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Solving The Anorexia Puzzle: A Scientific Approach is not for those who are inexperienced or who have only a casual interest in the treatment of eating disorders. It is an intricate work, in which the authors present a closely argued position that the condition that has generally been referred to as “anorexia nervosa” is not a homogeneous entity. They contend that there is at least one other distinctly different type of anorexia, which they term “activity anorexia,” and that many cases of anorexia nervosa are actually misdiagnosed cases of activity anorexia.
The evidence they present to support this premise is compelling, and is drawn from numerous studies in fields ranging from biochemistry to cultural anthropology, as well as from their own extensive research. Their documentation is exhaustive, and their factual statements are unquestionably accurate. However, the way the authors interpret and relate these facts in constructing their theory of activity anorexia is somewhat less convincing.
The core of Epling and Pierce's premise is that “activity anorexia is not a psychological or mental disorder.” Rather it is a bio-behavioral cycle that is initiated by combining a severe restriction of food intake with a simultaneous, sudden increase in strenuous physical activity.
The excessive exercise that anorexics engage in is directly caused by acute food restriction and is not simply a secondary attempt to lose weight. In the presence of low body weight, this exercise produces complex neurochemical changes that further suppress the desire for food, which completes and perpetuates the cycle. In addition, the authors maintain that the behavioral, cognitive, and personality changes that are characteristically associated with anorexia are not the cause of this disorder, as has been traditionally believed, but are actually the result of self-imposed starvation.
However, there are apparent inconsistencies regarding some pivotal aspects of this theory. Although Epling and Pierce go