I thought I wasn’t thin enough to be anorexic

BMJ 2017;359:j5378

Caitlin S, 17, and her mother, Sally, talk about what helped, and what didn’t help, when Caitlin developed anorexia

Comment by Brian Maurer, PA-C

This piece highlights the issue of the distorted body image that patients with anorexia nervosa manifest.  Although this adolescent dropped her weight by 10 Kg, she didn't recognize that she had developed AN because (1) her BMI remained at an acceptable level, and (2) her perception of a desirable body habitus was reinforced by social media.

It is interesting to note that this adolescent started to buy into the fact that she was sick after her doctors and caretakers educated her about her eating disorder and supported the diagnosis with facts.  Many patients suffering from AN forcibly push back against the diagnosis, as they continue to perceive their distorted body habitus as normal and desirable.

This case also raises the issue of how a patient with a body image disorder might relate better to a clinician/counselor/caretaker of the same sex, particularly when the patient is an adolescent female.

Widespread use of social media among young people has resulted in an uptick of anxiety, depression, cyberbullying, and suicide in this age group.  Clinicians who care for adolescents need to be aware of these influences as they evaluate and care for patients who suffer from eating disorders, mental illness, suicidal ideation and abuse.

BTW, the latest eating disorder to hit the DSM-V is ARFID, avoidant/restrictive food intake disorder. While similar to AN, patients with ARFID lack the distorted body image component.  We follow a handful of kids who meet the criteria for ARFID in the practice.