Eating Disorder or Disordered Eating? By Shannan Blum, LMFT, CEDS
As a Certified Eating Disorder Specialist (CEDS), the most common questions I get about eating disorders (EDO) involve the difference between a full-blown diagnosable eating disorder versus the more mild ‘disordered eating’ patterns.
Sometimes people might state, “My child is just a picky eater,” or “My spouse has just never liked certain kinds of foods,” or even “Nobody eats breakfast anymore, it’s not a big deal.” They may not realize their child or partner has actually developed more robust food refusal, obsessive thoughts, or even compulsive behaviors around eating and appearance.
In this blog, I’ll walk you through some of the normative ranges for disordered eating patterns and the hallmarks of a criteria-based eating disorder. Keep in mind, eating disorders are very complex experiences and one blog about them will not provide a personal diagnosis. If you are unsure about the possibility of meeting criteria for an eating disorder, please reach out here and let us know you want to schedule an appointment for a full assessment.
Eating Disorder or Disordered Eating?
The primary difference you want to keep in mind when being curious about an EDO v. disordered eating focuses on three elements:
When considering the behaviors, here are some points to ponder:
- Does the person engage in multiple behaviors simultaneously (restriction, laxatives, excessive exercise, excessive weighing, etc.)
- Do some of the behaviors involve food (restriction, refusal, binge eating)?
- Does the person exhibit elevated body image beliefs or mood disturbance about food, weight, size, appearance?
- What is the frequency, severity, and duration of these behaviors?
- Did you recently discover the person has kept their behaviors a secret (keep in mind it may be very challenging to make a determination of EDO v. disordered patterns if behaviors are hidden!)
Engaging in one behavior, intermittently, might not warrant much concern but if many behaviors/rituals are happening with regularity – that indicates the situation has moved beyond disordered eating. If someone’s thoughts about themselves as a person are deeply impacted by their body’s size, weight or appearance, this is also more likely beyond a ‘disordered eating’ profile. Any secret eating, purging, laxative use, or exercising are also red flags for EDO instead of disordered eating.
When looking at obsessions, consider the following:
- Are thoughts about food, size, weight or appearance generally all-consuming or a majority of the time during the day?
- Does the individual also evaluate themselves based on weight, size, or appearance a majority of their time
- Are the person’s behaviors compulsive? exercise as a result of obsessions
- Do these behaviors and compulsions impair focus, the ability to stay present, and sleep?
If repetitive or intrusive thoughts are present a majority of the time, say 50-60% or more, it’s more likely to rise to the eating disorder level. If a person is thinking about what to eat, how they might ‘get out of eating’ at an event, their shape/size/weight, or their overall appearance related to these – that presents a high level of concern for eating disorders. If someone engages in these thoughts and also evaluates their worth or value (or perceived worth in the eyes of others) against these thoughts, that is a criteria for an EDO. If the person engages in compulsive behaviors – intense, impulsive or excessive behaviors with the belief they “feel better” after engaging in them – this is also a red flag. For instance, if a person states they feel better after exercising 1.5 hours, not eating yet that day, and yet also receives body signals they are lightheaded or weak – this is a concern.
of their time, typically 50-60% of their time or more
Lastly, when looking at functionality, it’s important to consider:
- Does the individual withdraw from family activities or refuse to go out with friends due to concerns about weight, food, size or appearance?
- Do they actively avoid or lie to get out of social activities with friends involving food?
- Are they missing work or school due to engagement in behaviors or beliefs about what they believe others will think?
- Do they struggle engaging in adequate self-care (personal hygiene, appropriate rest, enjoyable activities, etc?)
This last category essentially looks at the impact of the first two on the person’s functional activities. If behaviors and thoughts are so overwhelming they influence one’s functioning at home, socially, or work/school – it’s more than just disordered eating.
Taking Eating Disorders Seriously
Eating disorders have an extremely high death (mortality) rate compared with other mental disorders. People with anorexia are at risk of dying from medical complications associated with starvation. Suicide is the second leading cause of death for people diagnosed with anorexia nervosa. It is a mistake to consider these behaviors and beliefs a “lifestyle choice” although that is commonly done.
Eating disorder diagnoses are very complicated because they have social/psychological, physical, cognitive, and emotional impacts and influences. Often these disordered thoughts and behaviors have been going on for years before they are detected. Their actual severity and frequency is typically more than is first observed. It takes an entire team of specialized providers to successfully treat clients with eating disorders including: an individual therapist, a family therapist, a registered dietitian, a psychiatrist or medication provider and includes modalities such as CBT/DBT skills, family systems focus, nutritional therapy and support, yoga/body-based interventions, and sometimes medical interventions.
Criteria for Eating Disorders
From a “checklist” standpoint, here is what the criteria are for Anorexia Nervosa, in common language:
- Not eating enough to achieve or maintain appropriate weight
- Significant low body weight in the context of the age, sex, developmental history, and general physical health
- Intense fear of gaining weight
- Emotional distress regarding one’s body weight or shape
- Evaluating personal worth based on body weight, size, or shape
- If underweight, persistent lack of awareness of the seriousness of low body weight
- Restricting type: very limited binge/purge behaviors, mostly restricting of food or excessive exercise, etc.
- Binge/purge type: regular binge-eating or purging (1 time a week within the past 3 months)
Criteria for Bulimia Nervosa are:
- Recurrent episodes including both:
- Binge-eating (eating more food than is what most would consider typical within any 2-hour period).
- Feeling out of control or unable to stop what or how much one is eating.
- Recurrent behaviors to “compensate” for eating or prevent weight gain:
- self-induced vomiting, misuse of laxatives, diuretics, or other medications; fasting or excessive exercise.
- The binge eating and compensatory behaviors listed above occur, on average, at least 1x/week for 3 months.
- Self-evaluation is unjustifiably influenced by body shape and weight
You’ll notice some overlap and similarities between the two. Another common misconception is that someone only purges if they experience Bulimia. The fact is that both diagnoses can involve binge/purge behaviors and the primary distinction between the two really addresses the lower body-weight aspect of Anorexia.
If you believe you may need support around eating behaviors or determining if you have an eating disorder, please consider us at Connections Child & Family Center. We offer eating disorder assessments and services for outpatient treatment. We provide you with an unbiased assessment of eating/food/exercise behaviors, food rituals, beliefs, impact on self-evaluation and areas of work, family/social, or school. This assessment includes consideration for the presence of other mental health issues such as depression and anxiety, suicidal thoughts or urges for self-harm. The assessment includes 2-3 feedback sessions to present the findings of the assessment, make treatment recommendations based on those findings, and support the family as this information is provided.
Other resources include the National Eating Disorders Association’s (NEDA) website you can reach here: along with their helpline: (800) 931-2237.
Some local resources to the state of Texas/Houston area include:
Eating disorders are very serious psychiatric illnesses that also have a physical/medical component. They are not a lifestyle choice. Eating disorders can be fatal due to severe disturbances in someone’s eating behaviors and related thoughts and emotions.
If you require more support in understanding your behaviors and beliefs or those of a loved one, or for recovery support, please don’t hesitate to reach out for help. Call us at 281-210-6677 and ask for an assessment.