This post is from the Eating Disorders, Compulsions, and Addictions Service (EDCAS) of the William Alanson White Institute in recognition of National Eating Disorders Awareness Week.
It’s pretty easy to diagnose a full-blown eating disorder like anorexia or bulimia nervosa. But more subtle forms of disordered eating are difficult to pinpoint.
In our culture, there is an obsession with size and weight, diet, and exercise. The pervasiveness of disordered eating is astounding. Research suggests that up to 50 percent of the population demonstrate problematic or disordered relationships with food, body, and exercise. Rates of clinical eating disorders are much lower, estimated from 1 to 3 percent of the general population.
There are four diagnoses of eating disorders in The Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V): anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder otherwise not specified.
Specific diagnostic criteria are listed for each of the four diagnoses. However, falling short of meeting these criteria does not mean a person is maintaining a healthy relationship with food and weight. Individuals who demonstrate disordered eating may still be at risk both physically and emotionally.
Defining and recognizing disordered eating is a complicated issue. What are the signs and symptoms of disordered eating? How do you distinguish disordered eating from an actual eating disorder or even from more normative dieting behaviors? And what can be done to treat these behaviors once they become a problem?
Symptoms of Disordered Eating
The symptoms of disordered eating are similar to those of eating disorders. However, these behaviors are less severe or more infrequent, so they do not meet the criteria for the diagnosis of an eating disorder.
So what type of eating behaviors can be defined as disordered? Some examples include:
- Avoiding certain food groups
- Binge eating
- Calorie restriction or extreme dieting
- Changes in weight
- Eating due to boredom
- Eating as a way to cope with stress
- Eating to deal with emotions
- Elaborate rituals related to food and eating
- Eating the same things every day
- Engaging in limited or irregular binging and purging
- Feeling guilty for eating or eating certain foods
- Labeling foods as “good” or “bad”
- Misusing diuretics, laxatives, or enemas
- Only eating certain foods
- Self-inducing vomiting
- Skipping meals
- Taking an all-or-nothing approach to healthy eating
- Using diet pills or supplements to lose weight
Signs of an Eating Disorder
It is difficult to determine how much time a person spends engaging in dieting behaviors. Still, there are certain behaviors that might indicate that a person may have an eating disorder. Some signs to look for:
- Constantly feeling cold and wearing thick layers to stay warm
- Avoiding social situations where eating may be involved
- Engaging in periods of extreme food restriction
- Exercising excessively to prevent weight gain or to lose weight
- Hiding, stealing, or hoarding food
- Only eating in private
- Poor self-esteem
- Spending a lot of time preparing food for others and then refusing to eat
- Symptoms of anxiety and depression
- Wearing baggy clothing to hide weight loss
Such behaviors take up a great deal of time and mental energy. They may interfere with a person’s ability to function normally in different areas of their life, including home, work, school, and relationships. In many cases, people may avoid social events to avoid having to eat around other people.10
Disordered Eating vs. Eating Disorders
What distinguishes disordered eating from a full-blown eating disorder? It is all about degree. An individual with disordered eating is often engaged in some of the same behavior as those with eating disorders but at a lesser frequency or lower level of severity.
However, disordered eating is problematic and to be taken seriously, though the symptoms might not be as extreme as those of a diagnosable eating disorder. Individuals with disordered eating may be at risk for developing a full-blown eating disorder and are more likely to have a history of depression and/or anxiety, or be at risk for anxiety and depression at some point in the future.
Causes of Disordered Eating
The causes of disordered eating are varied and complex. Factors that can play a part include:
- Culture and society, including celebrity culture, television and movies, social media, and online influencers, can lead to distorted body image and unhealthy relationships with food.
- Mental health conditions such as anxiety, depression, or obsessive-compulsive disorder (OCD) may contribute to the onset of disordered eating behaviors.
- Stress or difficult life changes can trigger the onset of disordered eating patterns, such as loss of appetite or eating for comfort.
- Trauma can make people more vulnerable to disordered eating and eating disorders.
Preventing and Managing Disordered Eating
Here are some things you can do to prevent or manage disordered eating:
- Avoid fad or crash diet. Many diets are both too restrictive in terms of both quantity and variety. This can cause a feeling of deprivation and possibly lead to binge eating. It is healthier to adopt a more inclusive meal plan in which all foods are incorporated in moderation.
- Set healthy limits on exercise and focus on physical activities that are enjoyable. For example, it’s preferable to take a yoga class instead of staying on the elliptical machine until you burn a certain number of calories.
- Stop negative body talk. Be mindful of overly critical talk about yourself or your body.
- Throw away the scale. People with disordered eating often weigh themselves daily or multiple times per day.
Coping and Prevention
If you recognize signs of disordered eating, you can take steps to manage your behavior and develop a healthier relationship with food. Finding coping methods may help prevent such behaviors from progressing to a full-fledged eating disorder. Some steps you can take include:
Avoid Fad Diets
Crash diets tend to be highly restrictive and lead to feelings of hunger and deprivation. This often results in cravings and overeating behaviors, leading to feelings of failure and guilt. Instead of following fad diets, focus on eating in moderation and avoid labeling foods as inherently “good” or “bad.”
Use Positive Self-Talk
Disordered eating is often accompanied by negative self-talk and self-criticism. Instead of comparing your body to others or berating yourself over your appearance, focus on appreciating your good qualities. Think about what you like about your body and how your body serves you.
Building a positive relationship with your body, noticing the things you love about yourself, and using positive affirmations to build your confidence can be helpful.
Practice Body Neutrality
It can also be helpful to use an approach known as body neutrality to shift your focus. Body neutrality involves practicing accepting your body and focusing on caring for your body with adequate food, rest, water, and care. Learning to appreciate your body can help improve body image and combat disordered eating behaviors.
Strategies that can help include avoiding weighing yourself every day, limiting your exposure to unrealistic body standards, and practicing gratitude.
Try Mindful Eating
Mindfulness is a practice that involves focusing entirely on the present moment. When applied to eating, it can help you avoid unconscious, distracted eating and instead fully appreciate the food you eat and the experience of consuming it.
Mindful or intuitive eating can help you become more attuned to your body and learn to recognize when you are hungry and when you are full. It can also help you learn to identify unhealthy eating behaviors, such as using food to distract yourself from challenging emotions.
How to Get Help
Eating disorders can lead to serious health outcomes, including dental problems, malnutrition, menstrual irregularities, anxiety, depression, organ failure, and substance use. This is why it is so critical to seek treatment if you are experiencing symptoms of an eating disorder.
There are many different types of treatment available for eating disorders. Treatment typically includes a combination of individual, group, and/or family therapy and nutritional counseling. Treatment is multifaceted and designed to address thoughts, behaviors, coping skills, and lifestyle factors to help people recover.
If you are experiencing disordered eating or suspect that you might have an eating disorder, it is important to seek help as early as possible. Research suggests that early intervention improves the course of recovery and treatment outcomes. Treatment during the early stages of an eating disorder can reduce the detrimental impacts on physical health, increase the effectiveness of recovery, and minimize the need for higher levels of inpatient care.
If you think you might have an eating disorder, talk to your doctor or mental health professional. You can also contact one of the following organizations for more information and support:
- National Eating Disorders Association (NEDA)
- National Association of Anorexia Nervosa and Associated Disorder (ANAD)
- The Eating Disorder Foundation
- Eating Disorders Resource Center (EDRC)
If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237.
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