Fasting and Research




When Fasting Becomes Pathological

By Randi Fredricks

Pathological fasting is associated with organic derangement,
which makes one unable to take or retain food
.
John Fielder (2009)

The inquiry into the relationship between fasting and anorexia began during the Victorian era. From around 1850 to 1900, women carefully concealed their appetite for food in fear it would be misconstrued with an appetite for sex (Brumberg, 1988). Because food was associated with basic primary functions, such as defecation, women frequently restricted eating to once or twice a week. In response to this behavior, Charles Lasègue wrote the paper L'anorexie Hysterique in 1873, detailing the stages of anorexia (Brumberg, 1988). Since then, the argument as to whether fasting is pathological has gained momentum.

When someone makes a decision to fast—whatever the motivation—there is a desire to create a transformation, whether it is physiological, psychological, or spiritual. It seems shortsighted to assume the modern anorexic’s motivation is entirely pathological and devoid of spiritual intent, when in fact he or she may be in the midst of a spiritual crisis.

When discussing fasting and pathology, it may be a matter of which came first. Maud Ellmann (1993) conveyed a story about an imprisoned hunger striker in Northern Ireland who survived the hunger strike only to die of anorexia nervosa within a year after being released from prison. Ellmann said, "Fasting as a protest differs so profoundly from fasting as a personal pathology that it seems almost perverse to link these two strange disciplines at all" (p. 1). This begs the question as to what percentage of anorexics start out with a noble intent when fasting. Researchers report only a modest increase in the incident of anorexia in countries like India, where religious devotees routinely fast for long periods (Ghosh & Merchant, 1999). Yet it stands to reason that the mechanisms that constitute a clinical diagnosis of anorexia nervosa are most likely present throughout a myriad of religious and cultural contexts.

Fasting and Anorexia Nervosa

As mentioned in the case of the hunger striker, long periods of fasting can evolve into anorexia nervosa in some people. Additionally, deliberately skipping meals can turn into into anorexia in individuals who are predisposed to the disorder. How does a mental health professional determine if someone developed anorexia nervosa? The American Psychiatric Association has a clear definition. Typically, a person with anorexia does not eat enough to maintain a healthy weight and eventually loses at least 15% of their body weight. Some other symptoms unique to anorexia include:

  • Feeling overweight even when underweight
  • Picking at food, eating very little
  • Feeling cold, even in warm weather, due to electrolyte imbalance, and or lack of body fat
  • Anemia
  • Wearing baggy clothes to hide their body for fear of being perceived as fat (even if underweight)
  • Scanty or absence of menstruation
  • Thinning hair
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) differentiates between two specific types of anorexia nervosa. The first, "Binge-Eating/Purging Type" describes those who regularly binge (consume large amounts of food in short periods of time), and purge through self-induced vomiting, excessive exercise, fasting, the abuse of diuretics, laxatives, and enemas, or any combination of these measures. The second category, "Restricting Type," denotes individuals who lose weight primarily by reducing their overall food intake through dieting, fasting and/or exercising excessively. This would be the DMS diagnosis for a patient who fasted and met the other diagnostic criteria: Anorexia Nervosa, Restricting Type. The biggest clue that a mental health professional will get for a patient with this disorder is extreme thinness. But before this point, an obsession with thinness and food restriction will be the prodominent features.

Obviously, religious, therapeutic, and political fasting does not fall under this description, but fasting facilities must screen for eating disorders none the less. References
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Randi Fredricks is a Naturopathic Psychotherapist with a Doctorate in Naturopathy and a Masters in Psychology. She sees clients at her office in San Jose, California. She can be reached at 800-957-5655 or you can contact her online. This article is an excerpt from Randi Fredricks' book Fasting: An Exceptional Human Experience. Copyright © 2009. All rights reserved. No part of this article may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems.





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