On Eating Disorder Diagnostic Labels…
While terms like "anorexia" and "bulimia" have gained widespread recognition, the number of psychiatric labels applied to issues related to food and body image has increased dramatically over the past century. To put it simply, a clinical diagnosis is a description of some important traits or symptoms in terms of behaviors, feelings, and thought patterns. Diagnostic labels can be useful in describing a common set of characteristics among those diagnosed with a particular condition. They can also assist in the distinction between "unhealthy" behavior and "disordered" behavior, although this line is often blurred. There must be a significant and long-lasting pattern of difficulties with food and eating in order to be diagnosed with an "eating disorder." Overindulging in ice cream on occasion, for example, does not imply that someone has a binge eating disorder.
However, diagnostic labels can feel both stigmatizing and diminishing. Labels and generalizations about eating disorders have the unfortunate side effect of making our inner system of pain and suffering seem less complicated than it is. It's critical to realize that diagnoses do not provide explanations; rather, they are descriptive. Diagnostic labels have influenced how we talk about eating disorders and body image issues over the years, but they don't necessarily give us a better understanding of the daily struggles we face. They don’t offer insight into the reasons behind our distorted relationships with food, ourselves, and the people around us.
In some cases, a formal diagnosis of any of these disorders is not required or desired, but knowing the clinical features and typical patterns of behavior associated with each disorder can still be useful. While the definition of “eating disorder” is ever-evolving, anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorder (OSFED) are some of the more widely recognized diagnoses.
Individuals with eating disorders frequently transition between diagnostic categories due to the high degree of overlap between them. This suggests that they have similar causes and that the lines between them are mostly arbitrary. Because ED diagnoses don't stay the same over time, people often get an OSFED diagnosis before they get an AN, BN, or BED diagnosis or while they are recovering from one of these eating disorders. Because of the heterogeneity among diagnoses, symptom overlap in diagnostic categories, and frequent diagnostic migration across time, there has been a recent conceptual transition away from the traditional categorical classification systems, such as the DSM-5 and the International Classification of Diseases (ICD), and toward a dimensional approach that focuses on the relationship between psychological factors, symptomatology, and body image disturbance.
Consider the following diagnostic categories for eating disorders with these caveats in mind.
Common Categories of Eating Disorders
Anorexia Nervosa
Although anorexia is one of the rarest forms of eating disorders, it may be the most well-known. Anorexia is characterized by extreme self-restraint when it comes to food and a pervasive fear of gaining weight. It is common for people with anorexia to restrict their food intake and engage in extreme physical activity in order to achieve or maintain a weight that is significantly lower than their natural weight. Due to extreme weight loss, anorexia has become one of the most recognizable eating disorders to the general public.
People diagnosed with anorexia often don't see themselves the way others do. They often have a distorted body image, called body dysmorphia, and may “feel fat" even with visible bones in extreme cases. It's a vicious cycle: the more a person thinks they're "big" or "ugly," the more motivated they are to lose weight, and yet no amount of weight loss seems to be enough. There are times when food, weight, and body shape are the only things on the mind of the person in question. As a result, the individual may isolate themselves from friends and family and avoid social events that involve food, such as birthday parties, family dinners, or a night out.
Anorexia can bring on a range of conflicted emotions. Continuous self-criticism and self-monitoring can lead to feelings of hopelessness and disgust at one's perceived shortcomings, whereas achieving weight loss goals can bring a strong sense of satisfaction and pride, however fleeting. These feelings play a significant role in the long-term maintenance of the disorder.
Anorexia is often marked by very low body weight and malnutrition, which can cause a number of physical symptoms and problems. Women may experience irregular periods, problems with fertility, hair thinning, loss of muscle and bone strength, mental fogginess, and memory loss. Some of these complications can be reversed with weight gain and proper nutrition, but severe anorexia that has gone on for a long time can cause lasting damage. Anorexia is the most lethal of all mental illnesses. Extreme cases may result in death from starvation, cardiac arrest, other medical complications, or even suicide.
There are two “subtypes” of anorexia. Those who fall into the restricting subtype limit both their caloric intake and the types of food they eat, and they may also engage in excessive physical activity. Individuals who fall into the binge-purge subtype not only severely limit their caloric intake and food variety, but also engage in episodes of purging or binge eating. The hallmark of a binge eating episode is the experience of being out of control while consuming a large amount of food, while the hallmark of purging behavior is engaging in compensatory behaviors after eating, such as the misuse of enemas, laxatives, fasting, diuretics, or self-induced vomiting.
Bulimia Nervosa
Bulimia nervosa is another form of an eating disorder that receives a lot of attention and is somewhat more common. Bulimia is characterized by alternating periods of bingeing and purging. People with this disorder often worry too much about their weight and shape, and they can have problems with how they look, just like people with anorexia. Bulimic symptoms are distinct from those of anorexia in that they are characterized by an occasional and recurrent loss of control over their eating. Uncontrollable binges can happen out of the blue or be carefully orchestrated. Feeling guilty or ashamed about one's eating habits can lead to an urge to purge to compensate for the additional calories, prevent weight gain, or relieve discomfort.
People with bulimia tend to be of average body weight, slightly above average, or overweight, making it difficult for loved ones, colleagues, or healthcare providers to notice the signs. While patients with bulimia nervosa may fast on occasion, this does not lead to the long-term weight suppression seen in those with anorexia nervosa. Individuals with anorexia nervosa who engage in bingeing and/or purging as part of their illness will experience persistent weight loss.
The negative effects on one's physical and mental health from chronic binge eating and subsequent purging are not to be underestimated. Abdominal pain, bloating, and digestive issues are common complaints, as are mood swings, fatigue, irritability, depressive symptoms, anxiety, and low self-esteem. People's social and work lives are often messed up by bingeing and purging cycles. This is because feeling out of control can make a person feel ashamed and like they aren't worth anything.
Binge Eating Disorder (BED)
One of the most common eating disorders is Binge Eating Disorder (BED), which has only recently been recognized as an eating disorder in its own right. It is similar to bulimia in that it is marked by bingeing, but without subsequent compensatory behaviors. Binge-eating episodes may be planned and involve specific foods, or they may occur without warning. However, the binge itself can be a stressful experience, marked by feelings of being out of control, followed by shame or guilt, which can make the experience even worse. The frequency and duration of these binges vary from person to person. Individuals who fit this diagnosis tend to eat normally at other times of the day in between binges, making it harder to spot their binge eating patterns.
Due to their habitual overeating, many people who suffer from BED are overweight, though this is not always the case. Mobility issues, chronic pain, diabetes, depression, and low self-esteem are just a few of the mental and physical problems they may face. A preoccupation with one's weight and appearance is another common feature of BED, even though it isn't listed as one of the formal diagnostic criteria. BED can lead to feelings of social isolation or stigmatization because of one's weight. This can cause them to withdraw and disrupt their personal, professional, or educational lives. While anorexia and bulimia typically begin in adolescence, the onset of BED tends to be later in life, often beginning in early adulthood. BED has also been found to be more common than either anorexia or bulimia across ethnic groups and among boys and men.
Other Specified Feeding And Eating Disorders (OSFED)
OSFED, previously known as EDNOS (eating disorders not otherwise specified), is now used to describe eating difficulties that don't neatly fit into any established category. Due to its wide range of symptoms, many of which may be similar to those of other types of eating disorders, OSFED is the most commonly diagnosed eating disorder. Atypical forms of anorexia, bulimia, and binge eating disorders can fall under the umbrella of OSFED, such as when a person engages in eating disorder behaviors (e.g., restricting food intake, binging, and purging) but does so less frequently or for a shorter duration. Since all forms of disordered eating are potentially harmful to the individual, a diagnosis of OSFED should not be dismissed as less serious than other forms of eating disorders. There is also a chance that so-called "mild'' symptoms will get worse over time.
Disordered Eating/Subclinical Eating Disorders
The prevalence of subclinical eating disorders in the general population should also be noted. Nearly half of the population has problematic or disordered relationships with food, body, and exercise, while clinical eating disorders affect only 1%-3% of the general population. "Subclinical" is a medical term used to describe a condition that isn't severe enough to warrant a formal diagnosis. Subclinical eating disorders are distinguished from clinical eating disorders by the frequency and severity of symptoms. Subclinical eating disorders can present with a wide range of symptoms because the term itself is so vague. What this means is that not everyone with a subclinical eating disorder will show all of the symptoms.
Eating disorders and disordered eating can be distinguished by whether or not their symptoms and experiences match those defined by the American Psychiatric Association (APA). Many individuals with atypical disordered eating symptoms are diagnosed with OSFED. However, patients must meet specific criteria for OSFED, just like they do for anorexia or bulimia, and those criteria are also limited. As a result, it is possible to have disordered eating patterns that do not fall under the current definition of an eating disorder. "Disordered eating" is a phrase that describes a problem, not a medical diagnosis.
People may share similar concerns about food, body image, and exercise, for example. Both may have severe dissatisfaction with their bodies. Restrictive dieting, bingeing and purging, and/or compulsive exercise may be exhibited by both. However, if one of them falls into a "dangerous" weight range, they are more likely to be diagnosed and treated than the other, even though they may be going through the same internal struggles.
All eating issues, not just those that meet the diagnostic criteria for an eating disorder, deserve attention and treatment. People who exhibit disordered eating behaviors may be under intense psychological, physiological, and social pressure. Treatment for disordered eating is available to everyone, regardless of body size or the complexity of the problem. Each and every one of us has the right to a healthy relationship with food, physical activity, and our own bodies.
An Eating Disorder Spectrum?
The best way to tell if someone has an eating disorder is to look at how much their relationship with food, dieting, and how they see themselves affect their ability to live a full, meaningful life. Eating disorders are frequently misunderstood because of a focus on physical appearance, even among those in the mental health profession. They think, "How can someone have an eating disorder if they don't appear to have one?" How can I tell that something is there if I can’t see it?
In reality, not all people with anorexia are underweight, and not all people with binge eating disorders are obese. Not all people who are underweight have anorexia, and not all people who are obese have binge eating disorders. Regardless, the majority of individuals with eating disorders fall somewhere in the middle. Unfortunately, many treatment programs, therapists, and self-help groups intended to help people find their way into recovery support or reinforce this belief. In the end, this seems to overshadow the fact that recovery is more than just a matter of losing, maintaining, or gaining weight. For the majority of people suffering from an eating disorder, their weight and self-perception are merely symptoms of a larger issue.
I believe we should reexamine the common misconceptions and stereotypes about eating disorders. It’s helpful to think of disordered eating in terms of a spectrum. Formal clinical diagnoses of anorexia, bulimia, binge eating disorder, and other specific eating disorders can be found at one end of the spectrum. At the other end of the spectrum, we have what is deemed "normal," which may include periodic dieting or dissatisfaction with one's physical appearance. Those in the middle of the spectrum show some of the symptoms but don't meet the criteria for a diagnosis.
Identify. Don’t Compare.
When we compare ourselves to stereotypes of what eating disorders look like, it's far too easy to brush them off by saying, "It's not that bad," "I don't purge all the time," or "I'm not that thin." When it comes to "identifying," it's about being able to relate to the thoughts and feelings of someone with an eating disorder. As a matter of fact, anyone who suffers from an eating disorder can identify with the feeling of hopelessness that comes with repeatedly trying to "control" their compulsions.
There is a common bond among people with eating disorders which, on the surface, stems from their dissatisfaction with their physical appearance and unhealthy eating habits. When we dive deeper, we discover that the core issues are complex and highly individual. What connects people is more important to recovery than what separates them.
Have you received a formal diagnosis of one of these eating disorders?
If not, do your symptoms or experiences clearly fit into one category?
What do you think about the concept of a spectrum of disordered eating?