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 (February 23th through March 1th).
By Carrie Gottlieb, Ph.D.
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% 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% 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 Not Otherwise 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?
Signs and Symptoms of Disordered Eating
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). However, disordered eating might also include:
- 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
- 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
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.
Understanding and Assessing The Risk of Disordered Eating
As with other mental health issues, it is important to explore how and to what extent disordered eating is affecting an individual’s daily functioning. Issues to consider include the following:
- Concentration and ability to focus-- do thoughts about food, body and exercise prevent concentration or impede performance at work or school?
- Social life--is socializing restricted because it might require eating in a restaurant, consumption of foods that are scary or uncomfortable, or disruption of exercise routine?
- Coping skills-- Is food consumption and/ or restriction used as way to manage life’s problems or cope with stressors?
- Discomfort or anxiety-- How much discomfort do thoughts of food and body cause? Are these thoughts hard to shake and anxiety provoking?
A mental health professional can help to distinguish between disordered eating, eating disorders, and more normative diet and exercise patterns and determine whether you might be at risk.
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 weight themselves daily or multiple times per day.
Treating Disordered Eating
The relationship we have with our bodies, as well as how we experience our size and shape is complex emotionally and physically. Difficulties with self-esteem and body image are common among those with and without eating disorders. Psychotherapy can help people understand these complex relationships, achieve body acceptance, and explore the relationship patterns and other psychological issues that contribute to the disordered eating. In addition, a nutritionist, who specializes in eating disorders and adopts a non-diet approach to food and exercise, can also be a good resource, particularly with respect to increasing attention to the body’s natural hunger/fullness cues.
Dr. Gottlieb is a clinical psychologist specializing in the treatment of eating disorders. She is trained in cognitive behavioral, interpersonal, relapse prevention and DBT therapies and adopts an integrative approach to psychotherapy with her patients. Dr. Gottlieb is currently on the steering committee of the William Alanson White Institute Eating Disorders, Compulsions, and Addictions program (EDCAS). She is in private practice in New York City. firstname.lastname@example.org.