Cynophagia

Cynophagia (pronounced)

The practice of eating dog meat.

Late 1700-early 1800s: The construct was cyno- + phagia.  Cyno was a combining form of the Ancient Greek κύων (kúōn or kýon) (dog) and the suffix –phagia was from the Ancient Greek -φαγία (-phagía) (and related to -φαγος (-phagos) (eater)), corresponding to φαγεῖν (phageîn) (to eat), infinitive of ἔφαγον (éphagon) (I eat), which serves as infinitive aorist for the defective verb ἐσθίω (esthíō) (I eat).  In English, use is now most frequent in mental health to reference the consumption of untypical items.  Being a cynophagist (a person who engages in cynophagia) is not synonymous with being a cynophile (a person who loves canines) although it’s not impossible there may be some overlap in the predilections.  The construct was cyno- +‎ -phile.  The –phile suffix was from the Latin -phila, from the Ancient Greek φίλος (phílos). (dear, beloved) and was used to forms noun & adjectives to convey the meanings “loving”, “friendly”, “admirer” or “friend”.  In the context of metal health, the condition would be described as cynophilia.  The -philia suffix was from the Ancient Greek φιλία (philía) (fraternal) love).  It was used to form nouns conveying a liking or love for something and in clinical use was applied often to an abnormal or obsessive interest, especially if it came to interfere with other aspects of life (the general term is paraphilia).  The companion suffix is the antonym -phobia. The related forms are the prefixes phil- & philo- and the suffixes -philiac, -philic, -phile & -phily.  Cynophagia, cynophagy, cynophagism & cynophagist are nouns and cynophagic is an adjective; the noun plural is cynophagists.

The word cynophagia was coined as part of the movement in European scholarship in the late eighteenth & early nineteenth centuries which used words from classical languages (Ancient Greek & Latin) as elements to create the lexicon of “modern” science & medicine, reflecting the academic & professional reverence for the supposed purity of the Ancient world.  The reason there was a cynophagia but not a “ailourphagia” (which would have meant “the practice of eating cat meat”) is probably because while the reports from European explorers & colonial administrators would have sent from the orient many reports of the eating of dogs, there were likely few accounts of felines as food.  The construct of “ailourphagia” would have been ailour-, from the Ancient Greek αἴλουρος (aílouros) (cat) + phagia.  The Greek elements of ailouros were aiolos (quick-moving or nimble) & oura (tail), the allusion respectively to the agility of cats and their characteristic tail movements.  There are of course ailurophiles (one especially fond of cats), notably the "childless cat ladies" and disturbingly, there's also paedophage (child eater). 

Historically, east of Suez, consuming dog meat was not uncommon and in some cultures it was a significant contribution to regional protein intake while in other places it was either unlawful of taboo.  Carnivorism (the practice of eating meat) is an almost universal human practice but what is acceptable varies between cultures.  Some foods are proscribed (such as shellfish or pig-meat) and while it’s clear the origin of this was as a kind of “public heath” measure (the rules created in hot climates in the pre-refrigeration age) but the observance became a pillar of religious observance.  Sometimes, a similar rule seems originally to have had an economic imperative such as the Hindu restriction on the killing of cattle for consumption, thus the phrase “sacred cow”, the original rationale being the calculation the live beasts made an economic contribution which much outweighed their utility as a protein source.  So, what is thought acceptable and not is a cultural construct and that varies from place-to-place, the Western aversion to eating cats & dogs attributable to the sentimental view of them which has evolved because of the role for millennia as domestic pets.  Over history, it’s likely every animal in the world has at some point been used as a food source, some an acquired taste such as the “deep fried tarantula” which, long a tasty snack in parts of Cambodia, became a novelty item in Cambodian restaurants in the West.  There are though probably some creatures which taste so awful they’re never eaten, such as parrots which ate the seeds of tobacco plants, lending their flesh a “distinctive flavor”.  The recipe for their preparation was:

(1) Place plucked parrot and an old boot in vat of salted water and slow-cook for 24 hours.
(2) After 24 hours remove parrot & boot.
(3) Throw away parrot and eat old boot.

Analysts had expected “more of the same” from Donald Trump (b 1946; US president 2017-2021) in his debate with Kamala Harris (b 1964; US vice president since 2021): the southern border, illegal immigrants, inflation et al.  What none predicted was that so much of the post-debate traffic would be about Mr Trump’s assertion Haitian immigrants in Springfield, Ohio (one of literally dozens of localities in the country so named, one factor which influenced it becoming the name of the town in the Fox cartoon series The Simpsons) were eating the pets of the residents (ie their cats & dogs).  As racist tropes go, it followed the script in terms of the “otherness, barbarism, incompatibility” etc of “outsiders in our midst” although there seemed to be nothing to suggest there was any tradition of such consumption in Haiti.  Still, at least it was something novel and it wasn’t the first time pet cats had been mentioned in the 2024 presidential campaign, Mr Trump’s choice of running mate as JD Vance (b 1984; US senator (Republican-Ohio) since 2023) bring renewed attention to the latter’s 2021 interview then Fox News host Tucker Carlson (b 1969) in which he observed the US had fallen into the hands of corporate oligarchs. Radical Democratic Party politicians and “…a bunch of childless cat ladies who are miserable at their own lives and the choices that they've made and so they want to make the rest of the country miserable, too.”

Eventually, that would be answered by the childless cat ladies, notably the most famous: the singer Taylor Swift who posted an endorsement of Kamala Harris, posing with Benjamin Button, the Ragdoll she adopted in 2019.  Benjamin Button was no stranger to fame, the seemingly nonplussed puss appearing of the cover announcing Ms Swift as Time magazine’s 2023 Person of the Year.

Childless cat lady Taylor Swift with ragdoll Benjamin Button (as stole).  Ragdoll cats make good stoles because (apparently because of a genetic mutation), they tend to "go limp" when picked up.  

Ms Swift is of course a song-writer so well accustomed to crafting text to achieve the desired effect and one word nerd lawyer quickly deconstructed, much taken by the first three paragraphs which interlaced the first person (“I” & “me/my”) and the “you” while avoiding starting any sentence with “I” (a technique taught as a way of conveying “objectivity”) until the she announces her conclusion:

 “Like many of you, I watched the debate tonight. If you haven’t already, now is a great time to do your research on the issues at hand and the stances these candidates take on the topics that matter to you the most. As a voter, I make sure to watch and read everything I can about their proposed policies and plans for this country.”

“Recently I was made aware that AI of ‘me’ falsely endorsing Donald Trump’s presidential run was posted to his site. It really conjured up my fears around AI, and the dangers of spreading misinformation. It brought me to the conclusion that I need to be very transparent about my actual plans for this election as a voter. The simplest way to combat misinformation is with the truth.”

“I will be casting my vote for Kamala Harris and Tim Walz in the 2024 Presidential Election. I’m voting for @kamalaharris because she fights for the rights and causes I believe need a warrior to champion them. I think she is a steady-handed, gifted leader and I believe we can accomplish so much more in this country if we are led by calm and not chaos. I was so heartened and impressed by her selection of running mate @timwalz, who has been standing up for LGBTQ+ rights, IVF, and a woman’s right to her own body for decades.”

So, a classic example of a technique which might be used by someone disinterested: two premises which lead to a conclusion, the rhythm of the lyric being “I, I, you, you, you.”  Then, after the “you, you, you” of the “discussion” has made it clear where her focus is, every sentence in the third paragraph begins with “I”, emulation a cadence which might appear in a musical track: “I’ve done my research, and I’ve made my choice. Your research is all yours to do, and the choice is yours to make.”  One can see why her songs are said to be so catchy.

The intervention of Ms Swift and Benjamin Button produced reactions. 

Newspapers haven’t always been effective in changing voting intentions or nudging governments in particular public policy directions.  During the inter-war years the Beaverbrook (the Daily & Sunday Express and the less disreputable Evening Standard) press in the UK ran a long and ineffective campaign promoting “empire free trade” and the evidence suggests the editorial position a publication adopted to advocate its readers vote one way or the other was more likely to reflect than shift public opinion.  One reason is that in the West, while politics is very interested in the people, the people tend not to be interested in politics and most thoughtful editorials are barely read.  People are however rabid consumers of popular culture and one opposition leader would later claim an interview a woman’s magazine conducted with his (abandoned) ex-wife did him more political damage than anything written by political or economics reporters, however critical.  With 283 million followers on Instagram (Ms Harris has 18 million), Ms Swift’s intervention may prove decisive if she shifts just a few votes in the famous “battleground states”.

Celebrity endorsements are not unusual; some successful, some not.  In 2016, Lindsay Lohan endorsed crooked Hillary Clinton (who did win the popular vote so there was that).

Whether Ms Swift’s endorsement of Kamala Harris will shift many opinions isn’t known (many analysts concluding the electorate long ago coalesced into “Trump” & “anti-Trump” factions) but the indications are she may have been remarkably effective in persuading to vote those who may not otherwise have bothered, the assumption being most of these converts to participation will follow her lead and it’s long been understood that to win elections in the US, the theory is simple: get those who don’t vote to vote for you.  In practice, that has been difficult to achieve at scale (the best executions in recent years by the campaign teams of George W Bush (George XLIII, b 1946; US president 2001-2009) in 2004 and Barack Obama (b 1961; US president 2009-2017) in 2008.

However, in including a custom URL which directed people to vote.gov where they could register to vote produced a spike in voter registration, the US General Services Administration (GSA) revealing an “unprecedented” 338,000-odd unique visits to their portal in the hours after Ms Swift’s post.  Although the “shape” of the hits isn’t known, most seem to be assuming that (as well as some childless cat ladies), those who may be voting for the first time will tend to be (1) young and (2) female, reflecting the collective profile of Ms Swift’s “Swifties”.  They are the demographic the Democratic Party wants.  The GSA called it the “Swift effect” and added that while in the past there had been events which produced smaller spikes, they were brief in duration unlike the Swifties woh for days kept up the traffic, the aggregate numbers dwarfing even the “intensity and enthusiasm” in the wake of the US Supreme Court (SCOTUS) overturning Roe v Wade (1973) prior to the 2022 mid-term congressional elections.

In an interview with JD Vance, Fox News asked what he thought might be the significance of Ms Swift mobilizing the childless cat lady vote and he responded: “We admire Taylor Swift’s music. But I don’t think most Americans, whether they like her music, or are fans of hers or not, are going to be influenced by a billionaire celebrity who I think is fundamentally disconnected from the interests and problems of most people.  When grocery prices go up by 20 per cent, it hurts most Americans. It doesn’t hurt Taylor Swift. When housing prices become unaffordable, it doesn’t affect Taylor Swift, or any other billionaire.”  Fox News choose not to pursue the matter of whether self-described “billionaire celebrity” Donald Trump could be said to be “…fundamentally disconnected from the interests and problems of most people.”

In “damage-limitation” mode, the Trump campaign mobilized generative AI in an attempt to re-capture the childless cat lady vote.  After the debate, Mr Trump had added geese to the alleged diet of Springfield’s Haitian residents.

Mr Trump may have himself to blame for Ms Swift’s annoying endorsement because he’d earlier posted fake, AI-generated images on his social media platform, Truth Social, suggesting she’d urged her the Swifties to vote for him.  Such things were of course not foreseen by the visionary AI (artificial intelligence) researchers of the 1950s, the genie is out of the bottle and given that upholding the “freedom of speech” guaranteed by the First Amendment to the constitution is one of the few things on which the SCOTUS factions agree, the genie is not going back.

The meme-makers have really taken to generative AI.

So while generative AI doesn’t allow mean the meme makers can suddenly create images once impossible, it does mean they can be produced by those without artistic skills or specialized resources and the whole matter of the culinary preferences of Haitians in Ohio is another blow for the state.  It was only in May 2024 that a number of schools in issued a ban on Gen Alpha slang terms including:

Ohio: It means “bad” with all that implies (dull, boring, ugly, poor etc).  Because of the way language evolves, it may also come to mean “people who eat pet cats & dogs”.  The implication is it’s embarrassing to be from Ohio.

Skibidi: A reference to a viral meme of a person’s head coming out of a toilet; it implies the subject so described is “weird”.

Sigma: Unrelated to the 18^th letter of the Greek alphabet, it’s been re-purposed as a rung on the male social hierarchy somewhat below the “alpha-male”.

Rizz: This one has a respectable pedigree, being the the Oxford English Dictionary’s (OED) 2023 word of the year.  It’s said technically to be a “Gen Z word”, short for “charisma”.  It has been banned because Gen Alpha like to use it in the negative (ie “lacking rizz”; “no rizz” etc).

Mewing: A retort or exclamation used to interrupt someone who is complaining about something trivial.  Gen Alpha are using it whenever their teachers say something they prefer not discuss.

Gyatt: A woman with a big butt, said originally based on the expression “goddam your ass thick.”

Bussin’: “Good, delicious, high quality” etc.

Baddie: A tough, bolshie girl who “doesn’t take shit form no one”.  It’s a similar adaptation of meaning to a term like “filth” which means “very attractive”.

Autophagia

Autophagia (pronounced aw-tuh-fey-juh or aw-tuh-fey-jee-uh)

(1) In cytology, the process of self-digestion by a cell through the action of enzymes originating within the same cell (the controlled digestion of damaged organelles within a cell which is often a defensive and/or self-preservation measure and associated with the maintenance of bodily nutrition by the metabolic breakdown of some bodily tissues).

(2) In cytology, a type of programmed cell death accomplished through self-digestion (known also as apoptosis and associated with the maintenance of bodily nutrition by the metabolic breakdown of some bodily tissues).

(3) In psychiatry, self-consumption; the act of eating oneself.

The construct was auto- + -phagia.  The auto-prefix was a learned borrowing from Ancient Greek αὐτο- (auto-) (self-) (reflexive, regarding or to oneself (and most familiar in forms like autobiography)), from αὐτός (autós) (himself/herself/oneself), from either a construct of (1) the primitive Indo-European hew (again) + to- (that) or (2) the Ancient Greek reflexes of those words, αὖ (aû) (back, again, other) +‎ τόν (tón) (the) and related to Phrygian αυτος (autos), the existence of alternatives suggesting there may have been a common innovation.  Phagia was from the Ancient Greek -φαγία (-phagía) (and related to -φαγος (-phagos) (eater)), the suffix corresponding to φαγεῖν (phageîn) (to eat), the infinitive of ἔφαγον (éphagon) (I eat), which serves as aorist (A verb paradigm found in certain languages, usually an unmarked form or one that expresses the perfective or aorist aspect) for the defective verb ἐσθίω (esthíō) (I eat).  The alternative spelling is autophagal and the synonyms (sometimes used in non-specialist contexts) are self-consumption & auto-cannibalism.  Autophagia, autophagophore, autophagosome & autophagy are nouns, autophagically is an adverb, autophagocytotic is an adjective and autophagic is an adjective (and a non-standard noun); the noun plural is autophagies.

In cytology (in biology, the study of cells), autophagy is one aspect of evolutionary development, a self-preservation and life-extending mechanism in which damaged or dysfunctional parts of a cell are removed and used for cellular repair.  Internally, it’s thus beneficial, the removal or recycling of debris both efficient and (by this stage of evolutionary development) essential, most obviously because it removes toxins and “effectively “creates” younger cells from the old; it can thus be thought an anti-aging mechanism.  It something which has also interested cancer researchers because all cancers (as the word and the parameters of the disease(s) are defined) start from some sort of cell-defect and the speculation is it might be possible to in some way adapt the autophagic process, re-purposing it to identify and remove suspect cells.

In psychiatry, autophagia refers to the act of eating oneself which is sometimes described as self-consumption or the even more evocative auto-cannibalism.  Perhaps surprisingly, the behavior is not explicitly mentioned in the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) which of course means there are no published diagnostic criteria nor recommendations for treatments.  The DSM’s editors note there are a number of reasons why a specific behavior may not be included in the manual notably (1) the lack of substantial empirical evidence or research, (2) the rarity of cases and (3) the material to hand being unsuitable (in terms of volume or quality) for the development of practical tools for clinicians to diagnose and treat a disorders.

It would be flippant to suggest autophagia might have been included when the revisions in the fifth edition of the DSM (DSM-5 (2013)) included a more systematic approach taken to eating disorders and as well as variable definitional criteria being defined for the range of behaviours within that general rubric, just about every other form of “unusual” consumption was listed 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).  The DSM-5 also codified the criteria for behaviour to be classified 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): 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.  However, pica encompassed only “non-nutritive substances” which of course one’s own body parts are not.

Finger food: Severed fingers are a popular menu item for Halloween parties; kids think they're great.  For those who like detail, those emulating nail polish seem to be following Dior shades 742 (top right) and 999 (bottom right). 

In the profession, autophagia seems to be regarded not as a progression from those who eat their fingernails or hair but something with more in common with the cutters.  Cutters are the best known example of self-harmers, the diagnosis of which is described in DSM as non-suicidal self-injury (NSSI).  NSSI is defined as the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned; it includes behaviors such as cutting, burning, biting and scratching skin.  Behaviorally, it’s highly clustered with instances especially prevalent during adolescence and the majority of cases being female although there is some evidence the instances among males may be under-reported.  It’s a behavior which has long interested and perplexed the profession because as something which involves deliberate and intentional injury to body tissue in the absence of suicidal intent (1) it runs counter to the fundamental human instinct to avoid injury and (2) as defined the injuries are never sufficiently serious to risk death, a well-understood reason for self-harm.  Historically, such behaviors tended to be viewed as self-mutilation and were thought a form of attenuated suicide but in recent decades more attention has been devoted to the syndrome, beginning in the 1980s at a time when self-harm was regarded as a symptom of borderline personality disorder (BPD) (personality disorders first entered DSM when DSM-III was published in 1980), distinguished by suicidal behavior, gestures, threats or acts of self-mutilation.  Clinicians however advanced the argument the condition should be thought a separate syndrome (deliberate self-harm syndrome (DSHS)), based on case studies which identified (1) a patient’s inability to resist the impulse to injure themselves, (2) a raised sense of tension prior to the act and (3) an experience of release or at least partial relief after the act.  That a small number of patients were noted as repeatedly self-harming was noted and it was suggested that a diagnosis called repetitive self-mutilation syndrome (RSMS) should be added to the DSM.  Important points associated with RSMS were (1) an absence of conscious suicidal intent, (2) the patient’s perpetually negative affective/cognitive which was (temporarily) relieved only after an act of self-harm and (3) a preoccupation with and repetitiveness of the behavior.  Accordingly, NSSI Disorder was added to the DSM-5 (2013) and noted as a condition in need of further study.

However, although there would seem some relationship to cutting, it’s obviously a different behavior to eat one’s body parts and the feeling seems to be that autophagia involves a quest for pain and that suggests some overlap with other conditions and it certainly belongs in the sub category of self-injurious behavior (SIB).  The literature is said to be sparse and the analysis seems not to have been extensive but the behavior has been noted in those diagnosed with a variety of conditions including personality disorders, anxiety disorders, obsessive compulsive disorder, schizophrenia and bipolar disorder.  The last two have been of particular interest because the act of biting off and eating some body part (most typically fingers) has been associated with the experience of hallucinations and patients have been recorded as saying the pain of the injury “makes the voices stop”.  Importantly, autophagia has a threshold and while in some senses can be thought a spectrum condition (in terms of frequency & severity), behaviors such as biting (and even consuming) the loose skin on the lips (morsicatio buccarum) or the ragged edges of skin which manifest after nail biting (onychophagia) are common and few proceed to autophagia and clinicians note neurological reasons may also be involved.    

Lindsay Lohan with bread on the syndicated Rachael Ray Show, April 2019.

Autophagia and related words should not be confused with the adjective artophagous (bread-eating).  The construct was the Artos +‎ -phagous.  Artos was from the Ancient Greek ἄρτος (ártos) (bread), of pre-Greek origin.  Phagous was from the Latin -phagus, from the Ancient Greek -φάγος (-phágos) (eating) from φαγεῖν (phageîn) (to eat).  Apparently, in the writings of the more self-consciously erudite, the word artophagous, which enjoyed some currency in the nineteenth century, was still in occasional use as late as the 1920s but most lexicographers now either ignore it or list it as archaic or obsolete.  It’s an example of a word which has effectively been driven extinct even though the practice it describes (the eating of bread) remains as widespread and popular as ever.  Linguistically, this is not uncommon in English and is analogous with the famous remark by Sheikh Ahmed Zaki Yamani (1930–2021; Saudi Arabian Minister of Petroleum and Mineral Resources 1962-1986): “The Stone Age came to an end not for a lack of stones, and the Oil Age will end, but not for a lack of oil” (the first part of that paraphrased usually as the punchier “the Stone Age did not end because the world ran out of rocks”).

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.