‘Eating Disorder’ vs ‘Disordered eating’ – though these terms are often used interchangeably, where to draw the line can be a decision that is difficult to make. So when does ‘disordered eating’ become an eating disorder? And how do you distinguish disordered eating from normative dieting behaviours that seem to be so prevalent in todays society?
Statistics from the National Institute of Mental Health suggest that 2.7 percent of adolescents suffer from an eating disorder. This number seems to be on the increase in younger children (age 8 – 11) and in males. However this is a relatively small percentage compared to suggested rates of disordered eating. It is thought that up to 50% of the population demonstrate a problematic or disordered relationship with food, exercise or their body image. In our culture there exists an increasingly prevalent obsession with size and weight, diet and exercise, meaning that many people may see their disordered relationship with food as ‘normal’. There remains a huge number of people with disordered eating who never seek help for their difficulties and the tendency to see these behaviours as ‘common, normal , or ‘healthy’ may contribute to this.
The most recent version of The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) recognizes 4 different categories of eating disorder: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Eating Disorder Not Otherwise Specified (EDNoS). This last category was designed to describe behaviors that meet some but not all of the criteria for anorexia or bulimia. EDNoS is actually a far more prevalent eating disorder than either anorexia or bulimia and it is likely that a large number of people with ‘disordered eating’ would meet criteria for EDNoS. Falling into this category does not mean that a person has a less significant problem with food, or that their difficulties exist without physical or emotional risk.
So what are the symptoms of disordered eating?
Symptoms of disordered eating may include the kind of behaviours that are commonly associated with the other three categories of eating disorder:
However, disordered eating might also include:
What distinguishes disordered eating from a diagnosable eating disorder is mainly about degree, and the amount of distress that changes to eating, weight or behaviour evokes. If someone engages in ‘disordered eating behaviours’ on a majority of days, or experiences distress and anxiety either when they are unable to use these behaviours or when they have chosen not to, it is likely that they may be diagnosed with an eating disorder. In our experience it seems that many people with ‘disordered eating’ would not view themselves as having an eating disorder, and would rarely even consider themselves to have disordered eating. It is more likely that they will see themselves as ‘getting it right’ or ‘being healthy’. However when food choices are made due to anything other than hunger and appetite, when food preferences are held with more importance than other things like attending social events, and when eating has the ability to evoke strong negative emotions – we would very much argue that this is an eating disorder and should therefore be taken seriously.
Many people see these behaviours as common, normal or healthy. However, whilst the behaviours might be increasinly prevalent in todays culture, they are certainly not healthy. Disorderd eating puts people at high risk of developing other physical and mental health conditions including more severe eating disorders. Other consequences may include:
• Concentration and ability to focus – people describe spending a huge amount of time thinking about or planning food and exercise – time that could (or should) often be spend focusing on other things.
• Social life – socializing is often limited due to anxiety about eating out in restaurants or prioritization of exercise.
• Coping skills – diet and exercise often starts to become a way of ‘coping’ with difficult life events. Whilst this may feel like an effective strategy in the short term, it actually prevents people from using healthy ways of coping with emotions meaning that stress can build up over time.
• Difficult emotions – thoughts about food and weight often start to become anxiety provoking, putting people at risk of depression or chronic anxiety
If your eating is causing you distress, or starting to have a negative impact on any areas of your life it is probably time to seek help. Many people avoid seeking help as they fear that their problem isn’t serious enough, or they feel anxious about what help will involve. If you want to, then it is never too soon to get help with what may become a significant problem the longer you allow it to continue.