The other day I walked past a table in the dining hall and heard a girl say, “I used to purge once in a while but I was never bulimic.”
One time a male friend said to me “what you feel sounds serious but at least it isn’t a real eating disorder.”
I once sat incredulously next to one of my girlfriends as she said to another “you haven’t eaten today at all, you’re like totally anorexic.”
For so many reasons, it’s important that we be very clear about what the difference is between an eating disorder and disordered eating.
In this post today I’ll demonstrate the difference, and then talk about why it’s so important, and what we should do with it in our own lives.
What is an eating disorder?
An eating disorder is a psychological disorder officially classified in the one document regarded as the world authority on mental disorders, the DSM. The DSM is re-issued periodically. The most recent issue was number V, and it came out just last year.
There are four diagnoses of eating disorders in the DSM: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specificed. Each of these disorders has specific criteria:
- Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
- Recurrent episodes of binge eating characterized by BOTH of the following:
- Eating in a discrete amount of time (within a 2 hour period)large amounts of food.
- Sense of lack of control over eating during an episode.
- Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging).
- The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of anorexia nervosa.
Binge Eating Disorder:
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
- a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
- The binge-eating episodes are associated with three (or more) of the following:
- eating much more rapidly than normal
- eating until feeling uncomfortably full
- eating large amounts of food when not feeling physically hungry
- eating alone because of feeling embarrassed by how much one is eating
- feeling disgusted with oneself, depressed, or very guilty afterwards
- Marked distress regarding binge eating is present.
- The binge eating occurs, on average, at least once a week for three months.
- The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.
All of which is to say that eating disorders are quite specific, and identifying someone’s behavior as such has important implications for the type of treatment they receive, the recommendations their doctors make, and the way in which their health insurance companies handle them.
What is disordered eating then?
Disordered eating is pretty much all neurotic or mentally unhealthy ways of interacting with food that do not fall under these set criteria.
Whereas 0.5% of American women suffer from anorexia and 2.5% of women from bulimia (and both of which having higher rates in college, statistics from here), it is estimated that more than 50% of Americans suffer from some sort of negative or disordered behavior around food. People who have clinical eating disorders are a small subset of a very large group of people who struggle with food.
Symptoms of disordered eating may include behavior commonly associated with eating disorders, such as food restriction, binge eating, purging (via self induced vomiting or excessive exercise, and use of diet pills and/ or laxatives). Disordered eating may also be indicated by:
- Yo yo dieting
- Obsession with diets
- Self worth or self esteem based highly or even exclusively on body shape and weight
- A disturbance in the way one experiences their body i.e. a person who falls in a healthy weight range, but continues to feel that they are overweight
- Excessive or rigid exercise routine
- Obsessive calorie counting
- Orthorexic behaviors, an obsesion with ‘clean’ eating
- Rigid adherence to a particular dietary paradigm
- Anxiety about certain foods or food groups
- A rigid approach to eating, such as only eating certain foods, inflexible meal times, refusal to eat in restaurants or outside of one’s own home
The difference between eating disorders and disordered eating is one of degree
The motivations that someone may have for developing an eating disorder are highly complex. We could talk about body image and food issues all day long, and that very well often plays a role in eating disorders. Yet more complex and varied psychological issues often play a role: significant trauma, childhood trauma, dysfunctional behaviors in the family, feelings of helplessness and lack of control, social anxiety, sexual and emotional abuse and many other problems often come into play. It is also often hypothesized that genetics may play a role in the development of eating disorders, making some people more susceptible to developing them than others.
These motivations result in behaviors that are demonstrably physically harmful to the person enacting them. Significant nutrient depletion and caloric deprivation are problems for anorexia, which very often lead to death in the end. For bulimia, metabolic derangement may result, and also many gastrointestinal disorders, stomach acid issues, and the decay of tooth enable. Binge eating disorder may also have significant physiological effects as bingeing cycles can also seriously harm the gut and the body’s metabolism.
In some sense, you could say that these severe psychological issues and severe physical problems are what distinguish eating disorders from disordered eating. Yet when we take a good, hard look at disordered eating we find that the same problems abound, simply with a result in less extreme eating behaviors. Whoever suffers the “most psychological damage” could never truly be evaluated.
Why this matters to all of us
Problems with eating exist on a spectrum. On one far end of the spectrum are severe eating disorders. On the other end of the spectrum is a perfectly mentally happy and peaceful person.
But pretty much all of us exist somewhere in the range in between.
Even if someone does not technically “have a disorder,” she may be quite near disorders on the spectrum. And even if in some particular regard she manages to escape the “official disorder,” say, because she doesn’t meet the criteria of bingeing often enough, she still may be under a truly significant amount of emotional distress and need real help. This help could come from friends, or it could come from a therapist.
Unfortunately, today in our culture in order for an individual to get the most powerful treatment she must qualify as having a precise disorder. This is unfortunate, and I believe the DSM and psychological and psychiatric facilities need to work together in order to be more inclusive for their treatments for people who do not meet rigid criteria.
Fortunately, most psychologists I believe are attuned to the potential severity of mental pain regardless of whether someone meets the specific criteria, and so will be able to provide high quality help to the people who need it.
I wanted to raise these points today because I believe we need to have more sympathy for everybody: more sympathy for those with official disorders, more sympathy for those who don’t qualify as having disorders, and more sympathy for ourselves. This last point is particularly important for many of us: just because our problems aren’t “official” doesn’t mean they aren’t problems. It doesn’t mean they aren’t worth addressing. They are. They truly are.
And, as with all psychological problems, with both support from our therapists, our friends, our communities, and whoever we may find ourselves amongst, and with unending forgiveness and patience for ourselves, we really can overcome the problems. The first step is acknowledging that they are real, and that we are not alone.
What do you think? Questions, comments, concerns, communal love? Love my ideas, hate them? I live for your thoughts!