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Anti-DepressantThe purpose of criterion (the preoccupation isn’t better accounted for by another disorder) is to ascertain that people with anorexia nervosa and certain other psychiatric disorders don’t get misdiagnosed with BDD. Anorexia nervosa is a disorder in which people—usually young women—think they’re fat and lose excessive amounts of weight to avoid being fat; in reality, they’re terribly underweight. Sometimes they become skeletal but still fear they are, or will become, fat. According to DSM-IV definitions, someone whose only concern is that she’s too fat and who is significantly (about 15% or more) underweight (and who meets certain other criteria for anorexia) should be diagnosed with anorexia nervosa, not BDD.
But the relationship between BDD and anorexia gets complicated when we consider the following: some researchers suggest that the core disturbance in anorexia nervosa isn’t a problem with eating or food, but with body image. Indeed, people with anorexia fulfill criterion 1 for BDD in that they’re preoccupied with a defect in their appearance (being fat) that others don’t perceive. This view raises the very interesting and even heretical question of whether anorexia might be a form of BDD. If so, we would need to delete BDD’s criterion. The interesting relationship between eating disorders and BDD is one that I’ll return to in Chapter 16. For the time being, however, if a person’s only significant appearance concern is that she’s too fat, and she otherwise meets all diagnostic criteria for an eating disorder, she should be diagnosed with an eating disorder, not BDD. However, a person can have both an eating disorder and BDD. A woman who thinks she’s too fat and her nose is too bumpy has both disorders. In fact, many women with an eating disorder also have BDD. In other words, they have additional problematic body image concerns unrelated to being fat or overweight.
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