It is to be expected that the Diagnostic and Statistical Manual of Mental Disorders, at least when it comes to anorexia nervosa, relies heavily on measures that are hard to quantify and measure objectively. The big exception is amenorrhea: the absence of menses (commonly known as “periods”) for three consecutive months. As I’ve mentioned before, this criterion will be removed from the next edition of the DSM, thankfully. But for now, it is still there.
Perhaps because it is easy to measure objectively, the resumption of menses is often taken to be a marker of “health” and “recovery.” It is a common goal in treatment for patients to reach a “menstruating weight.”
[Conversely, not losing one's menstrual cycle is often perceived by the patient that they are not "sick enough." Their eating disorder is not legitimate because clearly they are eating enough for their menstrual cycle to continue, and thus they should "snap out of it" or they "don't deserve treatment," which is of course not true.]
I often run into questions online with individuals in recovery …
Anonymous asked, “I’ve never lost my period. Weight restored I am naturally thin, but even at a BMI of 15 or so I always got my period (although it wasn’t always regularly). This makes me feel like I’m not actually sick because I hear about everyone losing their period.”
eatruncats replied: “To the anon who asked about losing periods: For all the times she worries about not being sick enough because she never lost her period, there are people who lost their periods at BMIs of 18, 19, and 20 who worry about not being sick enough because they never got to a BMI of 15. If you have an eating disorder, you are “sick enough.” Period.“
As it stands now, amenorrhea–or the loss of three consecutive menstrual cycles–is a diagnostic criterion for anorexia nervosa. Individuals who have not lost their periods are diagnosed with eating disorder not otherwise specified (EDNOS). A problematic catch-all diagnosis that makes up the majority of those diagnosed with eating disorders. I’ve discussed some of the problems with the EDNOS diagnosis elsewhere…
Recovery from an eating disorder is really hard. Unfortunately, the negative effects of that occur as a result of the eating disorder often persist long after recovery. It is hard to undo the mental and psychological aspects of anorexia or bulimia nervosa, but it may be just as hard, if not impossible, to undo the damage done to body.
What are some of the long-term health effects of eating disorders? What do patients with eating disorders – recovered or not – have to live with, for years, often decades, after recovery?
A really common consequence of anorexia nervosa is osteoporosis: thinning of bone tissue and loss of bone density. Unlike delayed gastric emptying - another consequence of EDs - which can make every meal a nightmare (particularly for someone recovering from an eating disorder): acid reflux, stomach pain and abdominal bloating are just some of the symptoms, bone density loss is easy to overlook. You don’t feel its effects (not initially, anyway), you probably wouldn’t even know it is happening. Many are unaware of just how quickly bone health …