ers (DSM-IV) (1994) as distinct disorders. Instances of combined anorexia and bulimic symptoms have now been identified as one of two subtypes of anorexia nervosa.
The essential criteria for a diagnosis of anorexia nervosa are identified in DSM-IV (1994). The anorexic individual refuses to maintain a normal body weight, with underweight defined as 85% of normal weight for the person's age and height. The person's extreme fear of becoming fat is not reduced by the loss of weight, and the fear may even become more intense as weight decreases. There is considerable distortion of body image, but the individual sufferer may feel that weight loss is needed in a particular body part or that it needs to be general. The anorectic also displays amenorrhea due to abnormally low levels of estrogen resulting from the severely decreased pituitary secretion of luteinizing and follicle-stimulating hormones. Thus menarche is often delayed in prepubertal anorectics and menstruation ceases in many older victims. Other frequent characteristics of the disorder include ritualistic treatment of food, excessive exercising, and obsessive weighing, measuring, and viewing of the body.
Dual diagnoses of anorexia and bulimia were often made in cases where both sets of symptoms were displayed. But DSM-IV (1994) distinguished bulimic and restrictor subtypes of anorexia nervosa. The distinction was based on differing levels of various associated symptoms or potentially predisposing conditions between anorectics with bulimic symptoms and those who only restricted their intake of food. But data justifying this subtyping is sparse and more studies, such as the successful demonstration of significantly different rates of recovery between the two subtypes (Herzog et al., 1996), are needed before the distinction will be widely accepted as definitive.
Two subtypes are also distinguished for bulimia nervosa in DSM-IV (1994). The basic criteria for a dia...