Often when people hear the term “disordered eating,” they assume it’s another way of saying someone has an eating disorder. However, we are dealing with two very distinct disorders: “disordered eating” and “eating disorder.”
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. Our culture is obsessed with size and weight, diet and exercise, to the point where disordered eating is very pervasive.
The research suggests that up to 50% of the population demonstrate a problematic or disordered relationship with food, body, and exercise. Whilst rates of clinical eating disorders are much lower, estimated from 1% to 3% of the general population.
They sound and look very similar, so what is the difference between “disordered eating” and “eating disorder?
Disordered Eating is generally having an unhealthy relationship with food and eating for reasons other than being physically hungry, such as when you’re bored, tired or stressed. Disordered Eating does not fall under the Eating Disorder set criteria.
Symptoms of disordered eating may include behaviours commonly associated with eating disorders, such as food restriction and body dissatisfaction. The difference lies in the frequency and severity of behaviours and the distress they cause to the individual.
Disordered Eating looks like:
- Yo-yo dieting
- Eat to cope with emotions
- Periodic binge eating
- Eating when bored, tired, angry, stressed
- Focus on weight and calorie intake
- Thinking that reaching a goal weight will make you happy
- Consuming large amounts of food in secret
- Self-worth or self-esteem based on body shape and weight
- Orthorexic behaviours – ‘clean eating’
- Rigid adherence to dietary paradigms
- Anxiety about certain foods or food groups
- Negative food talk and food shaming
Engaging in dieting or disordered eating is a risk factor for the development of an eating disorder.
An eating disorder is a psychological disorder officially classified in the one document regarded as the world authority on mental disorders, the DSM.
The number of people in Australia with an eating disorder at any given time is estimated to be 913,986, or approximately 9% of the population (Butterfly Foundation, 2012). Due to the significant feelings of guilt and shame one experiences with an eating disorder, these are likely to be conservative figures. It is estimated that 20% of women have an undiagnosed eating disorder (NEDC, 2012b).
Of these people, 47% have Binge Eating Disorder, 12% Bulimia Nervosa, 3% Anorexia Nervosa and 38% other eating disorders (Butterfly Foundation, 2012)
There are four diagnoses of eating disorders in the DSM: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and eating disorder not otherwise specified. Each of these disorders has specific criteria.
- Restriction of energy intake relative to requirements leading to a much low body weight in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
- Recurrent episodes of binge eating characterized by BOTH of the following:
- Eating in a discrete amount of time (within a 2-hour period) large amounts of food.
- Sense of lack of control over eating during an episode.
- Recurrent inappropriate compensatory behaviour to prevent weight gain (via self-induced vomiting or excessive exercise, and use of diet pills and/ or laxatives).
- The binge eating and compensatory behaviours both occur, on average, at least once a week for three months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Binge Eating Disorder:
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete time (such as, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar time under similar circumstances
- A sense of lack of control over eating during the episode (such as, a feeling that one cannot stop eating or control what or how much one is eating)
- The binge-eating episodes are associated with three (or more) of the following:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty afterwards
- Marked distress about binge eating is present.
- The binge eating occurs, on average, at least once a week for three months.
- The binge eating is not associated with the recurrent use of inappropriate compensatory behaviours and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.
The motivations behind a person developing an eating disorder is highly complex.
Eating disorders are highly complex and are NOT a “lifestyle choice”. They have a variety of co-morbid psychological issues contributing, such as depression, anxiety and Obsessive Compulsive Disorder (OCD).
The aetiology of eating disorders is thought to be: significant trauma, childhood trauma, dysfunctional family behaviour, feelings of helplessness and lack of control, social anxiety, sexual and emotional abuse and many other problems. It is also often thought that genetics play a role in the development of eating disorders, making some people more susceptible to developing them than others.
These motivations result in behaviours that are mentally and physically harmful.
Significant nutrient depletion and caloric deprivation are problems for Anorexia, which has the highest mortality rates of any mental health issue. For Bulimia, metabolic imbalance may result, and several gastrointestinal disorders, stomach acid issues, and tooth decay. Binge Eating Disorder may also have significant physiological effects as binge cycles can seriously harm the gut and the body’s metabolism.
In a sense, you could say that the serious psychological issues and dangerous physical problems are what distinguish disordered eating from eating disorders.
Problems with eating exist on a spectrum. On one end of the spectrum you have people with severe eating disorders. On the other end of the spectrum you have people who are mentally happy and peaceful eaters. Then you have 50% of the population that uses food to cope with their emotions – the disordered eaters. All of us exist somewhere on this spectrum.
Why does this matter?
Even if someone does not technically have “disordered eating or an eating disorder,” they may be on the spectrum. This may be because they do not meet the strict DSM criteria of bingeing often enough, or in my case, my BMI was considered normal (I was on the lower end of normal) and “not sick enough”; even though I had been bingeing and purging multiple times a day and engaging in excessive exercise behaviours for almost 12 years at that time.
The strict BMI “rules” meant I did not qualify for hospitalisation. The only way I was going to get “proper help” was for my parents to re-mortgage their house (I wasn’t going to let that happen) and pay an astronomical amount for private hospitalisation. Both myself and others with an eating disorder were/are under a significant amount of emotional pain, and physical and mental harm.
Fortunately, even though I wasn’t “sick enough” I had the support of a private psychologist and psychiatrist. Most psychologists I believe understand the potential severity of mental pain regardless of whether someone meets a specific criteria, and will be able to help those who need it.
When to Seek Help?
Seeking treatment will usually be very challenging for people experiencing disordered eating or an eating disorder. Those who view their behaviours as essential to maintaining their preferred weight or shape, or fundamental to their sense of identity, may actively resist treatment.
The length of treatment required will vary considerably from individual to individual, and will depend on the number and seriousness of symptoms, and the complexity of the issues that initiated these behaviours in the first place. Eating Disorders take longer to treat than disordered eating.
You do not need to wait for a formal diagnosis. If your relationship with eating or your body is causing you pain and suffering, then it is worth getting treated. “Nipping it in the bud” with early intervention is the most effective strategy.
In the early days one of the best things you can do is get educated on eating and body issues – the National Eating Disorders Collaboration and the Butterfly Foundation websites contain more information on eating disorders, the warning signs that you can look for, and ways that you can support someone you know is experiencing eating and body issues. It can also be beneficial to speak with your doctor or psychologist about your concerns and get support for yourself.
Don’t hesitate to get in touch if this is something that you need help with. Contact me here and we’ll organise a call.