As my presumed readership is likely aware, the DSM-V criteria has recently been released, and it includes a few changes to eating disorder diagnostics, notably EDNOS is gone (although not from the vernacular) and Anorexia Nervosa no longer stipulates amenorrhea in post-pubescent woman/pre-menopausal woman (AKA loss of period for woman who should get periods developmentally) which is understandable as it seems finicky as a basis for diagnosis of such a serious eating disorder as AN. (Sidenote: I have continued having periods with a BMI as low as 15, and the only time I ever had sex without a condom, I got preggers, so my uterus is obviously a beast — us woman all bloom in developmentally different ways!)
The biggest change in AN criteria, as you probably already know, is that there is no longer a specific point in which a person is considered underweight enough to qualify. You do still have have to be of “significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health)” to qualify as AN, but this point is indeterminate, it is blurred and fuzzy, left to the discretion of relevant parties.
The aforementioned change makes sense from the standpoint of both mental health and practicality considering the insurance value of a DSM V diagnosis and the perils of attaching this diagnosis to a concrete BMI (17.5, 16.5, 75%-85% ideal body weight which varies from 10-15 pounds depending on the formula you use anyway).
However, for a person who actually has AN, it is frustrating, because suddenly, you have no real basis by which to determine if you are of significantly low body weight […] or not. Maybe the whole scheme of that reworking is trying to get us to forget about that strict and comforting numerical basis of our Eating Disorders, but honestly nothing makes the numbers go away. They will still weigh you. They will still know your BMI. And you will still know your own BMI, if you’re still sick…
And suddenly you’re searching “what do people actually consider underweight anyway” – are we naturally aligned with the science (ie anything under a BMI of 18.5) and according to the internet, no, we aren’t. I was reading about how much people on CalorieCount.com think an ideal weight is at a height of 5 foot 1 and apparently for some 110 is entirely too thin “bony” or 100 pounds “like a crackhead” and if anyone there mentioned anything under 100 pounds it was kind of torn up by the community although the more rational of them pointed out that if you’re 5’1, anything between 95-130 pounds is considered “normal” and typically 100-115 is considered “ideal”.
Still, at 90 pounds and 5’1, I used a (TW!!!) nifty internet tool that ranks your individual BMI compared to your own country and also literally every other country – according to this tool my BMI is lower than 96% of girls in the USA in my age range and 87% of girls in the whole world. Shocking!
Even so, what is “significantly low”? No BMI is ever low enough. When your on this train, headed for nowhere, first you need to be under 18.5 so you can call yourself underweight — then you need to be under 17.5 so you can call yourself “skinny enough to be diagnostically anorectic” and then you need to be under 16.5 to “qualify as a ‘real’ anorectic” and then below 15 to be “a ‘really really real anorectic'” and so on, so forth, it never quite feels justified – admitting to your eating disorder. But there are so many sicker people and I’m not sick enough and I’d feel so stupid saying I have a problem when it’s obviously not that bad (but if you were somebody else talking to you, you know they’d say “get help”)
If I was skinnier then 100% of the girls in the world, I would be dead. Going from “skinnier then 96% of girls in the USA” to “skinnier then 98%” takes me from 90 pounds to 87 pounds. To be skinnier then 99% of girls in the USA, I need to be 80 pounds, BMI 15 (my lowest weight). To be skinnier then 100% of girls – just in the USA – I would need to be 69 freaking pounds. In the world? Yeah, you can’t even get that skinny.
What the hell is the point of all this numerical masturbation anyway? somehow I’ve been thinking about it all day? My BMI is currently 17, at what point do I think I’ll be worthy of admitting that I have a problem? Based on the evidence at my disposal, and lack of any solid diagnostic criteria to guide me…I’d say…I dunno, it all seems pretty arbitrary, but for some reason, a BMI of 16 is looking like a good bet.