Psyched Out

Anyone want to petition the American Psychological Association with me to remove the weight requirement from the anorexia nervosa diagnosis in the DSM 5 (psychiatric Diagnostic and Statistical Manual)?

That's right. No matter how malnourished and close to death you are from self-starvation, no matter if you meet every single symptom (what you report) and sign (what the diagnoser observes) of anorexia nervosa, if your BMI is 81% or more of the lowest "healthy" BMI, you can't be diagnosed with Anorexia Nervosa. My local inpatient hospitals take patients off behavioral plans and starvation precautions the second they hit 81% of "Ideal weight" - 82 lbs for someone my height (5'2') and 116 for a person a foot taller than me. Needless to say, this is less than helpful to my patients.

Did you notice that even at starvation level, we're only allowed a THIRTY FOUR POUND difference over a foot of height? That's less than four pounds per inch of (usually) torso.

GROSS OUT WARNING! SKIP the next paragraph if you are squeamish!

Anyone who has ever seen the "human steak" cross sections at the Chicago Museum of Science and Industry (or anywhere else) can appreciate that this is kind of ridiculous. If I had 32" circumference steak that weighed four pounds for my St. Patrick's Day party, people would think I'm a skinflint because I can guarantee it wouldn't be an inch thick.

Not to mention, putting a *weight* requirement in a psychiatric diagnosis would seem bizarre to anyone not bred in our fucked up culture. I mean, there's no requirement that we withhold the bipolar diagnoses from everyone not in the TOP 20% of BMI measures because everybody knows only REALLY fat people are "jolly." (Yes, I'm aware that mania isn't a bit jolly to live through - but it makes as much sense as labeling only REALLY thin people "starving.")

People can be dangerously malnourished at ANY weight - indeed, about half of the "10 fattest people" in a Dimensions article had died of malnutrition/starvation trying to lose weight. Even when the DSM was originally assembled, there were actual medical tests to diagnose malnutrition that were far more accurate than body weight, for crying out loud. Electrolyte levels. Anemia. Micro and macro nutrient deficiencies. Chronic dehydration. You know, all the problems bariatric surgery survivors (I say survivors both because this surgery is often fatal, and because it is deliberate amputation and mutilation of healthy organs.) encounter down the line.

Malnutrition, not weight, needs to be the basis of determining whether dieting has turned into self-starvation.

Of course, that would force psychiatrists and psychologists to acknowledge that the medical framing of self-starvation as pathological behavior for the thin and a "healthy lifestyle" for the fat is unscientific, superstitious and based on hatred rather than reason.