Talk:Anorexia nervosa/Archive 4

Assessment and Diagnosis Sandbox Edits for Anorexia Nervosa
Hello all, I have made changes in my Sandbox about this topic focusing on evidence-based assessment and diagnosis. It would be great if people would look at it and leave comments on my talk page before I post it on the article.

The sandbox link can be found here (https://en.wikipedia.org/wiki/User:Wsickenberger3/sandbox#Anorexia_Group).

I appreciate it! YenLingChen (talk) 20:33, 3 November 2014 (UTC)
 * Thanks for the heads up, . feedback:
 * I don't see in-line sourcing anywhere in that draft content. I would revert that immediately, if you added it to the article
 * the big table of demographics is to me, WP:OR and doesn't belong in WP
 * in general a lot of this is technical (for example "A cut scores", "B cut scores", with no explanation of what that means) and I suspect there is a lot of copyright violation in it. (without sources it would be a lot of work to tell)  Per WP:MEDMOS things should be written in plain English.
 * with regard to sections, please do see WP:MEDMOS
 * with regard to "local resources", you are doing part of what wikipedia is not - namely we are not a directory and we are not a self help guide. Please don't add that section to WP
 * there is some feedback. much the same as I wrote at the ADHD article Jytdog (talk) 21:15, 3 November 2014 (UTC)


 * I agree with some of what Jytdog states, namely that the information is not presented in a way that is understandable by the general reader - there is too much jargon - and the "local resources" info doesn't belong on Wikipedia. I would also add that Wikipedia is not a collection of tables. I think some of the information in the draft could be useful but it first needs to be presented in text (not tables) and in a much shortened summary form, and the sources used should be formatted as inline citations (i.e. between tags ) and clearly attached to the information they support. PaleCloudedWhite (talk) 22:52, 3 November 2014 (UTC)
 * and see User_talk:YenLingChen Jytdog (talk) 00:19, 4 November 2014 (UTC)

I additionally think it would be helpful to include a disclaimer in the diagnosis/clinical assessment section explaining the difficulty in diagnosing certain populations with AN, due to complicated relationships with healthcare professionals. White women are the most commonly diagnosed eating disorder patients, perhaps due to the fact that these individuals often have a more comfortable/open relationship with doctors. This is as opposed to sexual minorities, ethnic minorities, males, etc. Laurel2017 (talk) 01:14, 2 December 2014 (UTC)

Signs and Symptoms section
I noticed Tove added some signs and symptoms suggestions to the talk page but that they were removed so I listed them again, I like them and think they need to be added. If no one objects I'm going to put them in ok. Jinandtonicpark (talk) 14:02, 19 November 2014 (UTC) Don't worry I'll merge with like signs/symptoms already included in the list.

http://www.dsm5.org/documents/eating%20disorders%20fact%20sheet.pdf http://www.mayoclinic.org/diseases-conditions/eating-disorders/basics/symptoms/con-20033575 http://eating-disorders.org.uk/information/the-effects-of-under-eating/ http://www.webmd.boots.com/mental-health/anorexia-what-anorexia-can-do-to-your-body
 * Thin appearance including emaciation, may not have visible weight loss [52]
 * Refusal to eat and denial of hunger [53], includes excuse for lack of hunger, sickness, use stomach, nervous, anxious, planning of eating later
 * Obsession with calories and fat content of food. I'D LIKE TO ADD: Can include fixation on 'health' and 'good' and 'bad' foods. Definition of 'good' foods may be so limited that malnutrition occurs or individuals would rather not eat than eat something less nutritious.
 * Eliminating food groups: fats, carbs, sugars, proteins [54]
 * Dehydration, a large portion of our daily liquids come from food [56]
 * Low electrolytes from drinking too much [57]
 * Food rituals, such as cutting food into tiny pieces, refusing to eat around others, or hiding or discarding food
 * Eating around others and severely restricting food intake in private
 * Loss of hunger, may be psychological or physical in nature. Sometimes caused by hormone depletion. Decreased Leptin levels can result in weight destabilization and how your brain tells your body to start and stop eating or how to burn fat.[58]
 * Hypoglycemia or low blood sugar, feelings of fainting [62]
 * Image Orientation and seeming preoccupation with aesthetics including clothing or hair. Fixation on types of clothes they will wear, taking the perfect self portrait, posting very thin social media selfies, wearing revealing clothing to exhibit size
 * Preoccupation with social acceptance (from friends, family, coworkers, significant other), may include desire to act or dress a certain way, meet image demands or demands for time and energy (work over time, volunteer, conform).
 * Secretive behaviors including hiding food, eating and toilet habits or binging and purging actions, wearing baggy clothing to cover weight loss (anorexics may hide or display weight loss depending on motivations)
 * Intolerance to cold and frequent complaints of being cold; body temperature may lower (hypothermia) in an effort to conserve energy[63]
 * Solitude: EDIT: may avoid friends and family; becomes withdrawn and secretive, unwilling to discuss the disorder. May include loss of friends.
 * Abdominal distension or WOULD LIKE TO ADD: seeming weight around the midsection in relation to the rest of the body.
 * Dental discoloration, from vomiting or from insufficient food intake to remove the stains caused by dark liquids, especially tea and coffee
 * Digestive issues, stomach pains, constipation, diarrhea (made worse by laxatives and purging) [70]
 * Low blood pressure [71]
 * Irregular heart rhythms [72]
 * Trouble sleeping, bags under eyes [73]


 * New posts go at the bottom of the page. Most of the sources you list do not rise to the level of the sourcing guidelines for medical content.  Further, we must take great care in using DSM material, as the APA scrupulously guards the copyright.  Please do not add the proposed text without becoming familiar with Wikipedia's medical sourcing standards, and copyright concerns relative to the APA ... they have aggressively come after Wikipedia in the past for use of their material.  Sandy Georgia  (Talk) 15:00, 19 November 2014 (UTC)

I looked at the policy: "Peer-reviewed medical information resources such as WebMD, UpToDate, Mayo Clinic, and eMedicine are usually acceptable sources" My husband is a doctor and says they are sources doctors often go to, especially the UK National Health Service Site (its really respected). I will add them in, if you'd like to remove them I suggest also removing the signs and symptoms listed below which are not cited at all. 24.224.143.8 (talk) 12:16, 20 November 2014 (UTC)

Here are the others not cited in the list:
 * Obsession with calories and fat content of food
 * Food restriction despite being underweight
 * Food rituals, such as cutting food into tiny pieces, refusing to eat around others, or hiding or discarding food
 * Perception of self as overweight despite being told by others they are too thin
 * Hypotension and/or orthostatic hypotension
 * Bradycardia or tachycardia
 * Solitude: may avoid friends and family; becomes withdrawn and secretive
 * Abdominal distension
 * Halitosis (from vomiting or starvation-induced ketosis)
 * Rapid mood swings
 * Absence of menses


 * went ahead and added this material in this dif without dealing with the DSM issues and without dealing with the messy sourcing. I reverted in this dif.  the IP also added unsourced content... Jytdog (talk) 12:28, 20 November 2014 (UTC)


 * I am so confused, the page you referred me to said the sources were fine Mayo, Web MD, NHS is also very good. the document you sent me to says: "Peer-reviewed medical information resources such as WebMD, UpToDate, Mayo Clinic, and eMedicine are usually acceptable sources" I thought your objection was to breaking the rules. I was also in the process of touching up the citations but when I went to save my edit I couldn't and I'd been accused of starting an edit war. I am really offended at your behavior. I didn't add ambushing about the DSM and I don't understand what you are saying. Instead of accusing me of something talk to me like a person and don't hind behind the fact that we are on the internet. I am a human trying to make a contribution not a jerk out to defy you! Jinandtonicpark (talk) 13:25, 20 November 2014 (UTC)


 * first, some clarification. are you the same as the IP editor who added the content earlier this morning? Jytdog (talk) 13:28, 20 November 2014 (UTC)


 * I went to post and realized I wasn't logged in (did not realize I'd posted it though). I did not realize you had reverted it, however, sorry about that I was busy editing the article when you made the revision. I was looking up additional sources and looking for more information on the DSM requirement. To stick to the article on this page: I'm thinking we add the new signs and symptoms and also find sources for the ones which exist but have no citations. What do you think, she'll we divide up the work? I will get pubmed sources for the new signs and symptoms currently cited primarily by mayoclinic and you can tackle the existing signs and symptoms with no sources do you like the compromise? As for DSM, these new signs and symptoms do not cite DSM but I can put them in APA if thats what you'd prefer?Jinandtonicpark (talk) 14:01, 20 November 2014 (UTC)


 * Mayo clinic is okay-ish but not a particularly good source. DSM5 can be tricky due to copyright issues. Will see what I can do. Cas Liber (talk · contribs) 14:14, 20 November 2014 (UTC)
 * thanks!! Jytdog (talk) 14:42, 20 November 2014 (UTC)
 * Jinandtonicpark, thanks for acknowledging that you were also the IP editor, and for explaining how the editwar happened. That is all very understandable.  You seem to be confusing me with SandyGeorgia; we are not the same person.  You also seem to be misunderstanding what SandyGeorgia said.... let me try to explain. The American Psychological Association (APA) owns the DSM and the APA aggressively asserts their copyright.  We have to be very sure that anything citing the DSM is a paraphrase and is not copy/pasted.   That was the concern that SandyGeorgia raised about that.  (I am guessing you took the references to "APA" to be about citation style or something... otherwise I don't know how to interpret what you meant by "put them in APA").   So one step at a time... would you please verify that the content you want to add that is sourced to DSM is not a copy/paste and confirm that here?  thanks Jytdog (talk) 14:18, 20 November 2014 (UTC)

Wow, I think I got Jin in trouble. I was the one who originally deleted my own material. Someone deleted my post on the talk page asking if I could publish and she asked about it for me then tried to make the recommended changes. I think she was talking to you Jytdog btw just now. You said she "went ahead and added this material...without dealing with the DSM issues [Sandy recommended] and with messy sourcing [assuming this was Sandy's comment on Mayoclinic and WebMD not being good enough]." It looks like Sandy had an issue with the DSM as a source as you are saying because of copy write, neither Jin nor I quoted the DSM but paraphrased...she also looked at the wikipedia guidelines which approve mayo clinic web md etc. so she didn't just ignore what Sandy was saying. I'll help add pub med citations...Tovegrant (talk) 15:08, 20 November 2014 (UTC)


 * The mess of confusion above aside, there are two points (about the DSM/APA and about the quality of sourcing). I hope the DSM/APA situation is now clear?  On quality of sources, I see some overinterpretation above of what the guideline says.  The guideline currently says:"Consequently, they are usually poor sources and should always be used with caution, never used to support surprising claims, and carefully identified in the text as preliminary work. Peer-reviewed medical information resources such as WebMD, UpToDate, Mayo Clinic, and eMedicine are usually acceptable sources in themselves, and can be useful guides about the relevant medical literature and how much weight to give different sources; however, as much as possible Wikipedia articles should cite the more established literature directly."  Our guideline clearly advises caution in using these sources, and I would add that particularly applies in the psych realm.  (How Mayo came to be inserted in the guideline, without consensus, is a separate discussion).  Sandy Georgia  (Talk) 16:09, 20 November 2014 (UTC)


 * Issue one DSM: Yes Jytdog, as far as I see there is only DSM paraphrasing in the signs and symptoms Jinandtonicpark (talk) 18:10, 20 November 2014 (UTC).
 * Issue two sources: Sandy, while I appreciate your preference, those guidelines do permit all of her sources (this is just a symptom list), the article also has holes and its obvious to anyone who has had anorexia. I will get to the pubmed research eventually but I recommend you revert to Tovegrant's original edits which flush out the list and then we work on improving the citations as we get to them. I think I am no cut out for this kind of debateJinandtonicpark (talk) 18:28, 20 November 2014 (UTC)
 * The learning curve on Wikipedia is steep, but I encourage you to plod along and bear with it (for about six months after I started editing, I had a "who wrote the user manual for this thing" post on my user page). I haven't done any of the reverting here, and in fact, I didn't follow the chronology above of who did what, but I do not recommend reverting when we have Casliber-- a practicing psychiatrist and experienced Wikipedian-- at work on improving the issues raised.  Patience :)  Sandy Georgia  (Talk) 20:30, 20 November 2014 (UTC)

I think you are condescending. Instead of recognizing a difference in opinion and interpretation of the guidelines (please read Tove's comment below) since you only included half of the guideline quote. I think I will just leave the edits to Casliber then. I have been in anorexia treatment for over ten years and met with specialist of all varieties, my husband is a doctor and I think you need to work on that list. It would be nice for people to have a better picture of the possible signs and symptoms. It would be very good for people to identify other things as being related to this issue especially when the disease deals with hiding so much of it from others. Again I recommend improving the list from these 'substandard' sources and adding even better citations as you go on. I wish you luck in getting other people to participate in the improvement of this page Jinandtonicpark (talk) 15:40, 21 November 2014 (UTC)

Existing citation list
Someone needs to fix the BBC health news citation, national institute of mental health citation on what is mental health, the "What is Anorexia Nervosa? by Society of Clinical Child and Adolescent Psychology, they aren't peer reviewed journals and if we are requiring peer reviewed journals in the signs and symptoms section we should be consistent...may need to go through the citations a little and see if they are all up to standard. A few of the existing citations are from respected organizations which list signs and symptoms but aren't journals (I'm pretty sure they are peer reviewed however). What do you think?Tovegrant (talk) 15:07, 20 November 2014 (UTC)
 * With respect to the BBC, it is citing a cultural myth"Efforts have been made to dispel some of the myths around anorexia nervosa and eating disorders, such as the misconception that families, in particular mothers, are responsible for their daughter developing an eating disorder." which may be an acceptable use of laypress. Regarding the rest, please note the large banners at the top of this article disclaiming that most of the article is horrid, and review WP:OTHERSTUFFEXISTS.  Adding more bad information to an already bad article doesn't make it better.  If I Ruled The World, all of the bad content would be summarily deleted, and then the article would be rewritten from scratch using correct sources.  But I don't rule the world.  If new editors want to add new content, they should stick to good sourcing.  Sandy Georgia  (Talk) 16:13, 20 November 2014 (UTC)


 * Now, having said that, and having reviewed the BBC comment which is plagiarized, I will delete it, but not for the reasons you mention, rather for COPYVIO. Sandy Georgia  (Talk) 16:15, 20 November 2014 (UTC)


 * Do you really think those sources are so horrid, most doctors us them. If you just include journal article sources your wikipedia article looks very sparse and messy until someone can find just the right quality of citation...when others do perfectly well until a better one is identified.Jinandtonicpark (talk) 18:35, 20 November 2014 (UTC)
 * we aim high here, Jinandtonicpark. It is not about doing what is easy, it is about doing what is best.  and mayo clinic's pages are very uneven in quality. it is one thing for a doctor, who has training, to refresh their memory with them  - they will catch things that don't smell right -- but our sourcing guideline is meant to point editors to truly reliable sources.  treatment guidelines by APA, NICE, etc... things like that. consistently high quality sources.  or recent review articles.  Jytdog (talk) 18:44, 20 November 2014 (UTC)

Sandy your quote really reads: "Press releases, newsletters, advocacy and self-help publications, blogs and other websites, and other sources contain a wide range of biomedical information ranging FROM FACTUAL TO fraudulent, with a high percentage being of low quality. Conference abstracts present incomplete and unpublished data and undergo varying levels of review...Consequently, they are usually poor sources..." Thats what it says before the part of the quote you included, indicating not that WebMD and such are horrible (could be better) but its those other sources which are considered horrible. I'm not saying the journals arent better I'm just saying I don't see you offering to do the research, I just see Jin willing to plod along trying to help me over time. I think I give up too.Tovegrant (talk) 18:55, 20 November 2014 (UTC)


 * Rather than give up when pointed to Wikipedia guidelines, you might have a look at the multitude of good sources you can use: Wikipedia Signpost/2008-06-30/Dispatches gives additional help on how to find and apply them.  A search of PubMed on this topic yields almost 200 reviews that have free full text available, with scores of them being recent and up-to-date.  If you learn to use PubMed, your medical editing on Wikipedia will be more enjoyable and productive ... it will be hard to correct the substantial issues in an article like this without understanding our sourcing guidelines.  Sandy Georgia  (Talk) 19:00, 20 November 2014 (UTC)


 * I think she meant give up talking to you, although now that you mention it, I'm rather exhausted and researching anything is the last thing form my mindJinandtonicpark (talk) 19:08, 20 November 2014 (UTC)

Anorexia Nervosa in Sexual Minorities
Hi all,

I am currently an undergraduate student in a Women and Health class. Our final project aims to create a more cohesive Wikipedia page picture of an issue associated with women's health. I, along with my team, am working to include discussion of anorexia nervosa in sexual minorities. Here is a link to my sandbox page: https://en.wikipedia.org/wiki/User:Laurel2017/sandbox. I would love to hear people's opinions and feedback before posting.

Global issues
There are differences in how anorexia nervosa is diagnosed in western and non-western countries. In non-western contexts, cross-cultural research demonstrates that having body image or weight concerns as a defining diagnostic feature of anorexia nervosa seems to be minimal or absent.

It is important to ensure that the DSM (The Diagnostic Statistical Manual of Mental Disorders) criteria for Anorexia Nervosa do not exclusively refer to Western cultural phenomenon and western biomedical ideals in its classification. For instance, western pressures towards thinness in South African females may be blending with traditional idioms of distress and culturally sanctioned rituals of remedial purging and social over-eating, thereby placing this group at particular risk for a range of dysfunctional eating patterns that may not follow typically western paradigms or diagnostic systems

In a study about black women in Curaçao, researches found that most of the women diagnosed with Anorexia Nervosa were of a higher socioeconomic status; however, it is noted that women in Curaçao of lower socioeconomic statuses may very well have undiagnosed Anorexia Nervosa but do not receive equal medical attention, even with careful screening processes.

Link to the inside net of the university thus not usable. Doc James (talk · contribs · email) 02:36, 4 December 2014 (UTC)

Removed
Removed from article for evaluation and sourcing. The first chart is gibberish and needs to be evaluated for copyvio. The second chart is original research, based almost entirely on very old and poor primary sources. Sandy Georgia (Talk) 14:56, 20 March 2015 (UTC)

Citation issues
, there are citation issues in this series of edits. You changed the citation that went with named refs (Bergh 1996 and nutrition) without changing the named ref or updating subsequent occurrences of those named refs ... so it's hard to tell if the subsequent refs are accurate. Short of reverting everything, I'm not sure how to fix it ... could you please revise the ref names, rename as needed, and rescue the refs on subsequent occurrences where necessary? Sandy Georgia (Talk) 00:49, 24 March 2015 (UTC)
 * You're right, as usual. I think I've rectified the damage, but the outdated source is now back. It still needs more thought, have no qualms about changes needed. I have no ego engagement in this. ;-). LeadSongDog  come howl!  05:32, 24 March 2015 (UTC)
 * I'm still getting through newer sources (quite slowly), so don't have any new thoughts as yet ... thanks for the fixes! Sandy Georgia  (Talk) 12:30, 24 March 2015 (UTC)

Reinstatement of section on Autism and Anorexia Nervosa
I have reinstated the section on the relationship between anorexia nervosa and autism. I also note that that same editor, who also removed this section several years ago, previously agreed that it was worthy of inclusion. I pointed then, as I do now, that the link between AN and autism has gained main stream support in the medical community. The section was not cobbled together and nor was it Original Research. The link is discussed here on the UK's NHS wesbite. The link was also reported the news media a number of times e.g. Time Magaine, BBC News, The Guardian, Reuters and The Telegraph. .

The editor also mistakenly believes that peer reviewed articles are disallowed as they are a primary source. This is not the case. As stated on Wikipedia, "Peer-reviewed articles are generally highly preferred sources because the process of peer review by experts in the field helps to assure that the facts and opinions in the article, while not necessarily true, are at least reasonable within the field".

If the section is still not satisfactory, I accept that there may be too many references, it can be improved by including fewer more recent peer review references and if necessary, several tertiary news and other media sources. This could mention the recent work of the Cambridge Autism Research Centre led by Simon Barron-Cohen and Janet Treasure. Prof. Treasure is interviewed here in a short video, where she states that about 20% of people with an eating disorder also have an autism spectrum disorder. --Diamonddavej (talk) 01:33, 6 April 2015 (UTC)
 * Rather than restoring it in its entirety, it needs to be rewritten with much better and more recent sourcing. See WP:MEDRS and WP:BURDEN. Sundayclose (talk) 01:42, 6 April 2015 (UTC)
 * Need better sources. Doc James  (talk · contribs · email) 01:49, 6 April 2015 (UTC)

Adding information about remission
Hi everyone :) This is my first time using a talk page and editing a Wikipedia article, so I apologize in advance if I do this incorrectly. I am an undergraduate student working on a project. My proposed edit consists of two sentences--adding remission information. Under the Epidemiology section there is a Relapse subheading, but there isn't any information on the page about remission, and I think that remission statistics and information are very important and should be something that every disease should list.

The two sentences that I am proposing about remission have come from my Abnormal Psychology textbook by Susan Nolen-Hoeksema (this textbook has already been referenced for other information in the article). I think the entire final edit would look something like what you see below.

The average number of years from onset to remission of anorexia is 7 years for women and 3 years for men. 70% of people no longer qualify as anorexi after 10 to 15 years, but many still continue to have eating-related problems.

Clpgator (talk) 23:11, 6 April 2015 (UTC)
 * WP:MEDHOW explains how to betetr format your ref. Doc James  (talk · contribs · email) 09:11, 7 April 2015 (UTC)


 * Hi @Doc James :) Below is the updated entry with the new citation that it gave me.

Remission
The median number of years from onset to remission of anorexia nervosa is 7 years for women and 3 years for men. 70% of patients no longer qualify as diagnosable with anorexia nervosa after 10 to 15 years, but many still continue to have eating-related problems.


 * Clpgator (talk) 14:03, 7 April 2015 (UTC)

Hi, ; thanks for proposing your edit on talk. Have a look at WP:MEDORDER-- the information you want to add would flow more naturally, not with a separate "Remission" heading, but placed at the end of the second paragraph of "Prognosis" (the para that discusses that "the long-term prognosis ... is changeable"). Creating multiple section heads for small sentences results in a choppy article. Also, your citation isn't formatted the same way as the other citations in the article (see WP:CITEVAR), and there are some Manual of style issues with your proposed text (in particular, have a look at WP:MOSNUM, and don't start sentences with numbers). Correcting that would yield:


 * The long-term prognosis of anorexia nervosa is changeable: a fifth of patients stay severely ill, another fifth of patients recover fully and three fifths of patients have a fluctuating and chronic course. Recovery can be lifelong for some; energy intake and eating habits may never return to normal.   The median number of years from onset to remission of AN is seven for women and three for men. After ten to fifteen years, 70% of patients no longer meet the diagnostic criteria, but many still continue to have eating-related problems.


 * If you are able to rationalize the text already there with what you are adding, that would be grand. Sandy Georgia  (Talk) 15:52, 7 April 2015 (UTC)


 * Thank you for your advice! I will use the citation that you have suggested, matching the formatting of the one that is already in the article when the book was referenced previously, and I will add my sentences to the end of the prognosis section, rather than creating a new one!
 * Clpgator (talk) 17:39, 7 April 2015 (UTC)

Class editing
It appears that multiple students/classes are editing this article, and some potentially from unregistered courses. ,, , , , , and , if you are editing as part of a course, could you please indicate what course and what school so that you can be better informed as a group about Wikipedia's sourcing guidelines for biomedical or health content? Thanks, Sandy Georgia (Talk) 15:44, 9 April 2015 (UTC)
 * i emailed one of the students and got an email back from their teacher. unhappy. apparently are not going to do more here. I directed them to Project Education. 18:33, 9 April 2015 (UTC)
 * , see here. Sandy Georgia  (Talk) 18:36, 9 April 2015 (UTC)

new references
added one or two references within MEDRS (review or Google book 5 years or so), however the Anorexia nervosa comorbidity with Alcoholism reference found was 2000-2001*...should a newer one be found please update. thank you--Ozzie10aaaa (talk) 20:11, 9 April 2015 (UTC)
 * Hi, Ozzie .. thanks! I'm still trying to repair the edit conflict, but I'm not so sure about sources like this:   There are plenty of journal published reviews, so I try to avoid books like that one ... the title isn't promising?  What do you think?  Sandy Georgia  (Talk) 20:49, 9 April 2015 (UTC)
 * if you prefer reviews that is OK...I will look for a review for that particular reference. In general, for the Dyslexia article that went GA two weeks ago I used books and reviews...ill get a review also I put in  instead of review in "therapy" --Ozzie10aaaa (talk) 20:55, 9 April 2015 (UTC)
 * Thanks ... I generally use reviews when I can find them, unless I know of excellent and recent books-- but that particular book looks troubling. I appreciate the help here!  Also, I dislike google book previews/links because a) they aren't available eveywhere, and b) they can "expire" if you hit your max limit.  So, those who can't access a google book link can't verify if they don't have a page number ... which is why google book links don't fly at WP:FAC without page nos. While PMCs are always freely available online. Thanks again, Sandy Georgia  (Talk) 21:01, 9 April 2015 (UTC)


 * , thanks for those fixes to indicate page nos! I was hoping to model excellent sourcing for all the students involved here (that is, recent journal reviews, freely available if possible) and remain leery of using Google Books to source articles (curiously, on a user talk page right now is a discussion among several FA writers of the problems with Google Book sourcing), so I hope we can eventually replace some of those with journal reviews. In the meantime, at least we now have sources and page nos!  Sandy Georgia  (Talk) 21:52, 9 April 2015 (UTC)
 * No problem, . As a general rule, I don't go hunting for sources at Google Books. However, I do try to clean up these refs when I see 'em. —Shelley V. Adams ‹blame credit › 00:42, 10 April 2015 (UTC)


 * Ozzie, I am wondering if I missed something here? Sandy Georgia  (Talk) 21:54, 9 April 2015 (UTC)
 * apparently this review indicated that there was a decrease...though not consistent with some of the article text, however it is a review from 2013, PubMed indexed ?--Ozzie10aaaa (talk) 22:03, 9 April 2015 (UTC)

ICD copyvio
This section was cut-and-paste copyvio: needs to be rewritten in our own words and re-added.  More effective would be to summarize similarities and differences between ICD and DSM. Sandy Georgia (Talk) 23:10, 9 April 2015 (UTC)
 * That was inserted by an IP January 2014:  And there is lots more to be checked:   All of Jan 17, 2014:   I had earlier removed the DSM portion, so I believe there's no copyvio left from that IP.  Sandy Georgia  (Talk) 01:35, 10 April 2015 (UTC)
 * thank you so much! Jytdog (talk) 02:53, 10 April 2015 (UTC)

Proposed changes to Anorexia Nervosa Article
Below are my proposed changes to the Wikipedia page Anorexia Nervosa. I believe that it is important to state the difference between anorexia nervosa and bulimia nervosa because it is a common misconception that the two terms can be used synonymously when in fact, they are very different. Even though both are considered eating disorders in the DSM manual, they have different diagnosis criteria and impact people in different ways. — Preceding unsigned comment added by Jma919 (talk • contribs) 02:06, April 15, 2015


 * Anorexia Nervosa

Anorexia Nervosa is often confused with Bulimia Nervosa. People suffering from the binge/ purging type of anorexia nervosa tend to be significantly underweight and typically do not binge eat large amounts of food, yet they purge the small amount of food they eat. In contrast, those with bulimia nervosa, tend to be normal weight or overweight and binge large amounts of food.

Response
, thank you for the addition, but please review my changes to your addition, and consider the following Also, could you please sign your talk page posts by adding four tildes ( ~ ) after them? Could you please tell us who your professor is and what course you are editing with, as we are seeing lots of repeat info from this one textbook, and it would be optimal to work with your class and prof. Also, I am out of time, but your additions resulted in repetitive text; could you or someone please clean that up? Thanks, Sandy Georgia (Talk) 14:27, 15 April 2015 (UTC)
 * 1) WP:MEDORDER-- the correct place for that info was Diagnosis, specifically, differential diagnosis (common misconceptions is not a typical or useful section heading).
 * 2) The info you added was already in the article.
 * 3) Accessdates are used on websites, not books.
 * 4) We don't use uppercase on conditions.
 * 5) The citation you used was already in the article, and for repeat citations we used named refs (see my sample).

DSM-5 criteria
I am proposing to elaborate on the section DSM-5 criteria, specifically on the amenorhea part. I want to explain why it was removed in one sentence. It was removed as a criterion because some women who meet the other criteria for this disorder still report having some menstruation. It is important for people reading about this disorder to know why a certain criteria was removed.

Mandachang 17:13, 15 April 2015 (UTC)
 * , that would be a helpful addition, and this would be an ideal source (unlike the recent editing trend here of adding pages from a general textbook-- when we have an authoritative and highly reliable source that is also freely available for our readers, that is the preferable source).  Since that source is already present in the article, you can refer to it by named ref, without having to retype the citation info.  That is done by adding refname=DSM5/ (in this case) between the ref brackets after your proposed text.  Sandy Georgia  (Talk) 19:41, 15 April 2015 (UTC)


 * , I attempted to do the refname reference instead of citing it again, but when I did I checked it by clicking the footnote and it said the source was named but not invoked. So I cited it again if that's ok. Mandachang (talk) 15:26, 16 April 2015 (UTC)


 * , the problem with the named ref citation in this edit was that you added the slash twice.  You can see the correct format for named refs by viewing the correction I made here.  Sandy Georgia  (Talk) 17:06, 16 April 2015 (UTC)


 * I expanded the content to list all of the reasons. Sandy Georgia  (Talk) 17:17, 16 April 2015 (UTC)


 * , I see what I did wrong. Thank you for your help!    Mandachang (talk) 19:52, 16 April 2015 (UTC)
 * You are welcome! Please do not leave blank spaces before your talk page posts, as they do not format correctly on Wikipedia.  You can see how to thread responses by adding colons by viewing this section in edit mode.  Sandy Georgia  (Talk) 19:56, 16 April 2015 (UTC)

Autism
, I see that removed this edit with an edit summary that needs more explanation. Although you are using a WP:MEDRS-compliant source, there are several problems with your text: a) that text is already in the article (see Anorexia nervosa), b) the text already in the article uses a higher quality source (a 2013 systematic review), c) you added the info to the wrong section, and d) you didn't provide a page number (book sources require page nos). If you will thoroughly read the article before adding new info, that would be helpful and save time for everyone! Sandy Georgia (Talk) 01:30, 19 April 2015 (UTC)

Adding information about relapses
This is my first time ever editing a wikipedia article! I am a student at the University of Florida taking an Abnormal Psychology course. I would like to propose an edit to the relapse subheading under the prognosis section. I think that there should be a little more information about relapses in anorexia nervosa. Below is what the edit would look like:

Relapse
Relapse occurs in approximately a third of inpatients, and is greatest in the first half-year to year-and-a-half after release from inpatient institutions. Predictors, such as, patients with binge-purge type of anorexia nervosa, a high presence of obsessive-compulsive symptoms, and the level of motivation to recover that are all correlated with relapses after treatment.

Annelpichardo (talk) 23:15, 19 April 2015 (UTC)
 * Welcome to Wikipedia, and thanks for discussing this on the talk page. One concern I have about the source: It appears to be an online-only journal; is it peer-reviewed? Many online journals are not. I don't think that would comply with WP:MEDSCI. Sundayclose (talk) 23:21, 19 April 2015 (UTC)
 * Hi,, and thanks for proposing your edit on talk! The source you propose to use appears to be a primary source (an original study rather than a secondary review of a primary study).  Also, there are some grammatical issues in your proposed text.  And I'm not clear that the text you propose to add is verified by that source.  Perhaps you can find something along those lines from the Hasan source, which is freely available online, and a WP:MEDRS-compliant secondary review.  Sandy Georgia  (Talk) 23:42, 19 April 2015 (UTC)

Change to Restricting Type- anorexia nervosa
Hello,

I'd like to propose a change to the Restricting type- anorexia nervosa section (change shown below in italics):

Subtypes
There are two subtypes of AN:
 * Binge-eating/purging type: Individual utilizes binge eating or displays purging behavior as a means for losing weight.
 * Restricting type: the individual uses restricting food intake, fasting, diet pills, and/or exercise as a means for losing weight. People with anorexia vary greatly in the amount of time they go without food. When they do finally eat, it's mostly in order to appease their families or loved ones. They have little or no desire to consume food. 

I believe this change adds substantial information to the page, especially because the subtypes have very little information at all. The desire of people with anorexia to please their loved ones is an important aspect of the disorder that I believe alters the meaning of it drastically. The idea that they do not eat for their own sake but only for the sake of those they care about shows the severity of the disease.

Let me know what you think as I am new to the Wikipedia world and would appreciate your input. Thank you.

22:56 April 17, 2015 — Preceding unsigned comment added by Alexatmoore0 (talk • contribs)
 * Hi, ; welcome to Wikipedia, and thanks for proposing your edit here on talk. You can sign your talk page entries by entering four tildes ( ~ ) after them.  Two comments about your proposed addition:
 * People with anorexia vary greatly in the amount of time they go without food. When they do finally eat, it's mostly in order to appease their families or loved ones. They have little or no desire to consume food.
 * Page 362, fifth edition of Nolen-Hoeksema

After you provide the wording from the book, we might work on how to add something to the Signs and symptoms section. Sandy Georgia (Talk) 13:44, 18 April 2015 (UTC)
 * 1)  Could you put here on this talk page the exact wording from the book, for verification and paraphrase checking?  I do not have access to the book, and we need to make sure that we have adequately paraphrased to avoid copyvio.
 * 2) That sentence would be better placed in Signs and symptoms (rather than Subtypes, which is a diagnostic section).
 * , another editors has supplied the exact wording from page 362 of the fifth edition of Nolen-Hoeksema, which says:
 * "People with the restricting type of anorexia nervosa simply refuse to eat as a way of preventing weight gain. Some people attempt to go for days without eating anything; most eat very small amounts of food each day, in part simply to stay alive and in part because of pressure from others to eat."
 * So, retracting my earlier suggestion that the text does not belong in the restricting subtype section, there are still two problems with your proposed text:
 * Original research; while your text is written in your own words, it goes beyond what the source actually says.
 * The fifth edition of Nolen-Hoeksema was published in 2011, before the "refused" wording was removed from the DSM in the 2013 revision. You would be better served to use more updated sources.
 * Sandy Georgia (Talk) 15:16, 18 April 2015 (UTC)


 * Hello, thank you for your feedback. I could change my post to ''People with anorexia will go great lengths of time without food. When they do finally eat, many times it is only in order to appease their families or loved ones. They often have little or no desire to consume food for their own benefit." I do not have access to the 6th edition of Nolen-Hoeksema's textbook, so I do not know what page anorexia nervosa is discussed on. However, I do know that this information is still accurate in the DSM-5. Does this fix the issue? Thank you. Alexatmoore0 (talk) 03:51, 20 April 2015 (UTC)23:51, 19 April 2015
 * , here are the words you quoted from the source:
 * I do not see any mention of great lengths of time, nor any mention of loved ones or family; your wording is original research (that is, your words, not what the source says). And, the "refuse" statement is wrong-- that was changed in the DSM and changed in Nolen-Hoeksema's sixth edition of the book, published in 2014.  Sandy Georgia  (Talk) 04:48, 20 April 2015 (UTC)

New Edits/Definition clarity

 * Original

Symptoms of AN may include:


 * Amenorrhea, a symptom that occurs after prolonged weight loss; causes menses to stop, hair becomes brittle, and skin becomes yellow and unhealthy
 * Fatigue

Subtypes: There are two subtypes of AN:
 * Binge-eating/purging type: Individual utilizes binge eating or displays purging behavior as a means for losing weight.[16]
 * Restricting type: the individual uses restricting food intake, fasting, diet pills, and/or exercise as a means for losing weight.[8]


 * New Edit


 * Amenorrhea, a symptom that occurs after prolonged weight loss; hair becomes brittle, and skin becomes yellow and unhealthy. Essentially it is because the menstrual cycles for women and girls who have already begun it stops, but it has now since been removed from the DSM-IV. In some cases, women still experience some menstrual activity despite showing other symptoms of anorexia nervosa outlined in the DSM-V.
 * Chronic fatigue

Subtypes: There are two subtypes of AN:
 * Binge-eating/purging type
 * Individual utilizes binge eating or displays purging behavior as a means for losing weight.
 * It is different from bulima nervosa in terms of the individual's weight. An individual with binge-eating/purging type anorexia does not maintain a healthy or normal weight but is significantly underweight. People with bulima nervous on the other hand can sometimes even be overweight.
 * Restricting type
 * The individual uses restricting food intake, fasting, and/or diet pills as a means for losing weight.
 * The individual participates in excessive exercise to keep off/prevent weight gain.
 * Some cases involve individuals who eat minimal amounts of food to simply sustain life.

The added information just adds clarity to the already existing information.

--Oshinrai19 (talk) 05:24, 17 April 2015 (UTC)


 * , apparently you are proposing the edit above? Have you read this talk page?  Are you editing as part of a course?  If so, could you please indicate what course, what university, and what prof? As far as I can tell, your edit proposes to redo work just done by another student (three or more courses working here at cross purposes), and your proposal involves removing some high quality and authoritative sources that are freely available online and replacing them with a textbook that is not available to most of our readers.  It also proposed to add info about a condition that has its own article.  It's not clear to me that your proposal is a good one.  Sandy Georgia  (Talk) 15:02, 17 April 2015 (UTC)


 * , I see you added text anyway, without following up on the discussion here. Please note that amenorrhea was already discussed and is included in the section just above where you added text, and see my other corrections (you can re-use a citation by "naming" it, and please don't delete full-text recent journal reviews in favor of a textbook that most of our readers can't see). Sandy Georgia  (Talk) 06:57, 20 April 2015 (UTC)

Proposed changes to the Treatment Information
Hello, I am an undergraduate student enrolled in an Abnormal Psychology class. I am a beginner in the Wikipedia Editing world so please take that into consideration and let me know if I have made mistakes. I have come to the conclusion that there needs to be more emphasis on the difficulties of Treatment for People who suffer Anorexia Nervosa. I believe that it is very important to emphasize the challenges that therapists have to go through to help change the habits that Anorexic people face.

My proposed changes would be to add "Treatment for Anorexia Nervosa is challenging because Anorexia Nervosa patients can be resistant to therapy and to therapists' attempts to change their behaviors or attitudes in particular. It can be difficult to engage people with anorexia nervosa in Psychotherapy because they highly value the thinness they have achieved and believe they must maintain absolute control over their behaviors."

So, it would look like this:

Treatment
There is no conclusive evidence that any particular treatment for anorexia nervosa works better than others; however, there is enough evidence to suggest that early intervention and treatment are more effective. Treatment for anorexia nervosa tries to address three main areas. Although restoring the person's weight is the primary task at hand, optimal treatment also includes and monitors behavioral change in the individual as well. Not all anorexia nervosa patients recover completely: about 20% develop anorexia nervosa as a chronic disorder. If anorexia nervosa is not treated, serious complications such as heart conditions and kidney failure can arise and eventually lead to death.
 * Restoring the person to a healthy weight;
 * Treating the psychological disorders related to the illness;
 * Reducing or eliminating behaviours or thoughts that originally led to the disordered eating.

Some remedies are proven to not have any value in resolving anorexia. "Incarceration in hospital" prohibits patients from many basic rights, such as using the bathroom independently. Therefore, it has been seen as catalytic in increasing weight and pushing patients away from the path to recovery.

Treatment for Anorexia Nervosa is challenging because anorexia nervosa patients can be resistant to therapy and to therapists' attempts to change their behaviors or attitudes in particular. It can be difficult to engage people with anorexia nervosa in psychotherapy because they highly value the thinness they have achieved and believe they must maintain absolute control over their behaviors

Sssorayaaa 00:45, 19 April 2015 (UTC)
 * Please sign your talk page entries by entering four tildes ( ~ ) after them. Could you please indicate who your professor is, what university and what course so that we can better work with all of your class members and give them guidance on Wikipedia guidelines and policy?  I will look at your proposal soon, but I see several issues ... could you please provide the exact text from page 357 for verification?  Sandy Georgia  (Talk) 00:57, 19 April 2015 (UTC)

I am a student at UF in the Abnormal Psychology Course. Yes, of course. This is the exact text stated on page 357 of the textbook "It can be difficult to engage people with anorexia nervosa in psychotherapy. Because they so highly value the thinness they have achieved and believe they must maintain absolute control over their behaviors, people with anorexia nervosa can be resistant to therapy in general, and to therapists' attempts to change in behaviors or attitudes in particular." Sssorayaaa 21:11, 19 April 2015 (UTC)


 * Thanks, . Could you please specify what is meant by UF, and indicate if your professor has registered an account?  Suggested ... pls see WP:MEDMOS, avoid the use of the word patients ... and you did not wikilink psychotherapy correctly ... and you have too closely paraphrased the original content (plagiarism) ... and we don't use accessdates on books (only websites) ... so ... suggested:  Sandy Georgia  (Talk) 21:41, 19 April 2015 (UTC)
 * Psychotherapy for individuals with for AN is challenging because they may seek to maintain control and resist change.


 * UF usually refers to the University of Florida. Instructors aren't required to register classes, and students can't be held responsible for their instructors' choices to register or not anyway.  This is the encyclopedia anyone can edit, even students with an interest in a popular article.  WhatamIdoing (talk) 22:19, 19 April 2015 (UTC)
 * Such a nice post! There may be many UFs.  No, instructors aren't required, but we can still ask, because it will be helpful all round.  While you are here, would you like to take a moment to help with sourcing, paraphrasing, copyvio, teaching new users how to sign post, etc?  Thanks ... real help is always welcome!  Sandy Georgia  (Talk) 22:26, 19 April 2015 (UTC)

Yes, Sorry for the misunderstanding. I meant University of Florida. and Okay, got it! I checked WP:MEDMOS! Contains a lot of valuable information that I will consider for future editing. Your suggested post sounds way better and concise. I added "that they take pride in their skinniness" to make sure readers understand why exactly they resist change and maintain control. So, it would look like this:


 * Psychotherapy for individuals with AN is challenging because they take pride in their skinniness and may seek to maintain control and resist change.

Sssorayaaa 02:45, 20 April 2015 (UTC)
 * I edited your wording to avoid "skinniness", which is rather informal language for an encyclopedia:  Thanks for the info about your University.  Sandy Georgia  (Talk) 04:43, 20 April 2015 (UTC)

Great! Thank you Sssorayaaa 16:19, 20 April 2015 (UTC) — Preceding unsigned comment added by Sssorayaaa (talk • contribs)

A more comprehensive biological discussion
Hello everyone. I think that the Biological section of this page (under the heading of Causes) could undergo some improvement and would certainly benefit from a more comprehensive acknowledgement of the scientific literature published in this area. Firstly, I think this Causes section in general would benefit from a mention of the 'chicken-and-egg' controversy surrounding AN, in that a key challenge researchers face is determining cause and effect i.e. what are primary symptoms and what are secondary symptoms; what comes first, the disturbance in neurocircuitry or the social influences etc. It would also be beneficial to discuss the neurocircuitry thought to be involved in AN (eg. appetitive circuitry, reward circuitry, mono-aminergic circuitry) and how it is altered to create a more complete picture of the neurochemicals thought to be of significance (also thereby highlighting prospective therapies of the future). This would perhaps provide more biological context for the chemicals presently mentioned as potentially playing a role (eg. serotonin, orexin). I also think that this article could benefit from a more detailed section on the genetics of AN (including a mention of the possible role of epigenetics) <10.1146/annurev.nutr.27.061406.093713>. As a result of including this, the Treatment section could also be extended to include a sub-section of prospective future therapies that are being proposed based on this understanding of neurocircuitry (and what, if anything, has been done to advance the development of these therapies so far). I have a collection of reviews and original research articles from respected journals on this topic that I can draw upon to work on this. I thought, however, that it would be worth introducing myself to the community presently working on this first to ask your thoughts on my ideas. Autumnstorm19 (talk) 22:33, 13 May 2015 (UTC) 14/05/15


 * Hi, . If you could break your posts up in to paragraphs, they would be more readable.  Also, article talk discussions are facilitated by providing links to your sources so others don't have to look them up.  I have listed your proposed sources below, with links:
 * is, a 2009 review
 * goes nowhere, no idea what it is.
 * is, a 2007 review


 * By viewing these in edit mode, you can learn how to link sources on talk, and you can use the search engine at PubMed to look up PMIDS. One of the DOIs seems to be bad, so I don't know what that article is.  The other two sources are WP:MEDRS-compliant secondary reviews, but they are quite dated.  There is a good amount of recent secondary reviews on AN, so if you could use those, your writing will be more productive. At the top of this talk page, you will find a box titled Ideal sources which will allow you to access recent reliable secondary sources, which would be more useful as a basis for proposing content additions and changes.  Please be sure to familiarize your self with Wikipedia's medical sourcing guidelines and Wikipedia's medical content guidelines.  Sandy Georgia  (Talk) 00:00, 14 May 2015 (UTC)
 * Thank you kindly for your helpful feedback and guidance; I've begun to familiarize myself with inserting links, utilizing the PubMed sources and the medical content guidelines. I look forward to contributing and please do let me know if you have any further suggestions. Autumnstorm19 (talk) 04:47, 20 May 2015 (UTC)

, good sources on your first addition. I've corrected the first set of citations you added, here.  Google book links don't work for everyone and may go dead over time, so by linking to the page number (rather than in URL), we won't have someone complaining in the future that they can't get the link and the citation is no good. We give them the full citation with a page no, and they can go to a library if that page no link doesn't work :) The journal citation you used required a bit more cleanup.  You entered this:

I corrected it to this:


 * 1) You had used curly quotes in the title (probably from a word processor); Wikipedia uses straight quotes.  You also had a carriage return in the article title (maybe from a word processor) that caused a line break.
 * 2) You left off authors-- very important to have :)
 * 3) We don't need all that date formatting.
 * 4) We don't use accessdates on journal articles.
 * 5) You left off the page number.
 * 6) Please use a PubMed identifier (PMID) on all journal sources-- it helps other editors look up sources to be sure they are reviews.
 * 7) ANd most importantly, in the case of this article, the full free text of the article is available in Pubmed central (PMC), so by providing the PMC, our readers can access the article.

If you locate articles in PubMed, you can copy the identifier (PMID) to this template filling tool, and get a full citation. Sandy Georgia (Talk) 07:08, 20 May 2015 (UTC)


 * Here is the citation corrected on your next edit, and we should prose redundancies like "It should be noted that"-- encyclopedic prose doesn't tell readers what to "note"-- it just says it. Regards, Sandy Georgia  (Talk) 07:28, 20 May 2015 (UTC)
 * Thank you very much for your help. I didn't see your post about referencing until after inserting the epigenetics reference. I had a go at correctly formatting it but you beat me to it! And thank you also for the comment regarding encyclopedic prose; it's a writing style that I'm increasing my familiarity with. Autumnstorm19 (talk) 07:38, 20 May 2015 (UTC)
 * Great-- we're on track then. Sandy Georgia  (Talk) 07:50, 20 May 2015 (UTC)
 * The first thing we need to do is seperate cause from mechanism. I have started by spliting some stuff off into a mechanism section. Doc James  (talk · contribs · email) 12:09, 24 May 2015 (UTC)

Complete article re: biology but the 'media effects' is thin. Pun intended. Trends like thinspo should be explained and included. — Preceding unsigned comment added by 74.62.206.188 (talk) 15:21, 19 October 2015 (UTC)

LGBT tag
Why does the article on Anorexia talk page, have a category tag classifying it as an "LGBT" article? Is this plain homophobic bullying? There is nothing even about this relationship in the anorexia article itself 182.255.99.214 (talk) 12:54, 27 January 2016 (UTC)
 * I think it is more common in this community. Doc James  (talk · contribs · email) 13:24, 27 January 2016 (UTC)
 * Diff for the addition is here. The editor, now retired, was highly unlikely to be engaging in homophobic bullying. Try to assume good faith. William Avery (talk) 13:40, 27 January 2016 (UTC)

Anorexia vs Bulimia
This text is wrong:

Seemingly minor changes in a people's overall behavior or attitude can change a diagnosis from anorexia: binge-eating type to bulimia nervosa. A main factor differentiating binge-purge anorexia from bulimia is the gap in physical weight. Someone with bulimia nervosa is ordinarily at a healthy weight, or slightly overweight. Someone with binge-purge anorexia is commonly underweight.[75] People with the binge-purging subtype of AN may be significantly underweight and typically do not binge-eat large amounts of food, yet they purge the small amount of food they eat.[75] In contrast, those with bulimia nervosa tend to be at normal weight or overweight and binge large amounts of food.[75] It is not unusual for a person with an eating disorder to "move through" various diagnoses as their behavior and beliefs change over time.[32]

This makes it look like doctors look at a patient's weight, and call them anorexic if they're underweight, or bulimia if they're normal or slightly overweight.

Doctors don't do this. They use the DSM 5, which says that - if you have bulimia in the context of anorexia, it is still anorexia. The one for anorexia says:

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Coding note: The ICD-9-CM code for anorexia nervosa is 307.1, which is assigned regardless of the subtype. The ICD-10-CM code depends on the subtype (see below).

Specify whether: (F50.01) Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

(F50.02) Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Specify if: In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A (low body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met.

In full remission: After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time.

Specify current severity: The minimum level of severity is based, for adults, on current body mass index (BMI) (see below) or, for children and adolescents, on BMI percentile. The ranges below are derived from World Health Organization categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision.

Mild: BMI ≥ 17 kg/m2

Moderate: BMI 16–16.99 kg/m2

Severe: BMI 15–15.99 kg/m2

Extreme: BMI < 15 kg/m2

The one for bulimia says:

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.

2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Specify if: In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time.

In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time.

Specify current severity: The minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.

Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week.

Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors per week.

Severe: An average of 8–13 episodes of inappropriate compensatory behaviors per week.

Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.

I'm going to notify the resident medical genius at Wikipedia, James Heilman to add his 2 cents to this too 182.255.99.214 (talk) 12:45, 27 January 2016 (UTC)
 * User name is "Doc James". To get my attention you need to . Let me look. 15:00, 27 January 2016 (UTC)
 * Yes agree we should base it on the DSM 5. You want to update it to that? Better source than the abnormal psych textbook. Doc James  (talk · contribs · email) 15:03, 27 January 2016 (UTC)

Risk factors
The risk factors for anorexia should be classified according to "predisposed", "precipitated", and "perpetuated", like this: http://autoprac.com/anorexia-nervosa Ana4eva (talk) 13:01, 17 February 2016 (UTC)
 * Not sure. We should use easier language than those. Doc James  (talk · contribs · email) 13:26, 17 February 2016 (UTC)

Low weight requirement for AN

 * Let's start with removing the low weight requirement. DSM 5 has removed that 182.255.99.214 (talk) 12:52, 17 February 2016 (UTC)
 * This is the DSM 4 requirement: A.     A refusal to maintain body weight at or above a minimally normal weight for age and height (e.g. weight loss leading to a maintenance of body weight less than 85% of that expected, or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
 * Compare this with DSM 5: A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
 * This is DSM 4: B.	Intense fear of gaining weight or becoming fat, even though underweight.
 * Compare this with DSM 5: B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
 * This is DSM 4: C.	Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
 * Compare this with DSM 5: C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
 * This is DSM 4: D.	In postmenarcheal females, amenorrhea, i.e. the absence of at least three or more consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g. oestrogen, administration).
 * Compare this with DSM 5: (removed)
 * This is DSM 4: Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behaviour (i.e. self-induced vomiting or the misuse of laxatives, diuretics or enemas)
 * Compare this with DSM 5: (F50.01) Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
 * This is DSM 4: Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behaviour (i.e. self induced vomiting or the misuse of laxatives, diuretics or enemas).
 * Compare this with DSM 5: (F50.02) Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). 182.255.99.214 (talk) 06:23, 18 February 2016 (UTC)
 * I've emphasized where the low weight requirement has been modified. It is also highlighted here: "In addition, the first criterion for Anorexia, which is currently that the "patient must be 85% or less than their recommended body weight," is removed. The DSM-5 now addresses weight by requiring ""restriction of energy intake . . . leading to significantly low body weight."". "For example, many insurance companies have long relied upon the DSM-IV criterion that "the patient must be 85% or less than their recommended body weight" as a way to restrict or terminate treatment for Anorexia for anyone above that percentage or who reached that percentage while in treatment. Without this criterion, insurance companies can no longer rely upon percentage of body weight as a barrier to treatment". (http://www.kantorlaw.net/Blog/2012/December/The-DSM-5-Makes-Important-Changes-to-the-Diagnos.aspx) "In anorexia nervosa, the removal of the amenorrhoea criteria and clarification of the low body weight criterion are also significant in nutritional management" (http://www.nedc.com.au/e-bulletin-number-thirteen) 182.255.99.214 (talk) 06:28, 18 February 2016 (UTC)
 * This is DSM 4: Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behaviour (i.e. self induced vomiting or the misuse of laxatives, diuretics or enemas).
 * Compare this with DSM 5: (F50.02) Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). 182.255.99.214 (talk) 06:23, 18 February 2016 (UTC)
 * I've emphasized where the low weight requirement has been modified. It is also highlighted here: "In addition, the first criterion for Anorexia, which is currently that the "patient must be 85% or less than their recommended body weight," is removed. The DSM-5 now addresses weight by requiring ""restriction of energy intake . . . leading to significantly low body weight."". "For example, many insurance companies have long relied upon the DSM-IV criterion that "the patient must be 85% or less than their recommended body weight" as a way to restrict or terminate treatment for Anorexia for anyone above that percentage or who reached that percentage while in treatment. Without this criterion, insurance companies can no longer rely upon percentage of body weight as a barrier to treatment". (http://www.kantorlaw.net/Blog/2012/December/The-DSM-5-Makes-Important-Changes-to-the-Diagnos.aspx) "In anorexia nervosa, the removal of the amenorrhoea criteria and clarification of the low body weight criterion are also significant in nutritional management" (http://www.nedc.com.au/e-bulletin-number-thirteen) 182.255.99.214 (talk) 06:28, 18 February 2016 (UTC)
 * I've emphasized where the low weight requirement has been modified. It is also highlighted here: "In addition, the first criterion for Anorexia, which is currently that the "patient must be 85% or less than their recommended body weight," is removed. The DSM-5 now addresses weight by requiring ""restriction of energy intake . . . leading to significantly low body weight."". "For example, many insurance companies have long relied upon the DSM-IV criterion that "the patient must be 85% or less than their recommended body weight" as a way to restrict or terminate treatment for Anorexia for anyone above that percentage or who reached that percentage while in treatment. Without this criterion, insurance companies can no longer rely upon percentage of body weight as a barrier to treatment". (http://www.kantorlaw.net/Blog/2012/December/The-DSM-5-Makes-Important-Changes-to-the-Diagnos.aspx) "In anorexia nervosa, the removal of the amenorrhoea criteria and clarification of the low body weight criterion are also significant in nutritional management" (http://www.nedc.com.au/e-bulletin-number-thirteen) 182.255.99.214 (talk) 06:28, 18 February 2016 (UTC)

Autism comorbidity
I think it's important to separate autism and anorexia being somehow linked, as supposed to just having similar symptoms (http://www.eatingdisorderhope.com/treatment-for-eating-disorders/types-of-treatments/autism-and-anorexia-examining-the-correlation). "It is clear that autism spectrum disorders (ASD) and anorexia nervosa (AN) have some similarities. Both groups demonstrate a lower capacity for empathy, difficulty set shifting and rigid attitudes. These traits often come across to most of us as “uptight” or “tightly wound” and “cold” or “impersonal”."

'' "When they are underweight, people with anorexia get even more like people with autism," says Treasure. "They can't interpret other people's emotions, they can't regulate their own emotions, and they get overwhelmed when they are frightened or angry." "The theory is that hunger focuses the brain so sharply on the task of getting food that, as with other stressors, it shuts down higher cognitive functions, like reading other people's emotions''"(http://content.time.com/time/health/article/0,8599,1904999,00.html)

It's also important to differentiate anorexia from autism, because having autistic traits, doesn't even mean it's on the spectrum. They're different things Ana4eva (talk) 06:37, 18 February 2016 (UTC)
 * Please read WP:MEDRS regarding what type of sources we generally use. The popular press is not suitable for medical content. Best Doc James  (talk · contribs · email) 10:34, 18 February 2016 (UTC)

Redundency
''It is estimated to occur in 0.9% to 4.3% of women and 0.2% to 0.3% of men in Western countries at some point in their life. About 0.4% of young females are affected in a given year and it is estimated to occur ten times less commonly in males.'' Is it necessary to give the "ten times less commonly in males" point when we gave a more a specific estimate that essentially says the same thing in the previous sentence? I understand that in the body we should give all the estimates given in all the reliable sources we have consulted, but the lead is supposed to summarize, so one or the other should be sufficient. Hijiri 88 ( 聖やや ) 06:17, 29 February 2016 (UTC)
 * Yes, because percentages don't make it as clear as saying 10x less prevalent in males 182.255.99.214 (talk) 11:06, 7 April 2016 (UTC)

"Orthorexia nervosa"
Should this non-scientific link be removed? It isn't even recognized as a mental illness under DSM 5, and is some sort of self diagnosis that is being made. I think it probably is better classified under EDNOS 182.255.99.214 (talk) 11:07, 7 April 2016 (UTC)

Unable to get refs to work
"The Royal College of Psychiatrists has developed a checklist which is intended to be used be used in concert with the MARSIPAN guidance.

Psychotropic medication

Medicating the very sick patient with AN is often difficult. The patient may be very agitated, and treatment with a small oral dose of a benzodiazepine or a neuroleptic can be beneficial. For more extreme agitation, for example, when a very emaciated patient is fighting the insertion of a nasogastric tube, the use of parenteral medication can be very dangerous, because in such a patient a small intramuscular dose of a benzodiazepine can cause fatal hypotension or apnoea. The advice given in MARSIPAN is to manage such a patient in a medical Intensive Care setting, so that cardiovascular and respiratory support can be given if required."

Doc James (talk · contribs · email) 18:49, 10 April 2016 (UTC)


 * Sorry, what do you mean @User:Doc James? Yes, benzo and antipsychotics (sometimes people call them neuroleptics) are sometime used so that we can help put NG tubes in etc. Is your point because it can cause hypotension or apnea, to send them into ICU so they can get cardio or resp support? It's correct, but that's not already on here? It should be, at least under an acute care area for Tx 182.255.99.214 (talk) 14:44, 11 April 2016 (UTC)
 * Which ref supports this content? WP:MEDHOW provides some advice on ref formatting. Doc James  (talk · contribs · email) 14:58, 11 April 2016 (UTC)

Thank you Doc James. I have put the link in under reference 101 and it works on my machine.

I have been trying to understand your objection to the advice about benzos and neuroleptics. Yes, you are right, the problem is that the use of these drugs, especially parenterally, in a patient with a BMI of 9 and a BP of 80/30 can be very tricky, and considering ICU care is a reasonable option. This came not from a publication but from a discussion that is reported in the MARSIPAN guidelines. Perhaps I didn't understand your point well enough. Please clarify.

Paul2322 (talk) 15:41, 11 April 2016 (UTC)
 * And what is the page number for this ref ? Doc James  (talk · contribs · email) 19:12, 11 April 2016 (UTC)

The mention of medication problems is on page 24. Paul2322 (talk) 08:03, 12 April 2016 (UTC)

The list of problems that can occur is on page 10 of the same guideline Paul2322 (talk) 08:12, 12 April 2016 (UTC)

Anorexia Nervosa: Hospital admission
BallenaBlanca: I think you edited the changes I made to this article. If not, please forgive the error. I understand the objection to links from within the article and accept that. However, I wanted to indicate in the title of the section that it refers to Medical admission, not any admission. Hence adding the word (Medical). Can you explain the objection? Regards Paul2322 (talk) 13:02, 8 May 2016
 * (Please create a new header for a new topic.) I can't speak for, but you added an inline external link, which BallenaBlanca reverted per WP:ELPOINTS; click and read the guideline. I'll also note that adding "Medical" is redundant and thus unnecessary. All hospital admissions are medical, including psychiatric admissions. Sundayclose (talk) 14:30, 8 May 2016 (UTC)
 * , you are referring to this edit (is better to include the diff for understanding what you mean).  explained perfectly. Best regards. --BallenaBlanca (talk) 15:58, 8 May 2016 (UTC)

Thank you Sundayclose. The reason I wish to separate the two types of admission (general medical vs psychiatric) is that the problems are seen mostly in general medical settings, often because the patient's level of morbidity is higher in those admitted via A and E (ER). However, I'm not going to go on about it. I think it's clear from the text. Thank you for your careful attention. Paul2322 (talk) 17:30, 8 May 2016 (UTC)

Statistical Inaccuracy
"Globally anorexia is estimated to affect two million people as of 2013." That seems very low, but okay... "It is estimated to occur in 0.9% to 4.3% of women and 0.2% to 0.3% of men in Western countries at some point in their life." Those numbers do not add up. Even assuming on the low end that it affects 1% of all people, that's about 70 million people worldwide, not 2 million. I checked the reference for these statements and could not find any mention of anorexia whatsoever. — Preceding unsigned comment added by 2601:204:C103:6036:BC73:88F7:91D0:CDC7 (talk) 23:06, 17 March 2016 (UTC)


 * Maybe it's because the reference is to "anorexia", not "anorexia nervosa", which would also catch cachexia. I think that the prevalence of diseases like AN are overreported, particularly in certain segments of the population like teenage girls 182.255.99.214 (talk) 03:58, 28 June 2016 (UTC)

Nervous Not-Eatinng
I'll clean this up later (or you can do it yourself):


 * Comorbidity of Bipolar Disorder and Eating Disorders: What Can the Clinician Do? 2004
 * Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations? 2005
 * Depressive and manic-hypomanic spectrum psychopathology in patients with anorexia nervosa. 2007

2601:143:8000:86B0:2677:3FF:FE9A:A124 (talk) 10:23, 31 July 2016 (UTC)

"higher than expected"?
thanks to folks who have worked in this article, very good article. I came across one sentence that wasn't clear to me as a layperson: "The mortality rate is 6 to 12 times higher than expected". Could someone please make it clearer? In which way "than expected"? EMsmile (talk) 21:12, 22 April 2017 (UTC)


 * I've corrected the numbers which in the source are actually 11-12 times higher than expected. It'll be that the mortality rate is 11-12 times higher than the rate of the general population. PriceDL (talk) 21:59, 22 April 2017 (UTC)


 * thanks but can you also change it to "higher than the rate of the general population"? Otherwise it's still unclear I think. EMsmile (talk) 22:51, 22 April 2017 (UTC)


 * — Confirmed it relates to standardized mortality ratio and edited to reflect that. PriceDL (talk) 23:10, 22 April 2017 (UTC)
 * Great, thanks a lot, now it's clear. EMsmile (talk) 11:06, 24 April 2017 (UTC)

Claim of normal BMI
Anorexia does not exist if the BMI is normal but requires a low weight. Doc James (talk · contribs · email) 13:14, 3 January 2019 (UTC)
 * This is actually a large and contentious discussion that may warrant its own section. On one hand, many people including the American Psychological Association believe that someone who is overweight can be anorexic as they see anorexia as primarily about diet and relationship with food. On the other hand, the DSM-5 requires for someone to have a significantly low body weight. CLPond (talk) 02:52, 18 January 2019 (UTC)CLPond

Map key
I can't figure out what the key for File:Eating disorders world map-Deaths per million persons-WHO2012.svg means. What is 2-2 deaths per million people mean? Why does it go from 3-3 to 4-25? Wug·a·po·des​ 06:40, 7 August 2019 (UTC)

Literal meaning of anorexia nervosa - a clarification is needed
This article says that the term "anorexia nervosa" was first introduced by William Gull, but does not point out that the term literally means "neurotic loss of appetite" and that this is very misleading. Many anorexics do enjoy eating and talk about food obsessively - they have not lost their appetites, they are simply showing a compulsion to fasting (a loss of appetite is not incompatible with an addiction to fasting). Carltonio (talk) 21:03, 25 March 2017 (UTC)


 * what's the connection you're trying to make? puggo (talk) 15:22, 26 March 2019 (UTC)

A better name is needed - how about Buddha's syndrome, because it seems that the Buddha suffered from anorexia nervosa? Vorbee (talk) 06:59, 2 October 2019 (UTC)

Some proposed changes
I would like to find out if it is possible or allowable add to more info to this section "A review of functional neuroimaging studies reported reduced activations in "bottom up" limbic region and increased activations in "top down" cortical regions which may play a role in restrictive eating.[74]" I would want to add the following "Some scientists have found that functional neuroimaging is also useful in separating anorexia nervosa from body dysmorphic disorder " — Preceding unsigned comment added by Scientist418 (talk • contribs) 15:02, 10 December 2019 (UTC)


 * That's a primary source, but we try to summarize review articles. – Thjarkur (talk) 16:05, 10 December 2019 (UTC)

I would like to find out if is possible or allowable for me to add a section on 'Anorexia Nervosa and Men.' I feel it is important to address the stereotypes that AN affects just women and young girls, when actually it effects both sexes. Thank you and let me know what you think. All the information will be factual and merely highlight how men are affected differently and the main causes of the disorder.

Content on anorexia in men in 'epidemiology' section
I'm pretty concerned about the accuracy of the parts of this article focussing on AN in males under the 'epidemiology' subheading. I'm sure they were added with good intentions, but a lot of generalisations are being made, and statistics on 'eating disorders' as a whole seem to be cited, when anorexia nervosa is just one of numerous eating disorders that men can suffer from. I'm adding 'citation needed' templates but I thought I'd flag this up for anyone who has time to work on improving the section. Ohmeohmy666 (talk) 21:44, 20 June 2021 (UTC)

New non-medical sources
You recently sourced some statements which is great, but some of the added sources were not medical ones. Could you replace these blog posts (the USCF and lecturio ones) with proper medical sources?--Megaman en m (talk) 18:26, 23 June 2021 (UTC)
 * Thank you for the observation. USCF is the University of California San Francisco. I thought that qualifies for reliable source. I will do well to replace with appropriate reliable sources as recommended. Thanks GalactosemiaAtaxia (talk) 19:00, 23 June 2021 (UTC)

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 7 September 2020 and 18 December 2020. Further details are available on the course page. Student editor(s): Reine Saab.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 14:24, 16 January 2022 (UTC)