What is an Eating Disorder? Disordered Eating 101

As an eating disorder and disordered eating specialist, I often receive questions about one’s relationship with food. Many wonder if they have an eating disorder, and turn to sources such as Google for answers. However, as a specialist, I understand that black and white answers can be unhelpful and invalidating.

It’s important to recognize that eating disorders cannot be put into a one-size-fits-all box. Everyone’s experience is unique, and no two people with an eating disorder will feel, believe, or act the same.

In this blog, I will cover the fundamentals of eating disorders and disordered eating. Including the basics of what they are, types, signs, potential causes, and how to begin healing.

I often get asked what an eating disorder really is. In clinical terms, an eating disorder is defined as a complex mental health condition where the control of food is used to cope with other situations.

I think I can give a better definition than this: Eating disorders are behaviours and attitudes towards food and bodies that are unhelpful, harmful, and uncomfortable. But the behaviours and attitudes become so engrained that they take up a huge amount of space in your life – so much so you can’t escape. You become trapped in what was once a way to escape or cope with difficulty.

It is important to note that all relationships to food are deserving of support. Regardless of the diagnosis, severity, or length of time, they have been difficult. Not everyone receives a diagnosis, so it’s not a requirement to receive support.

How many eating disorders are there?

There are several types of eating disorders.

These include anorexia nervosa, bulimia nervosa, binge eating disorder, pica, rumination disorder, avoidant/restrictive food intake disorder, and other specified feeding or eating disorders.

Each of these disorders has its own set of symptoms and diagnostic criteria. It is important to seek professional help if you suspect that you or a loved one may be struggling with an eating disorder.

As someone who has researched eating disorders extensively, I can tell you that there are many different types. The current DSM (Diagnostic and Statistical Manual of Mental Disorders) includes nine different types of eating disorders, each with its own set of symptoms and criteria for diagnosis.

Anorexia Nervosa (AN)

Anorexia Nervosa (AN) is an eating disorder that centers on restriction of energy intake relative to needs which can lead to a lower body weight for age, sex, and physical activity.

However, it is flawed in regard to the weight criteria. Those with AN may have an intense fear of gaining weight and so show persistent behaviour that interferes with weight gain. AN is subdivided into AN restrictive type and AN binge/purge type.

Bulimia Nervosa (BN)

Bulimia Nervosa (BN) involves repeated episodes of binge eating, which is defined as eating an amount of food in a defined time period that is larger than most individuals would eat under similar circumstances, coupled with a feeling of no control over overeating during the episode.

This is normally coupled with compensatory measures to make up for food, guilt, or to start anew. Compensatory measures include self-induced vomiting, exercise, laxatives, diuretics, restriction, or going on a new diet.

Binge Eating Disorder (BED)

Binge Eating Disorder (BED) is characterized by recurrent episodes of binge eating, which is defined as eating an amount of food in a defined time period that is larger than most individuals would eat under similar circumstances.

The episodes are associated with any of the following: eating quicker than normal, eating until uncomfortably full, eating a large amount when not physically hungry, eating alone due to embarrassment, or feeling guilt and shame afterwards.

Other Specified Feeding and Eating Disorders (OSFED)

Other Specified Feeding and Eating Disorders (OSFED) applies to symptoms that are characteristic of an eating disorder that cause distress or impair functioning.

However the symptoms do not meet the full criteria for any other eating disorders. Examples include atypical AN, BN of low frequency, purging disorder, and night eating syndrome.

Avoidant / Restrictive Food Intake Disorder (ARFID)

Avoidant / Restrictive Food Intake Disorder (ARFID) is an eating or feeding disturbance causing a persistent failure to meet nutrient and energy needs. ARFID can be associated with significant weight loss, and nutrient deficiencies.

People with ARFID may also be dependent on enteral feeding or nutritional supplements.

Unspecified Feeding or Eating Disorder (UFED)

Unspecified Feeding or Eating Disorder (UFED) applies to symptoms that cause significant distress / impair functioning but do not meet the criteria for any disorders. Often used when there is insufficient information to specifically diagnose.

Body Dysmorphic Disorder

Body Dysmorphic Disorder is a preoccupation with perceived flaws in physical appearance that others may not see or that appear slight. The individual might perform behaviors like mirror checking, skin picking, reassurance seeking etc. repeatedly. This preoccupation causes significant distress or impairs function.

Orthorexia Nervosa (ON)

Orthorexia Nervosa (ON) is not clearly defined in the DSM-5 but has been proposed to refer to an obsessive focus on eating “healthy.”

The definition of “healthy” which may vary among individuals. Any violation of self-imposed “rules” can lead to negative thoughts and feelings. There may be a fear of disease, feeling impure, and guilt/shame.

This can lead to malnutrition, weight loss, or medical complications. There is of course the psychological element which can be isolating and lead to poor mental health.

Pica

Pica is when there is a persistent desire to eat non-food stuff. Including paper, ice, dirt, soap, or clay. It is most common during pregnancy, autism spectrum disorder, and other conditions.

Night Eating Disorder

Night eating disorder is when someone has recurrent episodes of eating after waking up at night, or having excessive food intake after the evening meal. This causes distress and/or impairment in functioning.

It can be a difficult question how exactly eating disorders develop because there are lots of factors. The development of an eating disorder follows the biopsychosocial model. This means that various genetic, social, and environmental factors come together to influence someone’s relationship with food.

Genetics

Research has shown that genetics can play a role in the development of eating disorders. If you have a first-degree relative who has or had an eating disorder, you are seven to twelve times more likely to develop one yourself. Studies have also found that genetic factors can account for around 40-60% of the risk for developing an eating disorder.

However, it’s important to note that having a family history of eating disorders doesn’t necessarily mean you will develop one. It’s also not anyone’s fault that someone has an eating disorder.

Social factors

Sociocultural expectations of thinness can also be a risk factor for developing an eating disorder. The media can play a significant role in this, with theories such as cultivation theory, social comparison theory, and objectification theory all contributing to eating disorder development.

Social media, in particular, has been heavily criticized for its impact on body image and eating disorder development. It’s important to be aware of these social factors and how they can influence our relationship with food.

Environmental factors

Environmental factors, such as upbringing, trauma, living arrangements, and peer pressure, can also contribute to eating disorder development. For example, a difficult upbringing with neglect has been linked to around a 3x risk of developing an eating disorder.

The Loaded Gun Theory is a useful metaphor for understanding how genetics and environmental factors can interact to lead to an eating disorder. If someone is genetically predisposed to an eating disorder, this is the “loaded gun.” Then, their environment and social factors can come together to “pull the trigger” and trigger the development of an eating disorder.

In conclusion, eating disorders develop through a combination of genetic, social, and environmental factors. While it can be challenging to pinpoint an exact cause, understanding these factors can help us better understand and support those who are struggling with an eating disorder.

There are some common symptoms that may indicate an eating disorder is present.

These include:

  • Excessive preoccupation with weight and body shape: Spending a large amount of time worrying about your weight and/or body shape can be a sign of an eating disorder. It’s important to note that this preoccupation may not always be negative, as some individuals may also excessively focus on gaining weight or building muscle.
  • Obsession with food: Being preoccupied with food is another common symptom of an eating disorder. This can manifest as constantly thinking about food, planning meals excessively, or hoarding food.
  • Binge eating: Feeling like you can’t stop eating, even when you’re full, is a sign of binge eating disorder. This may also be accompanied by feelings of shame or guilt.
  • Avoidance of social situations involving food: Individuals with eating disorders may avoid social situations that involve food, such as going out to eat with friends or attending parties.
  • Purging behaviors: Making yourself sick, taking laxatives, or diuretics after binge eating, or after eating a small amount of food, are all signs of purging behaviors.
  • Restrictive behaviors: Making up for food by limiting what you eat the next meal or day, or feeling like you should, and often feeling guilty or like a failure when you don’t, are signs of restrictive behaviors. Exercising to make up for food or feeling like you need to exercise a set number of times/minutes per week are also common.
  • Rigid routines: Having strict habits and routines around food, such as only eating at certain times or in certain ways, can be a sign of an eating disorder.
  • Constantly seeking new diets: Feeling like you need to find the next new diet or constantly trying new fad diets can be a sign of disordered eating.
  • Obsessive consumption of food-related media: Spending time watching a lot of food videos, including “what I eat in a day” videos or healthy recipe Tik Toks, can be a sign of an unhealthy preoccupation with food.
  • Spending a lot of money on food: Individuals with eating disorders may spend a lot of money on food, particularly on “safe” foods or foods that fit within their strict dietary rules.
  • Body dissatisfaction: Feeling like you can’t live fully until your body has changed, or constantly feeling dissatisfied with your body, can be a sign of an eating disorder.
  • Physical symptoms: Eating disorders can also cause physical symptoms, such as heart racing, fainting, feeling faint, poor circulation, brittle nails and hair, dry skin, feeling cold and tired, digestive problems, and amenorrhea (not getting a period).

It’s important to remember that not everyone with an eating disorder will exhibit all of these symptoms, and that each individual’s experience with an eating disorder is unique.

However, if you or someone you know is exhibiting several of these symptoms, it may be worth seeking professional help to address any underlying issues.

If you suspect you have an eating disorder, it can be a scary and overwhelming feeling. But it’s important to remember that you’re not alone and there are resources available to help you.

One of the first things you can do is confide in a trusted friend or family member who can support you. It takes a lot of courage to admit to yourself and others that you may have an eating disorder, but having a support system can make a big difference.

If you need emergency support, you can reach out to Beat, the UK’s national eating disorder charity. They have volunteers available to chat with you and provide signposting to other resources. If you’re in the US, you can reach out to NEDA for support.

It’s important to note that you don’t need a formal diagnosis to seek help for an eating disorder. Any eating disorder professional can assist you without a diagnosis. However, receiving a diagnosis can help you give a name to what you’re experiencing and provide a clearer path towards recovery.

When seeking help, it’s important to find someone who specializes in eating disorders. Beware of professionals who view eating disorders as an “add-in” rather than their core specialty. You can search for eating disorder professionals online or ask for recommendations from your doctor or therapist.

There are options for both in-person and online support. Online support can be helpful if you prefer to speak from the comfort of your own home or need appointments at flexible times. However, if you prefer face-to-face interaction, in-person support may be a better fit for you.

Lastly, it’s important to consider the Health at Every Size (HAES) approach when seeking treatment. HAES-aligned eating disorder professionals focus on eliminating weight stigma and promoting overall health and well-being. Changing your mindset towards your body and dismantling beliefs about weight and health can be a crucial aspect of recovery.

Recovering from an eating disorder is a challenging process that requires a support network and professional help. Here are some tips to help you along the way:

  • Build a support network: Eating disorders can be isolating, so it’s essential to surround yourself with people who will help you recover. This can include a professional, such as an eating disorder nutritionist, as well as family and friends.
  • Don’t compare yourself to others: Everyone’s recovery journey is unique, so it’s important not to compare yourself to others. Focus on your own progress and work at your own pace.
  • Seek professional help: While some people try to recover on their own, most people need one-on-one help. Working with an eating disorder nutritionist or therapist can provide the guidance and support you need.
  • Be patient: Recovery is a process that takes time. While the timeline varies for each individual, it’s important to remember that progress is not always linear. The two-year mark of being free from behaviors and thoughts may be a good indicator of full recovery, but it’s important to continue seeking support even after that point.
  • Prepare for relapses: Relapses are common, and it’s essential to maintain motivation and seek support from those around you when they occur. Remember that setbacks are a normal part of the recovery process.

It’s important to remember that recovery is not about erasing the eating disorder, but rather building a new life around it. This includes developing social skills, hobbies, interests, and a healthy relationship with food.

If you’re ready to start your journey towards a happier relationship with food, reach out for support. The first step is often the hardest, but it can lead to a brighter future.

I have a simply but effective guide available. It’s called 7 steps to disordered eating recovery, and it will help bring you clarity on the steps involved in healing.

Best wishes,

Shannon x

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