Anorexia nervosa, bulimia - medical causes of eating disorders - symptoms, treatment, diagnosis
How Belief Skews Perception


Defining the Terminology | Diagnostic Criteria | The Author Tells His Story | More Misdiagnosis Cases | A Quick Overview of the Genesis of Anorexia Nervosa | Medical Disorders And Conditions That Can Cause Anorexia, Weight Loss, Or Vomiting | Medical Tests | Diagnostic Deficiencies | A Message To Parents | A Message to Physicians | A Message to Therapists | A Quick Lesson on Human Nature | A Skeptical Look at the Conventional Wisdom | Public Awareness Campaigns Backfire | Depression and Anorexia | Classical Conditioning and Anorexia | Obsessive Compulsive Disorder | Excessive Exercise | Perfectionism | Sexual Abuse and Anorexia | Laxative Abuse | Bulimia Nervosa | Starvation Response | Malabsorption and Weight Loss | Body Mass Index : A Flawed Concept? | The Anorexic Voice | Art Therapy | Pro-Anorexia Web Sites | Celebrity Role Models | How Belief Skews Perception | Vegetarianism and Anorexia | Disturbing Trends in Medicine | Eating Disorder Clinics - Medical Testing | Frequently Asked Questions | About the Author | Contact Us | Bibliography | Disclaimer | The Future of Eating Disorders

Convictions are more dangerous
enemies of truth than lies.
                                                                Friedrich Nietzsche
If you firmly believe that UFO's are alien spacecraft that are responsible for crop circles and the like, you'll probably become very excited when you see strange lights moving erratically in the sky or if you see geometric patterns in a wheat field. What you may not realize is the effect your strong beliefs have on your perception of these phenomenon and your interpretation of them. You will unwittingly look for confirmation of these beliefs in what you observe. You likely will not thoroughly investigate whether the patterns were the work of a prankster, nor investigate whether the strange lights in the sky may be an illusion created by atmospheric conditions.
In like fashion, if you believe in faith healing, you may be firmly convinced that the people at the prayer meeting are actually being cured of their arthritis, cancer, or chronic headaches. It's unlikely you'll demand to see a before -and -after CT scan of the tumor, or monitor the headache sufferer for the next few years to see if they actually were healed. This is because your strong beliefs affect how you interpret what you observe. You need only minimal evidence to convince you that what you're observing fits with your belief. In fact, you may tend to ignore or dismiss anything that would make you question those beliefs.
This loss of objectivity also afflicts many eating disorder counsellors and therapists. Their belief system, instilled through their schooling and training, affects how they interpret the behaviors and symptoms of the anorexic patient. They generally will not thoroughly investigate whether their interpretation of what they observe is actually true.
Most  therapists will believe that depression plays a role in causing anorexia nervosa. They observe that many, if not most anorexic patients are depressed and often suicidal, so this is interpreted as a confirmation of their belief. No attempt is made to find out if the patient was depressed before the onset of the illness, or if it developed as a result of the disorder.
They may also observe that the patient gets good marks in school or is quite particular about certain things. This will confirm their belief that perfectionism is a predisposing factor, and that psychotherapy will be required to correct this dysfunctional behavior. What would normally be accepted as a positive trait, that being the pursuit of excellence, is now viewed with disdain. Derogatory terms like "chronic pleaser", or "obsessive" are used to describe their personality. They don't stop to consider that to excel at just about anything these days, you have make every effort to achieve excellence. The musician must be a perfectionist. One wrong note may spoil the whole concert. The aircraft engineer must be a perfectionist. One faulty part may result in the deaths of hundreds of people. The competitive figure skater must be a perfectionist, as even a slight underrotation on a triple lutz may cost him a medal. Why is the pursuit of perfection not viewed as dysfunctional in these people? It is a necessary characteristic of any high achiever.
The refusal to maintain a suitable body weight is seen as confirmation of the belief that anorexic patients suffer from an obsessive-compulsive disorder and that their perfectionist personality causes them to pursue thinness at all costs. No effort is made to find reasons why is it is so easy for the patient to not eat. Most people find it extremely hard to lose weight , and so once they've achieved their desired weight or fitness goals, they are eager to indulge in their favorite foods again.
Any excellence achieved by the patient in any area is often seen as evidence of the obsessive compulsive disorder. With the subjective nature of these evaluations, I wonder if most therapists wouldn't diagnose every world-class athlete, every accomplished musician, or successful business person as obsessive-compulsive. I believe a pattern starts to emerge in modern psychology where these buzz-words become the catch-all diagnosis for just about everything. Seems like just about all of us now suffer from low self-esteem, obsessive-compulsive tendencies and self-doubt. 
Exercising excessively is viewed as a compulsion induced by the obsession with weight loss. No effort is made to understand how the patient's body mechanics have been affected by the combination of malnutrition and exercise, giving an extraordinarily high strength-to-weight ratio. This allows the patient to do far more situps than normal before getting tired. Nor does the therapist understand how the anorexic patient has gradually adapted to their malnutrition so that they do not feel tired or weak. Or for that matter how  hypothermia (due to their low body mass and high surface area to volume ratio and also from metabolic imbalances) causes involuntary muscle oscillation even at normal room temerature (when you see an anorexic patient's leg bouncing up and down when they're sitting, ask to see their arm or leg and you'll notice goosebumps). Catch yourself the next time you start getting cold and you'll find your legs bouncing up and down without consciously thinking about it.
The urge to be hyperactive may also be a normal adaptive response to starvation that has been written into our DNA through millions of years of natural selection. Certainly, starving nomadic peoples or hunter-gatherers that had this hyperactive response would be far more likely to catch elusive game or travel great distances to better food sources, thus ensuring survival. 
The exercises engaged in by the anorexic patient are almost always seen as excessive, although compared to what any world-class athlete does, it is only a tiny percentage. If the patient is doing more than a few dozen situps or pushups, this is seen as compulsive behavior. Since the therapist may only be capable of  a few situps, perhaps this is seen as a reasonable limit (the average American teenage girl can do 9). I wonder what sort of diagnosis they would give Richard Knecht,  who set the world record of 25,222 consecutive situps in 11 hours, 14 minutes at the tender age of 8 in 1972.
Running is also a common exercise for anorexic patients, although determining what is excessive is quite subjective. Most patients only run a small fraction of what a world-class athlete would. Certainly far short of the world record non-stop run of 352.9 miles by Bertil Jarieker or Sweden in 121 hours  54 minutes from May 26-30, 1980.
As you can see, it is important to recognize just how subjective many of the diagnostic criteria are when it comes to assessing patient behavior. It is important, especially as a parent of an anorexic patient, to be skeptical of the therapist's interpretations of your child's behavior, as their beliefs may skew their perception of what is actually happening to your child.