Looking through the list of papers/articles you kindly sought out for us Carrie, the paper that initially stood out for me was: 'Nonfat phobic anorexia nervosa: Clinical characteristics and response to inpatient treatment'.

I describe my history of AN as being non-fat-phobic - because the primary reason for my restricting food and over-exercising was not body shape or body composition related; i.e. my primary fear was not of being fatter or of being fat.

Interestingly, however, the assumption based upon this and many other papers on non-fat-phobic AN is that if a person with AN doesn't fear being fat, then they don't fear gaining weight. Yet, I had a terrible fear of gaining weight when I was anorexic!

I think it needs to be understood that just because a person with AN fears gaining weight, that doesn't automatically assume that they fear 'fatness'.

I feared gaining weight because I fear change - in most areas of my life, and I somehow felt that if the number on the scale didn't rise then nothing awful would happen. While sick, the number on the scale also signified my degree of self control and capacity to adhere to the 'rules' I had set myself around eating and exercise. All-in-all, what I was trying to control while sick was anxiety, and I derived my sense of control of my anxiety through controlling my weight as well as following a series of daily routines and rituals.

Does the personal meaning of anorexic behaviours matter? I think the answer is 'yes'. At present the near axiomatic assumption is that AN is a body image disorder. But body image therapies were not only useless for me, but made me feel very misunderstood. I had an overwhelming fear of everything in my life spiralling out of control; not of getting fat, or looking fat.

Yeah, I've got to (surprise!) agree with Cathy about that study, it misses the point entirely. I don't know of any out of the hundreds of people with anorexia I have met who were not mortally terrified of weight gain - but I know several whose fear of weight gain was not related to getting fat, myself and Cathy obviously included. Non-fat phobic anorexia definitely does not indicate a lack of fear of weight gain! Throughout the last three of the ten years of my ED I would have rather died than gained weight, I was that scared of the prospect. The only difference between myself and a "typical" anorexic was that my fear of weight gain revolved around the idea that I would lose control over my anxiety if I stopped restricting, as I couldn't imagine ever being able to cope with my comorbid problems without ED behaviours and the biological effects of starvation to calm me.

What this study describes is a group of patients who are not quite as scared of gaining weight as the other patients. Labelling this as non-fat phobic anorexia does all people who suffer from this subtype a huge injustice, and just serves to fuel the misunderstandings around the illness. (This rant is not aimed at you, Carrie, but at the knob who named the study in the first place ;) )

interesting discussion above, because as I've probably said here before, I definitely considered myself to have a significant 'body image' related component to my ED - BUT, I still take issue with the 'fear of fatness' idea and think it's missing the point. I feared gaining weight. I feared not being emaciated. I thought I looked normal at horribly low weights. but I never once thought a) I WAS objectively fat or b) that I would become objectively fat. I probably used that WORD as there was no other way to express the illogical fear of weight gain/being normal which should be a 'good' thing. it seems more acceptable to be afraid of legitimate overweightness than to fear not being a skeleton, I guess. but yeah maybe I've been joining the wrong side of this argument all along :P this 'fatness' thing is bullshit for me.

@EvilGenius - interestingly, when my BMI was dangerously low I didn't consider myself to be as thin as other people thought I was - except when I looked at photos of myself and thought 'sh*t, I look like death..' Otherwise, most of the time I simply didn't realise, or care that I was emaciated.

There was another element to it as well... I was someone who for many years was somehow able to do crazy amounts of endurance exercise at a dangerously low BMI (until my heart started to fail..). So my distorted thinking was 'well if I were that thin and sick, then how come I am still able to exercise?'

So, in the above sense I had body distortions of some sort. However, the main point was that a desire for such emaciation was not my goal. What I found was that if I didn't complete my daily anorexic rituals that my anxiety escalated, so the behaviours themselves felt to be critically important to me psychologically. Emaciation was basically a 'side effect' of my compulsive rituals.

Interesting discussion we're have here :)

I was born in June!!! Coincidence...maybe not! haha

I was born in October, so I am apparently not high risk for the development of AN - lol.

@ Cathy - yep, November for me. lolz.
regarding your earlier comment - interesting! perhaps despite our past debates there's actually a more blurry line between fat phobic and non fat phobic AN than most people think. my experience was similar to what you describe, seeing myself more accurately in photos, being 'functional' at stupid weights so believing I must be ok until actual physical crisis happened...etc. I do know that the way I personally interpreted my ED cognitions was very much related to body image. but why that should be so for me when our actual thoughts sound very similar I'm not sure.