I think it is important to explore the difference between what an eating disorder and disordered eating is. However, if you struggle with your relationship with food, eating and body image you deserve support. Regardless, if you have an official diagnosis or not. And this is also not to minimise disordered eating in any way.
Eating issues exists on a spectrum. Diagnosed eating disorders are on one end of the spectrum, and ‘normal eating’ is on the other end of the spectrum. In between this is disordered eating.
I personally consider eating disorders biopsychosocial disorders, meaning that they arise at the intersection of socio-cultural, physiological, and psychological factors. In this mix inherent political factors are embedded. To call eating disorders ‘mental illnesses’ is to make it too simplistic. Whilst this may be fairly accurate for some anorexia sufferers, it leaves way too many other factors and people on the table.
Eating disorders tend to function as well-founded coping mechanism, that works. Until it doesn’t.
There are different types of eating disorders
When most people think of eating disorders, they tend to think of Anorexia Nervosa (AN), a restrictive eating disorder often hallmarked by very low food intake and drastic reduction in body weight. You might imagine an emaciated young teenage girl. This is the stereotypical “look” of an eating disorder.
Whilst there are some who fit this stereotype, it is important to remember that eating disorders don’t discriminate. Any person of any weight, gender, age, and ethnicity can have an eating disorder. They are not a choice. You do not have to be at a low body weight to have an eating disorder, or disordered eating.
Other diagnosable eating disorders
A part form Anorexia Nervosa (AN) other eating disorder diagnoses are;
Bulimia Nervosa (BN): is restricting and purging or bingeing and purging. Or using other forms of compensation like over exercising and/or laxative use. Typically, there is not major change in weight.
Binge Eating Disorder (BED): is eating a large quantity of food in a short space of time. Feeling out of control around food but not using compensatory behaviours. There may or may not be weight gain with BED.
Avoidant Restrictive Food Intake Disorder (ARFID): is an eating or feeding disturbance that shows up as; apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating (fear of choking). This can lead over long term to issues with malnutrition. ARFID is more common in autistic people.
Other Specific Feeding and Eating Disorders (OSFED): is applicable to individuals who are experiencing significant distress due to symptoms that are similar to disorders such as Anorexia, Bulimia, and Binge Eating Disorder, but who do not meet the full criteria for a diagnosis of one of these.
It is worth noting that Binge Eating Disorder was placed under this category until as recent as 2013 when it got its own category.
Atypical Anorexia (AAN) also falls under the diagnosis of OSFED, though the physical symptoms, the impact of under nourishment and the eating disorder behaviours are the same as AN. The only difference is that the person does not meet the low BMI criteria. I would argue that we could call this anti-fat bias in action. There is nothing “atypical” about atypical anorexia. It is actually more common than Anorexia, but often missed due to weight bias in the medical system.
Orthorexia Nervosa is an eating disorders manifesting in an extreme focus on healthy eating. It does not yet have an official diagnosis in the DSM. There are many overlapping behaviours with Orthorexia and Anorexia Nervosa.
What is classed as “disordered eating”?
Good question! I would argue that any eating behaviour / relationship with food that causes distress for a person falls under this category. But let me give you some examples;
- Counting calories
- Weighing oneself daily and alter food intake accordingly
- Dieting and then bingeing, aka having “cheat days”
- Seeing food as “good” or “bad” and feeling “good” or “bad” depending on what you’re eating.
- Cutting out whole food groups for non-medical reasons
- Avoiding going to social gatherings because you don’t know what will be served.
- Feeling out of control around food
- Needing to compensate for what you’ve eaten through exercise or restriction, or both.
- Avoiding socialising because of how you feel about your body
It does make me think and wonder, if chronic dieting and disordered eating is technically same as OSFED? Or that perhaps more people qualify for an OSFED diagnosis than what is typically given?
Who can diagnose an Eating Disorder?
The only helping professionals or mental health professionals that can give an official eating disorder diagnosis is a GP or a Psychiatrist. Some psychologists can too, depending on licensure and country.
One of the main problem with getting an official diagnosis is that it can be difficult to get one. It is more likely that if you are showing symptoms of Anorexia or Bulimia that you get an official diagnosis and an onward referral to mental health support, than if you have binge eating symptoms.
Binge Eating Disorder is the most common eating disorder and the least diagnosed one. My guess is this is because there is so much shame and stigma around binge eating so people are less likely to bring it up. And I think the other likely reason is that if you are in a bigger body, instead of getting appropriate support, you might get referred to ob*sity services. Something that is not helpful as restricting tends to drive binge eating.
Disordered eating behaviours are culturally sanctioned
All the different behaviours that I outlined above are culturally sanctioned. This is why it can be so difficult to realise that there is a problem. Often people have internalised the shame and feel like it is a “me problem”, and not something that is rooted in coping. Then we overlay this with Diet Culture and the obsession with thinness. And you have the perfect storm.
These disordered behaviours (that can fit the diagnostic criteria if they are occurring often enough), are the same types of “Tips & Tricks” that are freely given out as weight loss advice.
Weight stigma plays a major role. Both as a potential barrier to access, but it also stops us recognising that the restrictive eating in form of dieting wrecks havoc with our relationship with food, eating and bodies.
You don’t need an eating disorder diagnosis to deserve help
I want you to know that you don’t need an official diagnosis to get help. Yes, it might be beneficial if you are trying to access support within the public healthcare system. Or if you need an official diagnosis for your insurance to cover treatment. But please don’t let that hold you back from getting support.
The vast majority of people I work with and have worked with over the years did not have an official diagnosis. Either because they couldn’t get one (aka. Did not meet all the criteria), or never thought getting one was needed or possible.
If you struggle with restrictive eating, binge eating or purging or any compensatory behaviours, you deserve support to heal. Food does not need to be a thing that is all consuming. Recovery is possible.
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