Disordered Eating & Eating Disorder Specialty
What is the difference between the terms Disordered Eating and Eating Disorders?
Disordered Eating is very common. It occurs in a significant percentage of the population, affects both females and males and can begin at a young age and continue into adult life. This term, refers to a range of unhealthy eating behaviors and concerns about body image and weight. These concerns and behaviors can negatively impact many areas of a person’s life such as work, school, health and their social life. These behaviors could include chronic dieting, restrictive eating, binge eating, vomiting, laxative use or over exercising.
The term Eating Disorders refers to extreme disordered eating that occurs for a certain duration, frequency and meets specific criteria for a diagnosis of one of the following:
Anorexia Nervosa (AN):
- Excessive dieting and restriction of food intake that leads to severe weight loss
- Intense fear of weight gain but the person may not always recognize it
- Obsessed with losing weight or being thin
- Does not recognize their weight loss
- Insists on being fat or seeing fat on parts of their bodies
- May engage in excessive exercise or other purging methods (laxatives, enemas, vomiting)
- Other possible behaviors or signs may include chewing and spitting food
- May eat in ritualistic ways, pick at food, cut it into small pieces or hide or throw food out
- May focus on watching food shows, collecting recipes, cooking for others but refusing to eat what they cooked
Bulimia Nervosa (BN):
- Dieting and trying to control eating
- Binge eating (consuming large amounts of food in a short period & feeling out of control)
- Feeling guilty, embarrassed or disgusted after binge eating
- Worried about weight gain and uses over-exercising or purging (vomiting, laxatives or taking diuretics) to compensate
- Binge eating and purging both occur at least once a week
- Bulimia can be harder to recognize than AN because the person does NOT always lose weight
Binge Eating Disorder (BED):
- Eating significantly more food in a short period of time than most people would under the same circumstances
- Feeling a lack of control
- Binge eating occurs on average at least once a week.
- May eat quickly even when he or she is not hungry
- Often eats alone or in secrete due embarrassment
- May have feelings of guilt, embarrassment or disgust
- No purging behaviors or excessive exercise
- Individuals with BED often have higher weights, some struggle with obesity
Other Specified Eating Disorder
This category refers to when a person has many but not ALL of the specific criteria for AN, BN or BED. This category was previously known as Eating Disorders Not Otherwise Specified or EDNOS.
Some examples are:
- Atypical AN: having all symptoms of AN but the person is NOT considered under weight
- Bulimia Nervosa: a lower frequency and duration of bingeing and purging behaviors than BN criteria
- BED: a lower frequency and duration of binge eating than BED criteria
- Purging Disorder: purging by vomiting or misusing laxatives, diuretics or other medications to lose weight. The person is not under weight and does not regularly binge eat.
- Night- Eating Syndrome (NES): eating large amounts before going to bed or in the middle of the night continually eating many snacks. The person is fully awake during these episodes.
Unspecified Feeding or Eating Disorder
You have an eating disorder that negatively impacts your life but your symptoms don’t fit any of the categories
Who Can Have These Struggles?
Disordered eating and eating disorders can affect people of any age, race, gender, sexual orientation or socioeconomic class. They can also occur in persons of varying shapes and weights. Often eating disorders are identified in adolescence or young adulthood although it is not uncommon for a diagnosis to not occur until later in adulthood. Most eating disorders are more common in girls and women than in boys and men. However, with Binge Eating Disorder, there is a more even ratio between females and males. Overall though, males with eating disorders are still basically under reported.
What Causes Eating Disorders?
We do not know for sure what causes eating disorders. We do however know that they are complex illnesses that involve the interaction of a number of variables. These variables include genetic and biological factors, personality, mental health and social environment. More and more research is showing that there is a strong genetic factor to the risk of developing an eating disorder. As well, dieting can be a precursor to disordered eating and when other factors are present it can lead to a full eating disorder.
Just as there are many factors that cause an eating disorder there are many factors that may contribute to it or maintain it. For some individuals the eating disorder offers a way to avoid or numb out other problems or difficult emotions (e.g..., anxiety, anger, depression). For others the eating disorder may be connected to struggles with identity, transitions, confidence, expressing thoughts and feelings or feeling a lack of control over their lives.
Risk Factors
Certain factors and events might increase the risk of developing an eating disorder. Some of these factors may include:
- Having a parent or sibling who has or had an eating disorder
- Having depression, anxiety or an obsessive-compulsive disorder
- Needing to be perfect
- Low self esteem
- Poor body image
- Social pressure to be thin
- Being bullied or having few or no friends
- Struggling with changes and life transitions (e.g..., puberty, moving, relationship break up, starting post-secondary education or a new job)
- Having difficulties identifying & expressing emotions; difficulties managing stress
- Problems in the family; but families do NOT cause eating disorders
- Trauma, abuse or a history of neglect
- Involvement with activities that focus on weight and size (e.g..., ballet, modeling, gymnastics, running, figure skating and wrestling)
- Type 1 diabetes (for BED)
Warning Signs
There are numerous behavioral, psychological and medical signs that someone may have an eating disorder or disordered eating. Some common signs to watch for are:
- Changes in eating habits; aversion to previously enjoyed foods; counting calories or fat grams; dieting; excuses to not eat; avoiding meal times; obsessive thinking about food; preoccupation with cooking; trying to control food choices for the household; binge eating or emotional eating; eating in secrecy
- Fluctuations with weight; gains or losses
- Poor body image; making negative comments about self; obsessional thinking about weight; repeatedly weighing or checking self in mirror
- Over exercising; vomiting, using diet pills, laxatives or misusing diuretics
- Mood changes and increased anxiety; withdrawing socially; self-harming behaviors
- Feeling tired, dizzy, muscle cramping, headaches, retaining water; sleep issues, irregular or loss of menstruation, sore throat, swollen glands, blood in vomit, loss of hair, brittle nails & stress fractures
Co-Existing Mental Health Issues
It is not uncommon for someone with an eating disorder to also have other co-existing mental health concerns. As well, eating disorders often have many signs and symptoms that overlap with other mental health conditions. Below are a few examples. Please see section under Mental Health Concerns for further information on these topics.
- Anxiety
- Obsessions and Compulsions
- Depression
- Self-Harm- this refers to hurting yourself on purpose. For some people this is a way to deal with difficult thoughts and feelings.
- Substance Misuse or Abuse
- Trauma
- Personality Traits
Eating Disorders Are Dangerous
They can impact every organ and system in the body. People with an eating disorder are at risk for heart or kidney failure that can lead to death if not treated. Eating disorders have the highest mortality rate of all mental health issues.
Readiness for Change
Making any kind of change in life can be difficult. Whether it is quitting smoking, getting more active or recovering from an eating disorder. We typically don’t make changes over night. Instead there is a process or a few different stages that we go through. Understanding these stages will help you understand why it’s been so difficult for you or your loved one to seek help.
The 5 Stages of Change
- Pre-contemplation:
- You do not see a problem and you are not interested in getting help
- You deny there is anything wrong even others say they are concerned
Note: There are times when someone may need to be in treatment even if they don’t want to change, (e.g..., severe medical complications or imminent safety concerns).
- Contemplation:
- You realize something is not ok or you are ready to admit it
- You are starting to think about making changes
- You may be gathering information but not ready to initiate help
- Preparation:
- You decide to make a change and take small steps to prepare to change
- You may seek support from someone or ask a professional about treatment
- Action:
- You’re ready to get treatment and work on harmful thoughts or behaviors
- You’re ready to learn and try new strategies to cope
- It’s common for slips and relapse to happen at this stage
- Maintenance:
- You are sticking to your treatment plan
- You’ve made changes a part of your day to day life
- You avoid situations that might cause slips
- You have a plan to cope with the temptation of old eating disorder behaviors
- You reward yourself and celebrate success
Is Recovery Possible?
There is evidence that many types of therapy can reduce eating disorder symptoms and for many people full recovery is possible. Recovery, however will take courage, strength, hard work and support. It will be a journey that is an on-going process where most individuals have slips and minor setbacks along the way. For some, they will have relapses. Preventing and bouncing back from relapses is very possible.
The best path to recovery is early intervention and consistent efforts at restoring normal weights, nutritional needs and addressing the emotional and psychological issues. Full recovery means not just stopping the behaviors but also stopping the obsessing about food and weight and learning self-acceptance. It also means learning healthy ways to cope with difficult feelings and situations and discovering how to listen to your body and feelings.
