How did your anorexia nervosa start?

Society and addiction

Monika Gerlinghoff

To person

Dr. med., born 1939; Senior physician at the Max Planck Institute for Psychiatry and head of the Therapy Center for Eating Disorders, Munich.
Address: Max Planck Institute for Psychiatry, Therapy Center for Eating Disorders, Schleissheimer Strasse 267, 80809 Munich.
Email: [email protected]

Herbert Backmund

To person

Dr. med., born 1931; Neurologist, Munich.
Address: like M. Gerlinghoff.
Email: [email protected]

Publications by M. Gerlinghoff and H. Backmund, among others: Therapy of anorexia and bulimia. Instructions for independent action, Weinheim 1995; (together with Norbert Mai) Anorexia and bulimia. Understanding and coping, Weinheim 2001 (3); Eating has to be learned, Weinheim 2003.

Eating disorders are a disease for which biological and psychosocial as well as sociocultural factors are decisive. The most important sociocultural factor for the development of eating disorders is the prevailing ideal of beauty: slim is beautiful.


Anorexia nervosa is considered an eating disorder from a medical point of view. This includes bulimia nervosa and binge eating disorder. Although all three forms of eating disorders are each referred to as addiction in the German name, according to medical criteria, such as the diagnostic guidelines, they are not part of the actual addictions, nor are they abnormal habits.

Eating disorders are diseases. Their characteristic symptoms are specified in the internationally used lists of diseases (International Classification of Diseases, ICD) or mental disorders (Diagnostic and Statistical Manual of Mental Disorders, DSM), with somewhat different details.

Anorexia is characterized by an abnormally low body weight that is either 15 percent less than expected weight or a BMI (body mass index; kilograms divided by height in square meters) of 17.5 or less. Weight loss was self-induced, either through greatly reduced energy intake, through significant increases in energy-consuming physical activities, or through abuse of laxative or diuretic drugs. In addition, there is a morbid fear of becoming "fat" and a pathologically distorted perception of one's own body, a so-called body schema disorder, which can often relate to individual regions, for example the abdomen or thighs.

Characteristic of bulimia ("bull hunger") are cravings or eating attacks, usually referred to by those affected as "binge eating", in which large quantities of food are swallowed in a short time. The DSM-IV (DSM, 4th version) gives time information on the frequency of such attacks such as "3 months on average at least twice a week". Another diagnostic feature of bulimia is the attempt to counteract the fattening effects of overeating through various so-called compensatory measures: self-induced vomiting, abuse of laxatives or diuretic substances, fasting or excessive physical activity.

For both anorexia and bulimia, the American Psychiatric Association (APA) introduced the "exaggerated influence of body weight or figure on self-assessment" as a diagnostic criterion in the DSM IV [1] in 1994. This dependency of one's own appreciation of those affected on appearance and figure did not exist in earlier versions and is formulated more clearly in the DSM-IV than in the International Classification of Deseases, 10th version (ICD-10).

For binge eating disorder (BED) so far only so-called research criteria have been defined in the DSM-IV; In the ICD-10 it can be classified under the so-called "Not Specified Eating Disorders" (NNB). In terms of its characteristics, BED is similar to bulimia. Here too, food cravings occur, but those affected do not take any compensatory measures to avoid weight gain. In the case of food addiction, obesity gradually occurs; The diagnostic criterion required is considerable psychological stress due to one's own eating behavior. This type of eating disorder is likely to become more common. The demarcation from bulimia and the role of binge eating within eating disorders is still being discussed. [3]

Anorexia, bulimia, and food addiction can merge over time. There are two types of anorexia, depending on whether other compensatory measures are used in addition to starvation and excessive exercise (so-called restrictive or ascetic type) (binge-purging or bulimic type). More than half of the "ascetic" anorexics break through the restrictive behavior; Occasionally, and then more and more frequently, those affected eat much more than they originally allowed themselves to eat and then try to counteract the threat of weight gain. An anorexia of the ascetic type becomes an anorexia of the bulimic or binge-purging type. If an anorexic person exceeds the BMI limit of 17.5, the diagnostic criteria of bulimia nervosa apply. An anorexia can also develop from an overweight or food addiction without accompanying psychological disorders. So even with eating disorders it is very important to take a precise anamnesis of the development of the disease over time.