Eating disorders and disordered eating patterns are far too often misunderstood, minimized, or missed in our society. Being more prevalent than many may realize, it is estimated that 9% of Americans will have an eating disorder in their lifetime (1). In this post, we seek to provide an overview of how we can deepen our understanding of eating disorders and disordered eating, while unpacking some misconceptions. The more we are all aware about eating disorders and disordered eating, the better we can identify them and support healing.
How do we differentiate between disordered eating and eating disorders?
Differentiating between “normal” eating, disordered eating, and eating disorders is harder than you may imagine. “Normal” eating is in quotes here because while some have sought to put a definition to this term, “normal” eating truly looks different for everyone. Nuance around “normal” eating is needed because generalizations around “normal” eating can be harmful for people who are neurodivergent. One general way we can frame “normal” eating is meeting one's nutritional needs in a flexible manner by honoring hunger cues in a way that encourages eating without much thought or stress. Everyone’s take on this will be unique.
For some, it can be helpful to conceptualize disordered eating and eating disorders along a spectrum, with differences lying in the frequency and intensity of symptoms. Disordered behaviors can generally be thought of as interacting with food, movement, or one’s body in a way that hurts one's well-being. Disordered eating can be hard to spot since it is normalized and celebrated in our society, and it can often be hidden under the guise of “wellness” or lifestyle changes. When was the last time you heard someone speak about limiting what they were eating, talk about food with “good” or “bad” labels, count or track their food, express guilt about eating, or exercise to compensate for eating? These are comments that can come up frequently in social settings and they can be an indicator of disordered eating. Some further examples of disordered behaviors may include: frequent dieting, fasting, self-induced vomiting, avoiding food groups (when not medically necessary), counting calories, using diet pills, being stressed when eating new foods or eating around others, consistently eating past fullness, excessively exercising, thinking a lot about food or one’s body, weighing one’s self, and more.
With an eating disorder, one’s interactions with these behaviors may be more frequent and severe, often resulting in a greater amount of distress, fixation, and/or medical complications. The mind, heart, gut, hormones, and bones can all be impacted in the setting of an eating disorder. We recommend Dr. Guadiani’s book Sick Enough for a deep dive into the medical complications of eating disorders. To summarize, eating disorders are multifaceted conditions in which patterns with food, movement, or body may impair one’s ability to function or impact their quality of life.
How are eating disorders diagnosed?
Eating disorder diagnoses are categorized within the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Medical providers and mental health providers can assess for and diagnose eating disorders. The eating disorder diagnoses listed in the DSM-V are: anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), and other specified feeding or eating disorder (OSFED). More information about these diagnoses can be found here.
What are some significant misconceptions about eating disorders?
Misconceptions about the identities of people who suffer from eating disorders are far too common in our society. If you were to come up with a mental image of someone with an eating disorder, what would the result be? One answer may be the widespread stereotype of a thin, white woman (assumingly cis-gendered and able-bodied too). In reality, this answer is far from the truth, with disordered eating just as common, if not more common, among Black, Indigenous, and People of Color (BIPOC). One study found that Black teenagers were 50% more likely than white teenagers to binge and purge (2). Biases among healthcare providers impact the detection of eating disorders. Another study found that people of color with food and body concerns were less likely than white participants to have been asked by a doctor about eating disorder symptoms (3). Food and body concerns are also often overlooked for men and masculine-presenting people. A bias towards women and femmes has impacted the field of eating disorders in general, from how research has been conducted to how treatment is designed. Aaron Flores (a dietitian) has created a podcast to share insight and speak to food and body image concerns among men. A lack of awareness and representation in regards to diversity, alongside biases and barriers in healthcare spaces, has resulted in many people not getting the support they need.
Misconceptions are also common in relation to eating disorder diagnoses. Anorexia tends to be the most well-known diagnosis, so it may be surprising for people to learn that binge eating disorder is three times more common than AN and BN combined (4). An important critique of the anorexia diagnosis is that it centers a “low body weight” as a part of its criteria. On the other hand, a diagnosis of atypical anorexia falls within OSFED, and is nearly identical to AN in terms of criteria apart from a focus on weight. People with atypical anorexia are much less likely to receive eating disorder treatment, even though atypical anorexia is at least two or three times more common than AN (5.6). Even in its name, “atypical” implies that this form of anorexia is not as valid in some way. Eating disorders have significant physical, mental, and emotional consequences, irrespective of one’s body size, and people who are fat have been harmed through not having their eating disorders recognized or treated effectively as a result of anti-fat bias. To read more about atypical anorexia, we recommend this article “You Don’t Look Anorexic” by Kate Siber.
Where do we go from here?
Any food, body, or movement related stressors or concerns are valid and worth being attended to. It can be incredibly hard to know where one’s patterns or behaviors fall along a “continuum” that can lead to an eating disorder, and this is where support can be so valuable. Whether you notice patterns that resemble disordered eating in yourself or in those around you, we hope this post leaves you feeling more confident in navigating these hard situations and seeking help when needed.
Sources:
Economics, D. A. (2020). The social and economic cost of eating disorders in the United States of America: A report for the strategic training initiative for the prevention of eating disorders and the academy for eating disorders.
Goeree, M. S., Ham, J. C., & Iorio, D. (2011). Race, social class, and bulimia nervosa.
Becker, A. E., Franko, D. L., Speck, A., & Herzog, D. B. (2003). Ethnicity and differential access to care for eating disorder symptoms. International Journal of Eating Disorders, 33(2), 205-212.
Hudson JI, Hiripi E, Pope HG Jr, and Kessler RC. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3):348-58. doi:10.1016/j.biopsych.2006.03.040.
Harrop, E.N., Mensinger, J.L., Moore, M. & Lindhorst, T. (2021). Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. International Journal of Eating Disorders: 54(8); 1328-1357.
Stice, E., Marti, C.N. & Rohde, P. (2013). Prevalence, Incidence, Impairment, and Course of the Proposed DSM-5 Eating Disorder Diagnoses in an 8-Year Prospective Community Study of Young Women. Journal of Abnormal Psychology: 122(2): 445-457.