Post Punk Kitchen Forum

Oh god. I accidentally ran into that site recently. It was linked with a warning from a makeup blog, but I followed it anyway and wanted to throw up. It literally made me dizzy-nauseus, complete with buzzing in my head.

I know the Internet is full of nasty stuff, but I liked life better before seeing the existence of "thinspiration" sites myself.

Nobody follow that link!!, you'll be really super sorry.

I am so angry/upset about that site that I'm having a hard time forming one really good statement about it. Every time I go to type something, I erase it. I'm so frustrated by this.


What? Part of the criteria to be diagnosed with anorexia nervosa is to have lost/not maintain x% amount of body weight. It's right there in the DSM-IV.

You really will.
Man. I was having a really good morning until my curiosity got the better of me.
I had never seen an actual thinspiration site before.
Don't these people have real things to worry about than other people's bodies?

I was just in a line up at the drugstore and one of the tabloids at the checkout had the headline "Katie Holmes is Skin and Bones!" and the young girl behind me picked up the same magazine and said to her boyfriend: "That's how I want to be - skin and bones." Her boyfriend didn't respond. I'm not inside this girl's head or anything, but just from how she said it, I don't think she was kidding.

I actually agree with the quote. The BMI is a terrible tool for ascertaining whether a person's weight is healthy or not. My BMI is very low, but every doctor I have ever had has said I am a healthy weight for my frame, etc. Also, there really isn't a BMI standard for anorexia. BMI has nothing to do with weight lost or maintained. It's a simple computation of weight to height.

That site is horrendous, though. If all you have to be proud of is how skinny you are, you're a sad forking crasshole.

Exactly. Just skimming it made me feel like my head was going to explode. I hope the blogger gets the help she so obviously needs, but her hatefulness and "thinspiration" are just corrosive; who reads (and approves of) that stuff? If the only thing taking up space between your ears is snark about the size of other people's thighs, I'd say it's time to make some serious reassessments.

But there is a DSM IV criteria for anorexia nervosa that involves weight. I believe it's failure to maintain 85% or more of a normal weight. It doesn't define normal weight, but putting that together with the lowest "normal" BMI (I think BMI is pretty dumb, honestly), gives you a "BMI criteria for anorexia" of a little over 16. That's not the *only* criteria, but it is one of the criteria, and if most models have a BMI of 16 or less, then they do meet the BMI criteria for anorexia (even if they don't actually have anorexia).

But I get your point that laypeople shouldn't be diagnosing others with anorexia and that anorexia shouldn't be diagnosed solely on the basis of weight. I just don't think that's what the magazine was doing.

Yes, this. The definitions for eating disorders are problematic, that's well known and that's why they're revising the requirements for anorexia nervosa for the upcoming DSM V and are also adding another eating disorder in.

Sure, but when people say things endorsing an extremely flawed interpretation of a flawed diagnostic tool, which is what I think statements like "x% of models meet the BMI criteria for anorexia" are, then I will take issue. I'm sick of the idea that we, non-doctor observers, get to diagnose people based on weight, appearance, etc. That includes diagnosing people based on questionable internet articles and data parsed from google searches.

The magazine quote wasn't diagnosing the models, it was stating that x% of models fall within the weight range for anorexia nervosa which can be implied that they're not representing the average person; they're representing an ideal weight that's extremely dangerous and that many people with eating disorders strive for. I don't believe they were trying to "diagnose" a group of unnamed models, my interpretation was that they were trying to make a point about body image in the fashion industry. Anyway, my problem was with the SkinnyGurl's quote and you can't deny that there is a weight requirement to be diagnosed with anorexia nervosa, it's right there in the DSM IV and you can look for yourself. Just because you don't agree with the way something is done, doesn't mean that's not how it's done. You can take issue with the quote from the magazine but when you say that you agree with the quote from SkinnyGurl, that's a whole other issue. She's wrong and there's a book that psychologists and psychiatrists use to diagnose anorexia that proves this.

So, a person who weighs 300 pounds but who meets every other criteria for an anorexia diagnosis is not anorexic because of their BMI? What about people who have an "anorexic" BMI but are not anorexic? I'm not trying to be a dick, but I don't understand what you're saying. You're using a benchmark that I am not seeing. You said above that the weight requirement in the DSM IV for anorexia is "failure to maintain 85% or more of a normal weight." I get it, but what I am missing is what constitutes a "normal weight" within the bounds of the DSM IV. Is it defined somewhere within? Is there a reference to what BMI constitutes "normal weight?"

You're saying there's a BMI reference in the DSM entry for anorexia, but I don't see where it references BMI, I suppose is what I'm trying to say.

In the past I've read that there is some part of diagnostics that references BMI (can't lay my hands on a reference at present) but I've always had difficulty with that. During two times in my life I may have been diagnosed anorexic if it wasn't for my BMI. It feels almost as though eating disorders need to be visible to be believed, sadly as is the case with many conditions.

I just looked at it, and I don't see any reference to BMI, only "normal weight." I imagine that "normal weight" may be determined based on BMI, but it's not clear how exactly "normal weight" is being determined, unless there is a definition or guide elsewhere within the DSM IV.

The way DSM IV works (if I'm remembering correctly) is that a person has to meet most or all of the criteria to be given a diagnosis. So *one* of the criteria for anorexia nervosa is about weight. Someone who weighed 300 pounds but otherwise met the requirements for anorexia nervosa would probably be diagnosed with EDNOS (eating disorder not otherwise specified). As someone who was diagnosed with EDNOS at one point, I know you can meet a lot of criteria for either anorexia nervosa or bulimia nervosa but still not get the actual diagnosis. As far as I can tell, BMI is not mentioned in the code description, but every therapist or psychologist I talked to used BMI (e.g., my BMI was below the normal range but higher than the range required by the diagnosis criteria).

I don't think any of this is incompatible with the idea that you shouldn't diagnose people with eating disorders solely on the basis of weight or appearance. I totally agree with you that that's a horrible thing! But the article wasn't doing that. It didn't state that the models had anorexia nervosa, only that they met the clincal BMI criteria, which (if they have BMIs below about 16) is factually correct (again, doesn't mean they actually have anorexia nervosa). And, of course, we can take issue with the way anorexia is diagnosed and the way the DSM IV codes are written, but... that's not what the woman talking about the magazine was doing.

My take away from this is that it's not great that the vast majority of models have a BMI that for most (not all) people would be unhealthy. Models should come in all shapes and sizes.

Thanks - I understand and totally agree. However, I still just don't see where there's a clinical BMI criteria for anorexia, and that is my problem with the magazine article. I don't at all disagree with the assertion that holding up one body type as The Ideal is super forked up and terrible. However, given that I can't find a BMI indicator for anorexia (beyond an implied reliance on BMI by clinicians to apply the DSM standard), I don't think it's terribly honest to say that x% of models meet the BMI criteria for anorexia, since there doesn't appear to be one. Does that make sense? Am I blind? Is this real life? Help!

Well, we'd probably need to consult an actual psychiatrist or psychologist to be sure, but (as I mentioned above) I've never encountered any therapist who measured the weight criteria with anything other than BMI.

Here's an article that specifically mentions the DSM IV having a stricter criteria that is 17.5 for people over 20: http://ajp.psychiatryonline.org/article ... eid=174185.

Like I said, I'm not necessarily agreeing with this, but AFAIK, yes, BMI is part of measuring anorexia nervosa, and while there might be some disagreement about where that cut off is (17.5 vs. the 85% of normal), most models fall in this range. The woman who responded to the article by acting like this was ludicrous doesn't appear to have done any research and is throwing out misinformation (like the idea that anorexia nervosa is not diagnosed in part by looking at a person's weight).

I see. Thanks for your responses!

I guess what it comes down to is that while BMI may play a part in diagnosing anorexia, and while clinicians may have or use particular cut-off points for diagnosing the disorder, it isn't as simple as "a BMI of x or lower is one of the diagnostic criteria for anorexia." That's pretty much what I'm clumsily trying to get at when I take issue with statements like "x% of models have BMIs that meet the diagnostic criteria for anorexia." It's not that simple, and that's why I think saying stuff like that is a problem.

I get what you're saying, JoPa - as a bald statement it's as nonsensical as saying someone has a BMI measurement that means they are a Compulsive Eater. I wonder if it's partly being used because the target readership of the original article would not know what DSM-IV is?

I've been studying neuropsychology for the past 5 years and in my studies we've always used BMI to determine "normal weight", personally I've never seen anything else used within a clinical setting. I don't agree with it but so far, that's the way it's done. That's what leads so many people to fall within the range of EDNOS and it's ridiculous. It's even worse when you get into the insurance aspects which is where a lot of this garbage comes from- insurance companies look for any way that they can to deny you coverage for your health care. A big part of diagnosing people is trying to convince the insurance company that they need to pay for your health care, which usually requires you to set up a contract with your therapist and/or psychiatrist. In the upcoming, revised version of the DSM, there's going to be a larger weight spectrum for patients to fall within to be diagnosed with anorexia.

"If everyone in the world had the same BMI as you, it would remove 29,220,829 tonnes from the total weight of the world's population"

Well, so what? Would that be a good thing in any positive way or just a relief for the self-righteous skinny folks who don't have to look at the fat folks? Is the world going to collapse from all this weight?

Stupid.

Ugh. Obnoxious.

I do find it a tiny bit funny that when I plugged in my stats it told me I am fatter than "100%" of women my age worldwide. I am the fattest woman in the WORLD???? DO I WIN A PRIIIIIIIIIIZE??? haha.

If those stats are true, why have I not seen your sporky face in the Daily Mail???

Haha, that site is ridiculous! I don't get what the hell it's trying to prove. It told me that I am most like someone from Samoa based on my BMI, that's cool I guess.

Slightly off topic, but as someone who has fallen into the different ED diagnosis there was definitely a BMI under which you are classified as anorexic, I spent a long time striving for it, I reached it and when I went above it I found that I was treated a lot differently as an ED'd patient. Even worse when I was in treatment for bulimia and had a BMI that moved between healthy and overweight the treatment I got was below what it should have been. I was extremely ill, passing out left, right and centre and yet I had to request blood tests from my GP because the psychiatrist never bothered. Luckily in the UK I didn't have the added stress of insurance.

There is also is a BMI under which someone is classed as anorexic, not the mental disorder but the weight category, I believe?