Recognition of the Illness among Patients with Anorexia Nervosa : from Interviews Regarding Body Image among Patients with Various Eating Disorders

Abstract

Objective : Patients with anorexia nervosa (AN) often show an absence of concern about emaciation, even when advanced, and defend against therapy to improve their emaciation. Therefore, these patients could be considered to have no recognition of their illness. Not only patients with AN but also patients with bulimia nervosa have body image distortion, which is recognized to be influenced not by perceptual disturbance but by affective, or nonsensory factors. We interviewed patients with eating disorders about their evaluation of their own body as well as their desire about their body in order to explore the issue of the anorexic's recognition of illness. Subjects and Method : Subjects consisted of 402 patients (10 males and 392 females) with various eating disorders, which including 92 patients with the restricting type of AN (AN-R), 46 patients with binge-eating/purging type of AN, 12 patients with purging type of AN, 39 patients with subclinical AN, 147 patients with purging type of bulimia nervosa, 28 patients with nonpurging type of bulimia nervosa, 4 patients with subclinical bulimia nervosa, and 34 patients with eating disorder not otherwise specified. The mean BMI of these patients was 16.7 (ranging from 8.4 to 32.4). We asked the following questions during the first contact with our clinic. (1) "Do you think you are too thin?" (2) "Do you want to lose more weight?" (3) "Do you hate to gain weight?" (4) "Do you think any parts of your body are too fat?" (5) "How much do you want to weigh?" Result : Among patients with a BMI less than 16, 86% thought that they were too thin, while 97% of patients with a BMI more than 18 did not consider themselves too thin. Of patients with a BMI more than 18, 80% wanted to lose more weight, while 90% of patients with a BMI less than 16 did not want to lose more weight. The same pattern was found among patients with AN-R only. Even among patients with a BMI less than 16, 67% hated to gain weight. The percentage of patients who answered that some parts of their body were too fat increased in proportion to BMI, although even some emaciated patients thought that some parts of their body were too fat. The mean self-stated ideal weight was correlated with BMI and actual weight minus self-stated ideal weight also correlated with BMI. Conclusion : This study suggests that most anorexics with a BMI less than 16 were aware of their emaciation and wanted to gain more weight, although they imposed a low ideal weight. However, they hated gaining weight despite being emaciated. The dissonance between fear of gaining weight and perception of emaciation might induce a lack of concern about emaciation.