Symptoms of Starvation in Eating Disorder Patients

Abstract

The most extensive and thoughtful description of the symptoms associated with underweight and dietary restrictions, traditionally called “starvation symptoms”, was given by Keys et al. in 1950 in their classic book The Biology of Human Starvation. The individual reactions to dietary restrictions and to weight loss were heterogeneous among the men participating in the study. However, in most cases the participants experienced dramatic effects, developing abnormal attitudes and behaviors related to food and eating and various psychosocial and physical changes. The most frequent starvation symptoms reported by underweight eating disorder patients are preoccupation with thoughts about food and eating, irritability, mood changes, sleep disturbances, social withdrawal, weakness, gastrointestinal discomfort, cold intolerance, impaired concentration, apathy, and heightened satiety. The interaction of eating disorder psychopathology with starvation symptoms seems to stimulate further dietary restriction by undermining the person’s sense of being in control over their eating, shape, weight, or themselves in general. In addition, some eating disorder individuals interpret their starvation symptoms as a positive sign of being in control and as evidence that they are working hard to achieve their goal of controlling eating, shape, and weight. The knowledge of starvation symptoms and how they interact with eating disorder psychopathology have important implications both for understanding and treating eating disorders.

Appendix: Starvation Symptoms Check List

Riccardo Dalle Grave

Instructions: The following questions are concerned with the past 28 days only. Please read each questions with attention. Please answer all the questions circling the appropriate number on the right. Thank you

On how many of the past 28 days …	No. days	1–5 days	6–12 days	13–15 days	16–22 days	23–27 days	Every day
1. Have you spent much time thinking about eating and food?	1	2	3	4	5	6	7
2. Have you collected cookbooks and recipes?	1	2	3	4	5	6	7
3. Have you cut food into small pieces?	1	2	3	4	5	6	7
4. Have you hoarded food?	1	2	3	4	5	6	7
5. Have you eaten very slowly?	1	2	3	4	5	6	7
6. Have you eaten hot food?	1	2	3	4	5	6	7
7. Have you increased the consumption of coffee or tea or spice?	1	2	3	4	5	6	7
8. Have you eaten a large amount of food with the sensation of losing control over eating?	1	2	3	4	5	6	7
9. Have you been depressed?	1	2	3	4	5	6	7
10. Have you been anxious?	1	2	3	4	5	6	7
11. Have you been irritable?	1	2	3	4	5	6	7
12. Have you had mood changes?	1	2	3	4	5	6	7
13. Have you heard voices in your head?	1	2	3	4	5	6	7
14. Have you had hallucinations?	1	2	3	4	5	6	7
15. Have you noticed some change in your personality?	1	2	3	4	5	6	7
16. Have you been withdrawn socially?	1	2	3	4	5	6	7
17. Have you found it difficult to concentrate?	1	2	3	4	5	6	7
18. Have you been apathetic?	1	2	3	4	5	6	7
19. Have you had sleep disturbances?	1	2	3	4	5	6	7
20. Have you felt weak?	1	2	3	4	5	6	7
21. Have you had gastrointestinal discomfort?	1	2	3	4	5	6	7
22. Have you been intolerant to noise?	1	2	3	4	5	6	7
23. Have you been intolerant to light?	1	2	3	4	5	6	7
24. Have you felt your legs or other part of your body swollen?	1	2	3	4	5	6	7
25. Have you had a low body temperature?	1	2	3	4	5	6	7
26. Have you felt some tingling?	1	2	3	4	5	6	7
27. Have you felt a reduction of sexual interest?	1	2	3	4	5	6	7
28. Have you felt cold?	1	2	3	4	5	6	7
29. Have you felt an increase in hunger?	1	2	3	4	5	6	7
30. Have you felt an increase in your sense of satiety?	1	2	3	4	5	6	7
31. Have you felt full after eating?	1	2	3	4	5	6	7

In females:

How many periods have you had in the last 3 months?……………….

Have you been taking the “pill” ?……………….