Where I definitely had a break from reality about my weight and appearance...I was NEVER psychotic. Most anorexics aren't. Psychosis is an ENTIRELY different diagnosis and not to be taken lightly.
Common concurrent diagnonsenses (intentional error there) are Moderate to Severe Depression, Body Dysmorphic Disorder, Social Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder and Post Traumatic Stress Disorder...there are many more.
Even those who self-injure in addition to anorexia nervosa or bulimia nervosa are not "Psychotic". They are in touch with reality. We are pretty sure reality sucks, and that we should be punished or disappear. It's not about vanity. It may start that way for some, but truly the "I Feel Fat" is a cover up for an inability to voice deep and often primal emotions.
I may be perfectly able to write a diatribe at the moment...rant and rave with the big vocabulary words, but if I'm truly upset and in eating disorder/low self-esteem mode I am hard pressed to go more than the "six year old" vocabulary.
Therapist: How do you feel?
Me: (curled on couch, pouty face, sullen voice) I am sad.
Hello, hi?? Is that how an articulate young woman speaks? It's almost like aphasia when asked to reveal actual emotions and difficult feelings. It took my therapist six months to pry out of me that PERHAPS my Mom was less than perfect. (We were super enmeshed, I love her, but she is my best friend and my worst enemy, and a LOT of the time the Head Shrink with the drugs and the Counselor who have seen me at my WORST say I'm one of the saner people they've met.)
And Obese or not? A few pounds over your ideal, a BMI of 25 or more...is overweight. Obese is 30. THAT IS BIG. That is VERY big.
The difference between a BMI of 17 and the death camp look I had on my face and the rosy look of health and well being is a LARGE difference. The weight of an average FIRST GRADER difference and it's NOT that many BMI points. I'm still taller and smaller than the "Average" American woman...even after gaining 1/3 of a person. I have had people say they were "sorry" when I'll laugh and say how much I've gained...I'm PROUD. I'm alive and curvy in all the right places, I'm me sized and I wouldn't change it for the world. Thanks to my team (Therapist, Nutritionist, Medical Doctor, and Psychologist for meds.) I eat what I want, when I want. A little bit of everything. I walk my dog and I do yoga. That's it. I fluctuate by maybe 5 pounds either way. I'm not exactly sure. I smashed my scale with a hammer.
We're all "ME" sized, and MANY people have food issues. You don't need to be a skeleton and on tube feedings to be dying and be doing damage. By the time they are sticking tubes in you your body is PRETTY far gone and the damage is DONE. Osteoporosis, kidney and live damage, heart damage...with the wasting of muscle come the wasting of the HEART...a muscle. Eventually it EATS YOUR BRAIN.
Chronic dieters with their "flabby arms" and "big bust" are putting themselves for malnutrition as well...diet pills, yo yo diets and food group restriction can have some of the same effects as prolonged anorexia.
Per DSM-IV Revised edition anorexia nervosa has a BMI criteria, however the behaviors without the physical health symptoms can be classified as Eating Disorder Not Otherwise Specified(EDNOS) with Anorexic features.
For more information look at Something-Fishy.org or WebMD. My friend and sister-of-the-heart in recovery has her story there. (On Web MD.)
As grotesque as the show "Starved" can be...that's pretty much it. I actually love it, but that's because I can look back and laugh at some of the things I've done because they didn't kill me and I've crawled out of that hell.