of people with eating disorders too).

Society as a whole continually demands and expects so much of people that they can't physically achieve it all and the constant images of "the body beautiful" are something that is literally in your face and an instant reminder of how much of a failure a person must be. (according to the disordered thinking of someone with ED's)

We measure ourselves against what is portrayed as perfect and model size is an immediate thing we fail at.

Guess what I read in a, sic, Dutch newspaper this week: a survey among males shows that they prefer round and cuddly women(well I do not know the exact English terms) as their spouses. Skinny woman are considered to be more appropriate as a flirt or a mistress. It's really unbelievable the shit they put in print.

I'll address some of these issues in an update tomorrow.

Mikey, do you have an alternative term to "sufferers"? 'Patients' is out of favour in psych circles, while 'clients of mental health services' is unwieldy. So is 'individuals who suffer from the disorder' for that matter. I thought sufferers was accurate and succint, but if you have an alternative, I'll look at using that.

Many changes coming, just too busy at work today...

Matt

In general, patient advocacy groups for just about any disorder generally feel "sufferers" or "suffer with" to be demeaning ways to phrase it. It's not just patient groups, though -- those terms aren't really allowed in most medical journals anymore, either. Neither, for what it's worth, will most journals let you use the the name of the disorder as a noun describing people -- i.e., "diabetics", "anorexics", are all out.

Just something as simple "those with anorexia" or "anorexic individuals" is a lot cleaner and more accurate.

Let me know if you have questions about any of the other points.

Ooooooooo-kay, lots of changes:

-My information on the ratio of women to men was out of date (stupid Oxford textbook, grumble grumble...). It has been corrected, and I've added bits on the growing numbers of non-Western and male anorexics

-I meant to go more into the physical effects of starvation, so that has been remedied. I moved the mention of heart problems up into the symptoms section (it was previously languishing down the at the end of the Entry as a gloomy closer)

-Replaced the term sufferers throughout as per Mikey's suggestion

- Removed the reference to Karen Carpenter - I wasn't too sure about it to begin with, and only included it because when you search for 'anorexia' on hootoo that's the only thing you come up with (that's why I wrote the Entry in the first place)

- Explained more about the watershed weight idea. Delirium was the term I used originally, but it's a technical term which crept in there, and it basically boils down to what I've replaced it with. (A preposition is a terrible thing to end a sentence with sorry)

- Rearranged the description of the symptoms so that the universal problems (distorted body image, refusal to eat) are first, and the purging subtype is clearly identified as such

- Reworded some bits that people saw as perjorative

Other things:

I think that I've described amenorrhoea accurately, as something which some people think may be a sign of an hormonal abnormality which may predispose people to the disorder. It's not identified as a cause any more than other other factor, and I make clear that it's not simply a result of the weight loss (unless my Oxford Textbook is lying to me again). There have been small initial trials using IGF-1 (one of the hormones involved in menstruation) showing good effect on weight, not just periods.

I'm not sure whether I should encourage visits to pro-anorexic websites. They're disgusting and disturbing - not objective at all, I know. It might be worth a mention, but that's as far as I'll go.

I've left out technical descriptions of exactly how treatment is organised - just saying that drastic measures are needed in severe cases, and otherwise the mainstay is psychotherapy. I picked an intersting example of psychotherapy simply because it was interesting to a lay person, probably more so than an organisational explanation of treatment.

I'm going to be away over Easter, but I'm perfectly happy to make more changes when I come back.

See what you think,

Matt

I haven't read the updated version yet but something is ALREADY worrying me! You KEEP referring to the Oxford....is that the only book you're using to write this? If so I'd start cross checking all your info quickly before Mikey comes back

I have yet to see any evidence that amenhorrhea has ever been shown to be an *independent* cause of anorexia, and not simply in the causal pathway -- if you have evidence to that regards, I'd love to see it. And it's definitely inaccurate to say that amenhorrhea *usually* precedes any weightloss -- that is flatly contradicted by just about every study I've read.

The word sufferer is still used throughout, by the way.

I like the article. I have a coworker with anorexia (we weren't sure until we were looking through a magazine that had a pic of a model with it; Beth said; "She's not sick, she looks GREAT!").

I don't have a problem with the word "sufferers". I suffer from fibromyalgia. And I DO suffer. Why is that so patronizing? I'm reminded of a proffesor who told me that I couldn't use "petite" in a paper -- since it reffered to a woman's size, it was considered 'politically correct'. Ridiculous.

Some things might have been left out; but how long do you want the article to BE?!?

I think it was informative and entertaining. I liked it. I said that already; but I did!

Interesting article.

Not sure if this is relevant but here it is anyway: one of the reasons that some people acquire Anorexia Nervosa has nothing (or little, or it only begins with this) to do with their body image, but to do with the amount of contro they have (or feel they have) over their lives.

I was at an all girls boarding school, sadly we had at least one person in each year who had Anorexia, and they often came from families where they were strictly controlled as to what they wore, where they went and who they saw when they went there.

Anyhoooo good to see something like this in the guide. It is very useful.

It is incredibly common in high achievers.

I too believe it is the only way that sufferes (sorry Mikey - can't help but use that term) can have control over some aspect of their lives. There are a few outlets but anorexia is the one that is most physically apparent.

My homelife wasn't very restrictive but I was considered a high achiever and felt suffocated by the expectations on me by being the clever one of the family (amongst other stuff). It seemed that even though I wasn't happy unless my grades fell no-one noticed.

There were many ways I used to 'try to breathe' but when living in a family environment there is little about life that you can control - except food intake.

I've read the entry again. It looks to me.

There seems something to be said for being an under-achiever like me. How are you now, Mort?

"I'm not sure whether I should encourage visits to pro-anorexic websites. They're disgusting and disturbing - not objective at all, I know. It might be worth a mention, but that's as far as I'll go."

Please don't encourage this! I was just pointing out that they exist, and yes, they are very disturbing.

My LC biology textbook mentioned sexual abuse as a possible cause of anorexia. Does anyone have any idea how this might occur?

It goes back to the need for control.

Of course these things are not black and white, but abuse - be it physical, sexual or mental - all feed self disgust, failure and the need for having some control.

There is some theories that the pre-pubescent(sp) body shape and halting of periods is something a sexually abused person may desire.

Although I don't think it is an active thought - more a case that the person feels more comfortable as they see the signs of sexual maturity disappear (or never even begin). These things being a sign that they are guilty of participating in something which in reality they had no control of - the body making them be attractive and conspiratorial in the abuse (in their disordered thinking). Losing these things is a way of protection and denial - even if they weren't sexually mature when the abuse happened, their body betrays their disgust at what they have seen being sexual to be, by they have had forced on them.

I view anorexia as a self-defeating negative coping mechanism that the disordered mind uses to deal with things - from trauma to a feeling of inadequacy (not all anorexics are victims of abuse but what may seem a relatively small thing to some people will be a major trigger to others, or even just the accumalitve effect of small things)

Self harm, other ED's, alcohol, drugs etc are all tools to do the same.

Just my view so I could be talking rubbish.

You know you're not talking rubbish, so why are you saying it. O, o, o, when will we ever learn

I found this to be a good, well-balanced entry that has a lot of information to offer without coming accross as judgemental... difficult to accomplish with some subject matter.

The point about body image is well taken. I know of one support group for anorexics where each of six people around the table was asked to draw a quick sketch, in stick figure format, of everyone at the table, including themselves. Each of them drew themselves as fat and all the others as skinny. (Sorry. No reference. This information was given to me verbally.)

I don't have the technical or medical knowledge to critique this entry for its content, but the style is great as it is.

NBY

I've tidied a few things up and removed the references to 'sufferers' that I missed (hopefully I got all of them this time!).

Looking through my notes on the subject and browsing through the literature, I have to concede Mikey's right about the amenorrhoea thing. The theory about it being an independent cause appears in my notes from a paediatrics tutorial, but not anywhere else. It appears I've been the victim of a practitioner's pet theory - sorry.

Matt

I still reckon you should address Mikey's other points Matt. Regardless of the people who are saying they like it the way it is, I REALLY feel that those things are important. It's no good if some people like it and others don't. I'm DEFINITELY in your target audience for this entry and I think that with Mik's points it can be better. Currently I still feel isolated by it.

Kats

Hi Kat,

I've already answered quite a lot of Mikey's points, I think. If the general impression you get is still a bit isolating, could you suggest some specific things I could reword?

To clarify, here were Mikey's points:

1. "I'd take out the bit about Karen Carpenter in the beginning -- I think people either know who she was (in which case they generally know she was anorexic as well), or they have no idea who she was (in which case the reference is completely unhelpful)."

Done.

2. "The phrase "psychiatric eating disorder" is rather redundant. "

Done.

3. "In the first paragraph, you appear to define Anorexia as "excessive exercise and purging", when that's not how it's defined at all -- the true hallmark of the disorder is an unhealthy weight restriction prompted by an inaccurate body image. Excessive exercise and purging are two ways that those with anorexia can restrict their weight, but they are far from the only ways and are not required for anorexia to be diagnosed."

I've changed the definition so it's clear that exercise and purging are a subtype (albeit a reasonably common one) of anorexia, and aren't universal.

4. "I'm in general against using the word "sufferers" to describe any medical or psychological condition - it's patronizing and demeaning."

After a few false starts (sorry) this has been fixed.

5. "There are several things you describe or say, in which you give the impression that they are true for *all* people with anorexia, when they would not be. Hiding food would be one -- it may be common, but it's not universal."

I've reworded several parts, including the hiding food example, to make this clearer.

6. "I would emphasize that growth as well as sexual development can be stunted. And it's not only an issue during the early phases of adolescence -- even for someone who develops an eating disorder during later years, the secondary sexual characteristics are often the first to go for a woman. And stunting of growth and sexual maturation can even be an issue for those who are in the later stages of puberty -- if any sort of development is still happening, weight restriction can hamper that development."

Done.

7. "There are also several ways in which you word things that can come across as blaming the individual for their disorder. I'd suggest rewording such things as "punishing exercise programmes" and "They tend to put too much emphasis on their body shape to determine their self-esteem (discounting their other, non-physical qualities)."

Fair call. I've reworded them accordingly.

8. "Actually, excessive exercise falls into the same subgroup as those with other forms of purging. It's basically "restriction only" on one hand, and "excessive ways of getting rid of calories" on the other. This entry as a whole pretty much ignores the "restriction only" variation."

See my response to #3 above.

9. "It's not just unheard of for men to have anorexic symptoms, men can also develop the actual disorder -- and as the rates of men have been jumping rather markedly over the last decade, I would not downplay it to the degree you have here."

Reworded this in the "Who gets it?" section. Again, my bad.

10. "You describe ammenhorrhea as a *cause* of the disorder rather than as a *symptom*, which is incorrect. Yes, it is a symptom which can actually worsen the disorder -- but it is not an actual cause."

See my post above - it's now been addressed.

11. "You haven't mentioned that ballet dancers and gymnasts (for women) and wrestlers and jockeys (for men) are at far greater risk for developing anorexia, in large part because of the emphasis these disciplines place on body weight, especially at the elite levels."

It's now in the "What causes it" section.

12. "I would probably also mention that while eating disorders used to be seen as restricted to whites, this is no longer the case - there have been significant rises in diagnoses across other racial and ethnic groups in recent years."

Mentioned in "Who gets it?" now.

13. "The genetic role seems to be largely mediated by personality type, perhaps even more so than via anxiety disorders, etc. As opposed to other eating disorders, anorexia is more likely to affect those with perfectionist tendencies, and those who are not assertive in everyday life."

I've mentioned this briefly, but perhaps it could be expanded upon (Mikey's not the only one to have mentioned it). Any ideas on wording?

14. "You seem to completely ignore the effects on the body of anorexia -- the cardiovascular effects are incredibly important, and I would probably mention things like body hair growth and head hair loss as well."

Done.

15. "Rather than focusing the treatment section on type of psychotherapy used, I'd probably divide it by: inpatient treatment (often focused on stabilization of medical symptoms and tube feeding), day treatment (intensive outpatient), outpatient counseling (often used in the long-term as maintenance, and including both nutritional counseling and psychotherapy), and medications (including, but not limited to, psychotropics). "

I've answered this above. I'm inclined to think that the way I've done it is more interesting to a lay person, whereas Mikey's would be more useful in a healthcare person's article. Don't get me wrong, it's really a good point, but it's just a difference of style really.

16. "The bit on watershed weights seems to rather miss the point, to me. The main thing is that having an extremely low body weight actually has a significant impact on the brain and thought processes, and this does not come through clearly. It's after reaching this "watershed" weight that a patient is able to think more clearly, and decide whether to participate more fully and intentionally in treatment."

It was a bit fuzzy the way it was worded before, but I think it's a lot better now.

17. "I would probably also add that in many treatment settings, it's possible for an unhealthy competition to arise between those with anorexia - centres that specialise in this are generally well aware of this potential and take steps to prevent it from happening. "

I'll add this now.

Maybe the whole tone is a bit intellectual and clinical - I AM a doctor, though, so to a certain extent I can't change my style. Maybe it needs personal experiences or something else to make it more accessible to others. We collaborated on the anxiety Entry, have a think about whether there's anything else you can add to improve this one.

Matt

Oooh, and I clarified some stuff on twin studies and addressed one or two of Mort's changes.

As for Mort's other comments: the 'drops in a bucket' image is one I actually agree with, unfortunately (as with so much of psychology) actual evidence is thin on the ground, so I haven't included it. Even Mort was saying that it's more conjecture and discussion around the topic rather than explicit advice for the Entry itself.

Matt