Peptonize

Peptonize (pronounced pep-tuh-nahyz)

(1) In physiology and biochemistry, to hydrolyse (a protein) to peptones by a proteolytic enzyme, especially by pepsin or pancreatic extract (done usually to aid digestion).

(2) In biochemistry, any water-soluble mixture of polypeptides and amino acids formed by the partial hydrolysis of protein.

(3) To render a text or some other form into something more easily understood (ie a figurative use of the notion of “making more digestible”).

1877: The construct was peptone + ize.  The noun peptone was from the German Pepton, from the Ancient Greek πεπτόν (peptón) (cooked, digested), (neuter of peptos), the verbal adjective of peptein (to cook), from πέπτω (péptō) (soften, ripen, boil, cook, bake, digest); the ultimate root was the primitive Indo-European root pekw (to cook; to ripen).  The –ize suffix was from the Middle English -isen, from the Middle French -iser, from the Medieval Latin -izō, from the Ancient Greek -ίζω (-ízō), from the primitive Indo-European verbal suffix -idyé-.  It was cognate with other verbal suffixes including the Gothic -itjan, the Old High German –izzen and the Old English -ettan (verbal suffix).  It was used to form verbs from nouns or adjectives which (1) make what is denoted by the noun or adjective & (2) do what is denoted by the noun or adjective; the alternative form is –ise.  In British English, alternative spelling is peptonise.  Peptonize, peptonized & peptonizing are verbs, peptonic is an adjective and peptonization & peptonizer are nouns; the most common noun plural is peptonizations.

Peptone was adopted as the general name for a substance into which the nitrogenous elements of food are converted by digestion.  The word entered scientific English in 1860, the German Pepton having first appeared in academic papers in 1849.  Being used in chemistry, a number of derived forms were created as required including antipeptone (a product of gastric and pancreatic digestion, differing from hemipeptone in not being decomposed by the continued action of pancreatic juice), hemipeptone (a product of gastric and pancreatic digestion of albuminous matter, which (unlike antipeptone) is convertible into leucin and tyrosin by the continued action of pancreatic juice; it's formed also from hemialbumose and albumin by boiling dilute sulphuric acid), bactopeptone (a peptone used as a bacterial culture medium) and neopeptone (a commercial mixture of peptones & vitamins), amphopeptone (a product of gastric digestion, a mixture of hemipeptone and antipeptone

Peptides attracted interest some years ago when their use in the performance enhancing drugs (PED) supplied to athletes was publicized.  Peptones and peptides are both derived from proteins but have distinct differences in their structures and properties.  Peptides are short chains of amino acids linked together by peptide bonds and are naturally occurring molecules found in the body and in some foods (hence the interest in their use in PEDs), their biological functions including acting as signaling molecules, hormones, and enzymes.  Under laboratory conditions or during industrial process they can also be derived from the hydrolysis of proteins to be used as therapeutic agents, diagnostic tools, and in many research environments.  Examples of peptides include oxytocin, vasopressin, and insulin.  Peptones are mixtures of amino acids and peptides produced by the partial hydrolysis of proteins and are significantly larger and more complex than peptides.  In the body, they’re produced by the digestion of natural proteins using enzymes or acids and in microbiological culture media are widely used as a source of amino acids and peptides which readily can be utilized by microorganisms for growth and metabolism.  In the industrial production of food, peptones are a common flavor enhancer and examples include tryptone, casitone, and yeast extract.

Mother's other little helper: Peptonized port was once recommended for nursing mothers.

The reason the verb peptonize (and peptonise) is at all known beyond biochemistry & industrial laboratories is the form can by analogy be used to describe the process by which some long or unintelligible document is rendered into something more easily digestible.  In this it differs from “abridge” which describes reducing the size of a document and, strictly speaking, the process should be restricted to removing passages of text which are not essential to the meaning or which intrude on the narrative flow.  Abridgment of novels (of which those published by the Reader’s Digest periodical remain the best-known) have become a popular form and often appear in editions including several of an author’s works.  The Reader's Digest began publication of these anthologies (fiction & nonfiction) in 1950 and originally they marketed by advertisements in the periodical and in mail-order catalogues (which were for 150-odd years a form of distribution which can be considered the B2C (business to consumer) websites of the pre-internet age as “Reader's Digest Condensed Books” before in 1997 being re-branded as “Reader's Digest Select Editions”.  There were some who were rather snobby about the Reader's Digest because it avoided abstractions and wrote for a literate but not necessarily highly educated audience and the news in the 1980s that it was Ronald Reagan’s (1911-2004, US president 1981-1989) preferred periodical reinforced the prejudice although it appears also to have boosted circulation.  More sympathetic critics however have praised the editing of the company’s abridged editions which they in more than one case observed made for a better novel.

Among the more infamous suggested abridgments was that recommended by some critics for Joseph Heller’s (1923-1999) dark satire Catch-22 (1961).  Apparently not enjoying the mental gymnastics demanded by the structure, not only did they suggest one or more chapters should be deleted, the consensus appeared it be it would matter little which chapters were sacrificed in the desired abridgment.  Time has been kinder to the book and few would now suggest deleting anything although the author, like many novelists, discarded much from his early drafts and in 2003 release Catch as Catch Can which included two chapters which never made it to the final draft (the previously published Love, Dad & Yossarian Survives), both of which worked well as short stories which were more viciously condemnatory of the US military than even what appeared in 1961.  Six decades on, it’s difficult to make the case removing a chapter from Catch-22 would in anyway peptonize to work although in at least one literary studies course students were set the task of working out which chapter could be deleted with the fewest consequential changes needing to be imposed on the rest. 

In 1970 however, it became possible to assess what would happen if chunks of the book were deleted because that year a film “version” was released and to produce that, radically the novel was abridged.  Whether it was much peptonized by the process was at least questionable, the phrase in the review by Richard Schickel (1933–2017): “One of our novels is missing” capturing the view of many.  In fairness, given the sprawling scale, there was of course no other way it could be condensed into two hours of screen time and something spread over many viewings, a la Richard Wagner’s (1813–1883) Ring Cycle (1876), would have brought its own problems.  Still, by 2019 technology had made the habits of audiences change and a six-part mini-series was released.  With a total running time over four hours it was still not enough to encompass the whole novel but hardly of a length to intimidate the binge generation and as a piece of entertainment it was well received although the advice of the serious-minded remained the same: read the book.

Lindsay Lohan and her lawyer in court, Los Angeles, December 2011.

Both the film and the book actually went well beyond mere abridgment, verging solidly into what students of the visual forms call “interpretation” or “adaptation” so people can decide whether there was peptonization, simplification or both.  By contrast, a document subjected to a peptonization may be rendered shorter, longer or even transformed into a different format.  The genre known as “popular” (“popular science” and “popular history” the best known) often contain elements from technical or academic works which are re-written into a form more easily comprehended by readers without background in the specialization and is a classic form of peptonization.  Once can also exist as an adjunct document which accompanies the substantive text: an explanatory memorandum and an executive summary are both examples and even the abstract which sits as a header can fulfil the function and all three probably are valued by many because they obviate any need to read something which may be tiresomely and often needlessly long.  That may have been what Lord Salisbury (1893-1972) had in mind when in 1952 he remarked of the idea “…budget proposals could be simplified and summarized a little before being shown to the prime-minister.”: “Of course, I don’t know how far they are peptonized already.”  Even then, such use was rare (certainly outside the House of Lords) and now the meaning functionally be extinct.

Approved by His Majesty's Home Secretary.

In England in the late nineteenth and early twentieth centuries, peptonised milk was part of the treatment regimes used in the force-feeding of patients in lunatic asylums, suffragettes on hunger strike those afflicted by Anorexia Nervosa (then still often called Anorexia Hysterica).  The method didn’t long endure in dealing with the bolshie proto-feminists because the public reaction was such the Home Office usually relented.  It remained often used for the anorexics and it presumably enjoyed some success but in 1895 The Lancet (a weekly medical journal first published in 1823) reported a fatal case: “The patient refused food so ‘was fed an enemata of peptonised milk, beef tea and brandy.  This was carried out for two to three days and in ten days she could take a moderate diet by the mouth, but suffered from diarrhoea.  On the thirteenth day after admission she rapidly became worse, the temperature rose to 102°F, and on the fifteenth day she died.”

Anorexia

Anorexia (pronounced an-uh-rek-see-uh)

(1) In clinical medicine, loss of appetite and inability to eat.

(2) In psychiatry, as anorexia nervosa, a defined eating disorder characterized by fear of becoming fat and refusal of food, leading to debility and even death.

(3) A widely-used (though clinically incorrect) short name for anorexia nervosa.

1590–1600: From the New Latin, from the Ancient Greek ἀνορεξία (anorexía), the construct being ἀν (an) (without) + ὄρεξις (órexis) (appetite; desire).  In both the Greek and Latin, it translated literally as "a nervous loss of appetite".  Órexis (appetite, desire) is from oregein (to desire, stretch out) and was cognate with the Latin regere (to keep straight, guide, rule).  Although adopted as a metaphorical device to describe even inanimate objects, anorexia is most often (wrongly) used as verbal shorthand for the clinical condition anorexia nervosa.  The former is the relatively rare condition in which appetite is lost for no apparent reason; the latter the more common eating disorder related to most cases to body image.  Interestingly, within the English-speaking world, there are no variant pronunciations.

Anorexia Nervosa and the DSM

The pro-ana community has created its own sub-set of standard photographic angles, rather as used car sites typically feature certain images such as the interior, the odometer, the engine etc.  Among the most popular images posted on "thinspiration" pages are those which show bone definition through skin and, reflecting the superior contrast possible, there's a tendency use grayscale, usually converted from color originals.  The favored body parts include the spine, hip bones, clavicles (collar bones) and the shoulder blades.     

Although documented since antiquity, the condition in its modern form wasn't noted in western medical literature until an 1873 paper presented to the Royal College of Physicians (RCP) called “Anorexia Hysterica”, a description of a loss of appetite without an apparent gastric cause.  That same year, a similar condition was mentioned in a French publication, also called “l’anorexie hystérique”, and described food refusal combined with hyperactivity.  Although the author of the earlier work had within a year changed the descriptor to “Anorexia Nervosa”, the implication in all these papers was of an affliction exclusively female, something very much implied in “l’anorexie hystérique”, hysteria then a mainstream diagnosis and one thought inherently "a condition of women".

A slight Lindsay Lohan demonstrates "an anorexic look" which is something distinct from the clinically defined condition "anorexia nervosa" although there's obviously some overlap.

After its acceptance as a psychogenic disorder in the late nineteenth century, anorexia nervosa (AN) was the first eating disorder placed in the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM).  In the first edition (DSM-I (1952)), it was considered a psycho-physiological reaction (a neurotic illness).  In the DSM-II (1968), it was listed with special symptoms & feeding disturbances, which also included pica and rumination.  In DSM-III (1980), eating disorders were classified under disorders of childhood or adolescence, perhaps, at least in part, contributing to the under-diagnosis of later-onset cases.  At that time, the American Psychiatric Association (APA) created two specific categories that formally recognized the diagnosis of eating disorders: AN and binge eating (called bulimia in DSM-III and bulimia nervosa (BN; the obsessive regurgitation of food) in both the revised DSM-III (1987) and DSM-IV (1994).  In the DSM-IV, all other clinically significant eating disorder symptoms were absorbed by the residual categories of eating disorder not otherwise specified (EDNOS) and binge-eating disorder (BED), noting the disorders were the subjects for further research.  Subsequently, When the DSM-IV was revised (2000), eating disorders moved to an independent section.  The DSM-5 (2013) chapter for eating disorders added to the alphabet soup.  In addition to pica, AN, BN and BED, DSM-5 added  avoidant/restrictive food intake disorder (ARFID) and other specified feeding or eating disorder (OSFED), the latter including some other peculiar pathological eating patterns, like atypical AN (where all other criteria for AN are met, but weight is in the normal range).

Esurient

Esurient (pronounced ih-soo-r-ee-uhnt)

(1) The state of being hungry; greedy; voracious.

(2) One who is hungry.

1665–1675: A borrowing from the Latin ēsurient & ēsurientem, stem of ēsuriēns (hungering), present participle of ēsurīre (to be hungry; to hunger for something), from edere (to eat), the construct being ēsur- (hunger) + -ens (the Latin adjectival suffix which appeared in English as –ent (and –ant, –aunt etc) and in Old French as –ent).  The form ēsuriō was a desiderative verb from edō (to eat), ultimately from the primitive Indo-European hédti (to eat and from the root ed-) + -turiō (the suffix indicating a desire for an action).  English offers a goodly grab of alternatives including rapacious, ravenous, gluttonous, hoggish, insatiable, unappeasable, ravening, avaricious, avid and covetous.  Esurient is a noun & adjective, esurience & esuriency are nouns and esuriently is an adverb; the noun plural is esurients.

A noted Instagram influencer assuaging her esurience.

For word-nerds to note, a long vowel in the Proto-Italic edō from the primitive Indo-European hédti is illustrative of the application of Lachmann's law (a long-disputed phonological sound rule for Latin named after German philologist and critic Karl Lachmann (1793–1851)).  According to Lachmann, vowels in Latin lengthen before primitive (and the later proto-) Indo-European voiced stops which are followed by another (unvoiced) stop.  Given the paucity of documentary evidence, much work in this field is essentially educated guesswork and Lachmann’s conclusions were derived from analogy and the selective application of theory.  Not all in this highly specialized area of structural linguistics agreed and arguments percolated until an incendiary paper in 1965 assaulted analogy as an explanatory tool in historical linguistics, triggering a decade-long squabble.  This polemical episode appeared to suggest Lachmann had constructed a framework onto which extreme positions could be mapped, one wishing to attribute almost everything to analogy, the other, nothing.  With that, debate seemed to end and Lachmann’s law seems now noted less for what it was than for what it was not.

In memory of Tenuate Dospan

A seemingly permanent condition of late modernity is weight gain; the companion permanent desire being weight loss.  The human propensity to store fat was a product of natural selection, those who possessed the genes which passed on the traits more likely to achieve sexual maturity and thus be able to procreate.  Storing fat meant that in times of plenty, weight was gained which could be used as a source of energy in times of scarcity and for thousands of generations this was how almost all humans lived.  However, in so much of the world people now live in a permanent state of plenty and one in which that plenty (fats, salt & sugars) doesn’t have to be hunted, gathered or harvested.  Now, with only a minimal expenditure of energy, we take what we want from the shelf or, barely having to move from our chair, it’s delivered to our door.  In our sedentary lives we thus expend much less energy but our brains remain hard-wired to seek out the fats, salt & sugars which best enable the body to accumulate fat for the lean times.  Some call this the "curse of plenty".

For all but a few genetically unlucky souls, the theory of weight loss is simple: reduce energy intake and increase the energy burn.  For many reasons however the practices required to execute the theory can be difficult although much evidence does suggest that once started, exercise does become easier because (1) the brain rewards the body for doing it with what’s effectively a true “recreational drug”, (2) it becomes literally easier because weight-loss in itself reduces the energy required and (3) the psychological encouragement of success (some dieticians actually recommend scales with a digital read-out so progress can be measured in 100 gram (3½ oz) increments).  Still, even starting is clearly an obstacle which is why the pharmaceutical industry saw such potential in finding the means to reduce supply (food intake) if increasing demand (exercise) was just too hard.

Lindsay Lohan about to assuage her esurience.

For centuries physicians and apothecaries had been aware of the appetite suppressing qualities of various herbs and other preparations but these were usually seen as something undesirable and were often a side effect of the early medicines, many of which were of dubious benefit, some little short of poison.  Although the noun anorectic (a back formation from the adjective anorectic (anorectous an archaic form) appeared in the medical literature in the early nineteenth century, it was used to describe a patient suffering a loss of appetite; only later would it come to be applied to drugs, firstly those which induced the condition as a side-effect and later, those designed for purpose.  The adjective anorectic (characterized by want of appetite) appeared first in 1832 and was a coining of medical Latin, from the Ancient Greek ἀνόρεκτος (anórektos) (without appetite), the construct being ἀν- (an-) (not, without) + ὀρέγω (orégō) (a verbal adjective of oregein (to long for, desire) which was later to influence the word anorexia)).  The noun was first used in 1913.

Tenuate Dospan.  As an industry leader in promoting DEI (diversity, equity and inclusion), Merrell was years ahead in the use of plus-size models.

In the twentieth century, as modern chemistry emerged, anorectic drugs became available by accident as medical amphetamines reached the black market as stimulants, the side effects quickly noted.  Those side effects however were of little interest to the various military authorities which during World War II (1939-1945) made them available to troops by the million, their stimulant properties and the ability to keep soldiers alert and awake for days at a time functioning as an extraordinary force-multiplier.  Not for years was fully it understood just how significant was the supply of the amphetamine Pervitin in the Wehrmacht’s (the German armed forces (1935-1945)) extraordinary military successes in 1939-1941.  In the post-war years, various types of amphetamine were made commercially available as appetite suppressants and while effective, the side effects were of concern although many products remained available in the West well into the twenty-first century.  Probably the best known class of these was amfepramone (or diethylpropion) marketed most famously as Tenuate Dospan which was popular with (1) those who wanted to be thin and (2) those who wanted to stay awake longer than is usually recommended.  Tenuate Dospan usually achieved both.

The regulatory authorities however moved to ensure the supply of Tenuate Dospan and related preparations was restricted, the concern said to be about the side effects although in these matters the true motivations can sometimes be obscure.  In their place, the industry responded with appetite suppressants which essentially didn’t work (compared with the efficient Tennuate Dospan) but sold for two or three times the price which must have pleased some.  The interest in restricting esurience however continued and one of the latest generation is Liraglutide (sold under various the brand names including Victoza & Saxenda) which started life as an anti-diabetic medication, the appetite suppressing properties noted during clinical trials, rather as the side-effects of Viagra (sildenafil) came as a pleasing surprise to the manufacturer.  Being a injection, Liraglutide is harder to use than Tenuate Dospan (which was a daily pill) and users report there are both similarities and differences between the two.

Liraglutide (Saxenda).  The dose increases month by month.

On Tenuate Dospan, one’s appetite diminished rapidly but food still tasted much the same, only the desire for it declined and being an amphetamine, energy levels were elevated and there were the usual difficulties (sleeping, dryness in the mouth, mood swings).  Dieticians recommended combining Tenuate Dospan with a high quality diet (the usual fruit, vegetables, clear fluids etc).  By contrast, although Liraglutide users reported much the same loss of interest in food, they noted also some distaste for the foods they had once so enjoyed and a distinct lack of energy.  It’s still early in the life of Liraglutide but it certainly seems to work as an appetite suppressant although in the trials, the persistent problem of all such drugs was noted: as soon as the treatment ceased, the food cravings returned.  Liraglutide does what the manufacturer’s explanatory notes suggest it does: it is a drug which can be used to treat chronic obesity by achieving weight-loss over several months, during which a patient should seek to achieve a permanent lifestyle change (diet and exercise).  It does not undo thousands of generations of evolution.  The early literature at least hinted Liraglutide was intended for obese adolescents for whom no other weight loss programmes had proved effective but anecdotal evidence suggests adults are numerous among the early adopters.

Thinspo

Thinspo (pronounced thin-spoh)

Material created, curated or used (almost exclusively in distributed digital form) to inspire thinness or weight loss; a sub-set of the pro-ana community which exists to support those who have chosen to anorexia nervosa as a lifestyle.

2005–2010: The short form of thinspiration, the construct being thin +‎ (in)spiration.  Thin was from the Middle English thinne, thünne & thenne, from the Old English þynne, from the Proto-West Germanic þunnī, from the Proto-Germanic þunnuz (thin) (and related to þanjaną (to stretch, spread out)), from the primitive Indo-European ténhus (thin), from ten- (to stretch).  It was cognate with the German dünn, the Dutch dun, the West Frisian tin, the Icelandic þunnur, the Danish tynd, the Swedish tunn, the Latin tenuis, the Irish tanaí, the Welsh tenau, the Latvian tievs, the Sanskrit तनु (tanú) (thin) and the Persian تنگ‎ (tang) (narrow). A doublet of tenuis, it was related also to tenuous.  Inspiration was from the Middle English inspiracioun, from the Old French inspiration, from the Late Latin īnspīrātiōnem (nominative īnspīrātiō), from the Classical Latin īnspīrātus (past participle of inspīrō).  It displaced the native Old English onbryrdnes (literally “in-pricked-ness”).  Thinspo inspired others forms such as fitspo (encouraging fitness) and blondespo (advocating being blonde) and between thinspo and fitspo, critics noted some overlap, suspecting that in at least some cases the later identity is assumed as an attempt at disguise.  Thinspo is a noun; the noun plural is thinspos.

Thinspo's idealized bone definition.

The companion term ribspro (the short form of ribspiration (known also as bonespo)) is a particular genre within thinspo.  Whereas thinspo material can be long or short-form text, diagrams or images, rinspro is almost exclusively visual, the text limited to perhaps a few admiring or encouraging words and as the names suggest, the focus is on ribcages or other bones proximately highlighted against taut skin.  Backbones, ribs, clavicles and hipbones seem the most favored, presumably because they tend to provide the most definitional contrast but there’s also the suspicion that the particular aesthetic construct of the thinspo community finds there the most attractive, unlike a knee or elbow which, however boney, seems not to be thought photogenic.  Another genre (a kind of applied thinspo) within the community is meanspo (the short form of mean inspiration), from the “tough love” or “cruel to be kind” school of weight loss and this school of thought advocates issuing critical and insulting comments to those considered “insufficiently thin enough”, the rationale being this will convince them to reduce intake, exercise more, purge and thus lose weight.  The thinspo ecosystem has also proliferated thematic variations such as “vegan thinspo” although that to some extent was opportunistic give that the most extreme of the thinspo operatives had long since banished animal products, regarding recommendations like “lean mean” or “chicken strips” as just so much fat.

Like much in the pro-ana community, the thinspo sites exist on a spectrum, those thought innocuous left to continue while any judged to be encouraging eating disorders subject to being shutdown although the efforts undertaken by (and sometimes imposed on) the platforms is a Sisyphean battle, the content shifting as required.  It’s also organic in that thinspo, like all that’s curated by the pro-ana community, is just another function supply-demand curve; the supply of pro-ana content at least to some extent a product of demand and, like much that is on-line, some of the material is blatantly fake, something most obviously detected in the dubious before & after photos which appear with frequent duplication.  Whether there were statistically significant differences in the nature of the content of thinspo and fitspo sites attracted academic interest and there were studies, the results differing in detail (and demonstrating widely divergent results depending on the platform analyzed which was thought to be a reflection more of the degree of success a platform achieved in enforcing its policies than any difference in the collective user profile) but displaying the same general trends: Thinspo sites portrayed body parts with more than twice the frequency of fitspo and posts highlighting bony body features and references to mental illness were overwhelmingly almost specific to thinspo.  Interestingly, the differences between fitspo & thinspo relating to sexually suggestive images, appearance comparison and messages encouraging restrictive eating were not statistically significant, the divergences being striking but almost wholly correlated with the platform on which they were posted.  The more extreme of the forks such as self harm (cutters etc) appeared almost exclusively on thinspo.

Thinspo Rules

Lindsay Lohan during thinspo pin-up phase, 2005.

(1) Never eat something just because you want to finish it.  Eat only enough to stop the worst of the hunger pangs and don’t eat until sated; those extra bites add up.

(2) Don’t let emotions take over and eat only if hungry.  Stop yourself once you start eating if you know it’s for the wrong reasons.

(3) If you catch yourself in a binge, stop the moment you realize.  Don’t forgive yourself for screwing up; it will only permit you to screw up again.

(4) Every calorie counts.  Review every recipe and remove as many calories as possible.  Where possible, choose the diet or low cal version and drink water (soda water is fine), black tea or black coffee instead of other beverages.  Avoid zero-cal sweeteners (1) because they’re a chemical cocktail and (2) on thinspo goal is to completely cure the body’s natural sugar addiction. 

(5) Don’t feel guilt about wasting food.  The undesirability on environmental grounds is noted but the sooner you change yourself, the better.  Set a goal always not to eat everything you’re served and gradually increase this quantity.  Before long, you’ll be throwing away food without barely a thought.

(6) Eat slowly, savoring each bite.

(7) Drink water during meals, as much as you can manage.   This curbs hunger, is filling, aids in digestion and maintains hydration which has many benefits.  Water has zero calories and can be taken as ice.

(8) Chew your food more, taking at least one 1 full breathe after every bite.  It can vary according to what’s being eater but as a guide, chew 30 times for each mouthful. This not only assists digestion but slows the pace of eating, reducing consumption.

(9) Cut food into smaller pieces which slows eating, can make you you’re eating more and it will makes other people think you ate more, something which can be important.

 (10) Associate unhealthy food with something else: ice cream with saturated fat, bread with carbs, juice with sugar etc.  Concrete visual examples are also helpful: cake as fat sitting in your thighs, chips as a permanent lining in the stomach etc..

(11) Learn from other people eating because while there are individual variations, overall, the patterns should be consistent.  Watch skinny people and apply their principles to your own diet; watch fat people with disgust and revulsion, avoiding what they do.

(12) Decide beforehand how much you are going to eat and never eat more.  If cooking, cook only one serving, so you can’t eat anymore.  The idea model is to have no food in the house and each day but only what you’re that day allowed.  It can be difficult at first but it can be done and if stuck to, it’s a foolproof diet.

(13) Always remind yourself of your goals and rewards.  Keep track of daily nutrient and food goals (some use diet minder journal or cronometers but the best method is whatever works for you).  Weigh yourself twice a day (before morning coffee and just before going to bed), the goal being always to see a lower number than previous weigh-in.  If you have achieved a target weight and operate in a variation of +/- 100g, that is acceptable.

(14) Don’t eat 2½ hours before bed.

(15) You’ll sometimes eat with friends or family so you may need to develop techniques surreptitiously to dispose of food.  You’ll get good at knowing where to sit so one hand can always been unseen and a good trick is to wear clothes with big pockets you can line with plastic bags.

Pagophagia

Pagophagia (pronounced pag-off-faghia)

(1) The excessive and constant eating of ice, often as part of extreme dieting.

(2) A craving to eat ice, sometimes associated with iron-deficiency anemia.

Pre 900: A compound word, the construct being págo(s) + -phagia.  Págos is from the Byzantine Greek, the perfective stem of ἔφαγον (éphagon) (I ate; I devoured), singular first-person aorist active indicative form (by suppletion) of ἐσθίω (esthíō) (I eat; I devour).  Phagia is from the Ancient Greek πάγος- (phag-) (stiff mass; frost; ice) from pēnunai, (to stick, stiffen), from the primitive Indo-European root pag.  It was used also in a derogatory, figurative sense to describe a cold, unfriendly person (in the sense of one metaphorically cold like ice).

Ice, diet and the DSM

Pagophagia (the excessive consumption of ice or iced drinks), is often regarded as a recent phenomenon and a novel manifestation of pica (a disorder characterized by craving and appetite for non-edible substances, such as ice, clay, chalk, dirt, or sand and named for the jay or magpie (pīca in Latin), based on the idea the birds will eat almost anything) but in texts from Classical Greece are warnings in the writings of both the physician Hippocrates (circa 460–circa 370 BC) and the polymath Aristotle (384–322 BC) concerning the dangers of the excessive intake of cold or iced water.  The cause of the death of Theophilus (Byzantine (Eastern Roman) Emperor 829-842) was officially dysentery but, based on the original texts of Byzantine historians and chroniclers of the era, modern researchers speculate the cause of death may have been related to Theophilus' pagophagia (snow eating), a long-time habit he indulged to relieve the symptoms of gastric inflammation.  In the medical literature, from the sixteenth century on, there are discussions and illustrative case histories about the detrimental effect of immoderate usage of cold water, ice and snow, frequently in the context of eating disorders, another range of conditions with a long history.

A noted feature of the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5 (2013)), was the more systematic approach taken to eating disorders, variable definitional criteria being defined for the range of behaviours within that general rubric.  What may have appeared strange was including the ice-eaters within the psychological disorder Pica which is characterized by the manifestation of appetite for non-nutritive substances including sharp objects (acuphagia), purified starch (amylophagia), burnt matches (cautopyreiophagia), dust (coniophagia), feces (coprophagia), sick (emetophagia), raw potatoes (geomelophagia), soil, clay or chalk (geophagia), glass (hyalophagia), stones (lithophagia), metal (metallophagia), musus (mucophagia), ice (pagophagia), lead (plumbophagia), hair, wool, and other fibres (trichophagia), urine (urophagia), blood (hematophagia (sometimes called vampirism)) and wood or derivates such as paper & cardboard (xylophagia).  DSM-5 also codified the criteria for behaviour to be classified pica.  They must (1) last beyond one (1) month beyond an age in infancy when eating such objects is not unusual, (2) not be culturally sanctioned practice and (3), in quantity or consequence, be of sufficient severity to demand clinical intervention.  Interestingly, when the text revision of DSM-5 (DSM-5-TR, 2022) was released, the sentence “individuals with atypical anorexia nervosa may experience many of the physiological complications associated with anorexia nervosa” was added to the description of the atypical anorexia nervosa example to clarify that the presence of physiological consequences during presentation does not mean that the diagnosis is the (typical) anorexia.

However, it must be remembered the DSM is a tool for the clinician and, while it can be a useful source document for the lay-reader, there are other publications better suited to those self-diagnosing or informally assessing others.  An individual for whom the only symptom of pica is abnormally high and persistent ice consumption doesn’t of necessity need to be subject to the treatment regime imposed on more undiscriminating consumers.

The pro-ana community does recommend the eating of ice, not merely as a food substitute but because the body needs to burn energy both to melt the ice and subsequently restore the body to its correcting operating temperature.  With frozen water, this effect is greatest in negative calorie terms but the discount effect applies even to iced confections.  If a frozen confection is listed as containing a calorie content of 100 (25 grams of carbohydrate @ 4 calories per gram), this does not include the energy the body expends to melt the ice and the net consumption is actually around 72 calories.

All things in moderation: Lindsay Lohan enjoying ice-cream and (an allegedly virgin) iced mojito, Monaco 2015.

Pro-ana does NOT however approve of frozen confections, the preferred one litre of frozen water containing zero calories yet demanding of the body a burn of around 160 calories to process, the energy equivalent of running one mile (1.6 km).  The practical upper limit per day appears to be between 3-5 litres (.8-1.3 gallons) depending on the individual and it’s speculated a daily intake much over eight litres may approach toxicity, essentially because the localized symptoms would be similar to hypothermia and some organs fail optimally to work when body temperature drops too much.  Paradoxically, pro-ana also notes, ice shouldn’t be eaten when one is too hot.  After running, the body actually exerts energy through the active effort of dissipating excess heat and if one were to ingest large amounts of ice as one was cooling off, some of the heat generated would be neutralized by the coolness of the ice, minimizing some of the energy burning benefits.  There’s also the need to avoid dental damage; pro-ana recommending it be allowed to melt in the mouth or consumed as shaved ice.

Dysmorphia

Dysmorphia (pronounced dis-mor-fiah)

(1) In clinical anatomy, characterized by anatomical malformation.

(2) In general medicine, having or exhibiting an anatomical malformation.

(3) In psychology and psychiatry, the perception of anatomical malformation; any of various psychological disorders whose sufferers believe that their body is wrong or inadequate, such as anorexia, bulimia, and muscle dysmorphia (bigorexia).

(4) As Dismorphia astyocha, a butterfly in the family Pieridae, found in both Argentina & Brazil.

From Ancient Greek δυσμορφίᾱ (dusmorphíā) (misshapenness, ugliness), the construct being δυσ- (dus-) (hard, difficult, bad) + μορφή (morphḗ) (shape, form) + -ίᾱ (-íā).  The prefix dys- was from the New Latin dys-, from Ancient Greek δυσ- (dus-), (hard, difficult, bad”) and was used to convey the idea of being difficult, impaired, abnormal, or bad.  Morph was a back-formation from morpheme & morphism, attested since the 1950s, from the Ancient Greek μορφή (morphḗ) (shape, form) and related to the German Morph, from Morphem (although dating only from the 1940s).  It’s probably now most familiar in (1) formal grammar & linguistics as a physical form representing some morpheme in language (it exists as a recurrent distinctive sound or sequence of sounds), (2) in linguistics as an allomorph (one of a set of realizations that a morpheme can have in different contexts) and (3) in digital image processing where shapes are changed from one form to another with the use of specialized software, a popular type being that which wholly or (especially) partially blends two images.  The plural is dysmorphias and, in clinical use, the synonym is dysmorphosis.

The word dysmorphia first appeared in the Histories of the Greek historian Herodotus (circa 484–circa 425 BC) when he referred to the myth of the “ugliest girl in Sparta”.  Herodotus, even in his lifetime, was criticized for making an insufficient distinction between legend and historical fact but the veracity of much of his work, subject to forensic analysis by modern archeologists and archivists, has been established.  The story of the “ugliest girl in Sparta” however, Herodotus acknowledges as “a magical myth” in which a baby girl, born in Sparta, was terribly disfigured (which he described as dysmorphia (meaning “misshapenness” or “ugliness”).  Fortunately, she was from a well-connected family and her nanny suggested taking her to the shrine of Helen of Troy on hilltop of Therapne, and there pray for a cure.  There the nurse sat with the baby and while praying before the agalma (a carved image of Helen), from nowhere a apparition of Helen appeared and smiling, laid her hand upon the child’s head.  As the years passed, the disfigured infant would grow to become the most beautiful girl in the kingdom.

Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is a mental disorder.  It’s defined as an individual’s obsession with the idea that some aspect of their appearance is severely flawed and warrants exceptional measures to hide or rectify the offending part(s).  In BDD's delusional variant, the flaw is imagined and if some minor imperfection exists, its importance is severely exaggerated.  Sufferers find the symptoms of BDD pervasive and intrusive, symptoms including excessive attention to the perceived defect, social avoidance, camouflaging with cosmetics or apparel, the seeking of verbal reassurances, avoiding mirrors, repetitively changing clothes or restricting eating.

Italian physician Enrico Morselli (1852-1929) in 1886 reported a disorder he termed dysmorphophobia, a term still sometimes used in European literature to describe BDD.  Use spiked in academic literature in the 1950s although it wasn’t until 1980, the American Psychiatric Association (APA) recognized the condition in the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III).  The APA classified it as a distinct somatoform condition (characterized by symptoms suggesting a physical disorder but for which there are no demonstrable organic findings or known physiological mechanisms) and in 1987 replaced dysmorphophobia with body dysmorphic disorder as the preferred descriptor.

With the 1994 publication of DSM-IV, the APA noted BDD was a preoccupation with an imagined or trivial defect in appearance, one causing social or occupational dysfunction, and not better explained as another disorder such as anorexia nervosa but in DSM-5 (2013), it was reclassified as an obsessive-Compulsive and Related Disorder, adding diagnostic criteria including repetitive behaviors and intrusive thoughts.  Although the World Health Organization's (WHO) current International Classification of Diseases (ICD-10 (1994)) described BDD as just another hypochondriacal disorder, the revised ICD-11 (2019) aligned for all functional purposes with the DSM-5.

The DSM-5 diagnostic criteria for BDD requires the following:

(1) A preoccupation with appearance: The individual must be preoccupied with one or more nonexistent or slight defects or flaws in their physical appearance and “Preoccupation” is usually defined as thinking about the perceived defects for (in aggregate) at least an hour a day.  A distressing or impairing preoccupation with real and obvious flaws in appearance (anything easily noticeable such as obesity) is not diagnosed as BDD, being instead classified with “Other Specified Obsessive-Compulsive and Related Disorders.”

(2) Repetitive behaviors: Repetitive and compulsive behaviors must manifest in response to the concern with appearance.  These compulsions can be behavioral and thus observed by others (such as either excessively standing before or avoid a looking-glass, frequent grooming, skin picking, reassurance seeking or repeatedly changing clothes.  Other BDD compulsions include mental acts, the most often diagnosed being an individual frequently comparing their appearance with that of other people.  The DSM-5 included the note for clinicians cautioning that subjects meeting all diagnostic criteria for BDD except this one are not diagnosed with BDD; they are diagnosed with “Other Specified Obsessive-Compulsive and Related Disorder.”

(3) Clinical significance: The preoccupation must cause clinically significant distress or impairment in social, occupational, or other important aspects of functioning.  This criterion was included to differentiate the disorder BDD, which requires treatment, from more normal appearance concerns that typically do not need to be treated with medication or therapy.  This has been one of the more controversial revisions because of concerns it may exclude from helpful treatment some who have developed better coping mechanisms while still suffering from the underlying condition.

(4) Differentiation from an eating disorder: If the appearance preoccupations focus on being too fat or weighing too much, it may be that the appropriate diagnosis is an eating disorder and this applies especially if the subject’s only concern with their appearance focuses on excessive weight; provided the diagnostic criteria for an eating disorder are otherwise met, that should be the diagnosis, not BDD.  If not, BDD can be diagnosed, as concerns with fat or weight in a person of normal weight can be a symptom of BDD and it’s not uncommon for subjects to have both an eating disorder and BDD.

There are specifiers to BDD and following diagnosis, the subject should be sub-classified using the two (DSM-5) BDD specifiers:

(1) Muscle dysmorphia: Muscle dysmorphia is the (predominately male) concern that the build of their body is too small or insufficiently muscular, something which not untypically manifests with preoccupations with other body areas; the muscle dysmorphia specifier should still be used in such cases.  Studies have shown that among those diagnosed with BDD, those with muscle dysmorphia suffer the highest rates of suicidality and substance use disorders, as well as poorer quality of life.  Accordingly, the DSM-5 notes their treatment regimes may require some modification.

(2) Insight specifier: This specifier indicates the degree (not directly frequency although this is a factor in the analysis) of a subject’s insight regarding their BDD beliefs (eg “I look ugly”; “I look deformed”), an expression of how convinced the subject is that their beliefs about the appearance of the disliked body parts is true.  The DSM-5 levels of insight are (2a) with good or fair insight, (2b) with poor insight and (3), with absent insight/delusional beliefs (which are to be diagnosed as BDD, not as a psychotic disorder.

BDD has often been misdiagnosed, most often as one of the following disorders:

(1) Obsessive Compulsive Disorder: If preoccupations and repetitive behaviors focus on appearance (including symmetry concerns), BDD should be diagnosed rather than OCD.

(2) Social anxiety disorder (social phobia): If social anxiety and social avoidance are due to embarrassment and shame about perceived appearance flaws, and diagnostic criteria for BDD are met, BDD should be diagnosed rather than social anxiety disorder (social phobia).

(3) Major depressive disorder: Unlike major depressive disorder, BDD is characterized by prominent preoccupation and excessive repetitive behaviors. BDD should be diagnosed in individuals with depression if diagnostic criteria for BDD are met.

(4) Trichotillomania (hair-pulling disorder): When hair tweezing, plucking, pulling, or other types of hair removal is intended to improve perceived defects in the appearance of body or facial hair, BDD should be diagnosed rather than trichotillomania (hair-pulling disorder).

(5) Excoriation (skin-picking disorder): When skin picking is intended to improve perceived defects in the appearance of one’s skin, BDD should be diagnosed rather than excoriation (skin-picking disorder).

(6) Agoraphobia: Avoidance of situations because of fears that others will see a person’s perceived appearance defects should count toward a diagnosis of BDD rather than agoraphobia.

(7) Generalized anxiety disorder: Unlike generalized anxiety disorder, anxiety and worry in BDD focus on perceived appearance flaws.

(8) Schizophrenia and schizoaffective disorder: BDD-related psychotic symptoms (ie delusional beliefs about appearance defects or BDD-related delusions of reference) reflect the presence of BDD rather than a psychotic disorder.

(9) Olfactory reference syndrome: Preoccupation with emitting a foul or unpleasant body odor is a symptom of olfactory reference syndrome, not BDD (although these two disorders have many similar characteristics).

(10) Eating disorder: If a normal-weight person is excessively concerned about being fat or their weight, meets other diagnostic criteria for BDD, and does not meet diagnostic criteria for an eating disorder, then BDD should be diagnosed.

(11) Dysmorphic concern: This is not a DSM diagnosis, but it is sometimes confused with BDD.  It focuses on appearance concerns but also includes concerns about body odor and non-appearance related somatic concerns, which are not BDD symptoms.

One aspect of the condition BDD is that it’s not uncommon for subjects to be reticent in revealing their concerns or BDD symptoms to a clinician because of embarrassment or being negatively judged as vain or too concerned with trivial matters.  Case notes do suggest there is a pattern of subjects hinting at their issues and clinicians should thus be encouraged to respond by explicitly asking about BDD symptoms.

Although the brand-name is, strangely, no longer used, in the late 1950s and early 1960s, Chubbettes was a fashion-house supplying “slenderizing designs… designed to make girls 6 to 16 look slimmer” and therefore become “as happy and self-assured as her slimmer schoolmates”.  With a target market including those with eating disorders or BDD as well as the naturally chubby, Chubbettes helpfully offered with its fashion catalog a free booklet, Pounds and Personality.  Intended for parents of a chubby girl and written by Dr Gladys Andrews of New York University’s School of Education, it was packed with helpful hints about “understanding her problems, talent development, shyness, tactless remarks & the “game” of dieting etc.).  Chubettes’ clothing range was said to be “available, coast to coast at stores that care”; the parent company was L Gidding & Co Inc, 520 Eighth Avenue, New York City.

Times certainly have changed and with them the perception of body shapes.  Parents who would now regard young ladies of the type pictured in the Chubbette advertisements as being chubby might now be suspected of having Munchausen syndrome by proxy (MSbP).  In the mind of the girl herself, a similar perception wouldn't necessarily alone be enough for a diagnosis of BDD but might be considered in the context of other behaviors.  

Crooked Hillary Clinton, the Hamptons, August 2021.

Paradoxically, although in the early twenty-first century there’s a larger than ever market for what Chubbettes once served as a niche, the brand is long gone and a revival seems unlikely.  Many factors including more sedentary lifestyles and a higher consumption of processed food, the sugar content of which has risen alarmingly, means demand for more accommodating clothing will likely continue to increase but many manufacturers have stepped into the Chubbette void and customers enjoy a wide choice.