Disclaimer: I am not a medical professional. Think of me more like an advocate or your number-one fan. All information on this website is the result of independent research and personal experience. Please, please, please seek professional help if necessary. There are plenty of resources linked at the bottom and on our links page!
THE PROBLEM WITH THE DSM
WHAT LEADS TO AN EATING DISORDER?
NORMAL DIETING VS. DISORDERED DIETING
BINGE EATING DISORDER
OSFED / EDNOS
It is the intent of No Diets, No Masters to provide resources and information pertaining to disordered eating and eating disorders in part to help break stigmas of eating disorders – no certain weight or appearance defines ED. You can be “sick” without looking sick. EDs are unique mental illnesses. As EDs have serious physical and psychological implications, they cannot be classified purely as “mental illness,” though much of the disorder is a mental challenge.
The DSM (most currently in the 5th edition, the DSM-V) is what professionals use to classify eating disorders, though not all disorders are yet officially recognized in the manual. DSM is short for Diagnostic and Statistical Manual for Mental Disorders, and it is THE manual for all classifications of mental disorders, put together by the American Psychiatric Association.
The problem in the past with the DSM has been that if one does not meet the very specific requirements of a particular disorder, the patient and/or the doctor might think they are not “sick enough” to warrant being labeled with an eating disorder, thus missing out on proper treatment and recovery opportunities. For example, the DSM says that to be diagnosed with Anorexia Nervosa, one must have a low body weight. If someone is 5’4″ and rapidly drops from 250 pounds to 200 pounds due to starving themselves, there is clearly a problem but they would never be “Anorexic” in the eyes of the DSM because the body weight is not below “normal.” I believe it is unfair to classify Anorexia in this way, as eating disorders are a mental illness with physical repercussions – not a purely physical disorder. So, while the DSM is a good starting point, I think sometimes it hurts more than it helps. The DSM may discourage those who are suffering from reaching out because they feel they are not “sick enough” and do not meet all the criteria of a certain disorder.
Every person is an individual and has their own experience, and what is “sick” for one may not be for the other. I think that doctors should really only take a few things into account while diagnosing an eating disorder. Any time food makes you feel guilty or any time food and weight is an obsession – I think these are the building blocks of ED and they need to be taken in to account first and foremost. [Back to Top.]
There are many “Warning Signs” to look for if you believe someone is suffering from an eating disorder. Again, every person is different. Some are very good at hiding a disorder. Others may experience a few of these signs but are not disordered.
Guilt and preoccupation with foods is biggest warning sign there is. If food, calories, weight, and clothing size are an obsession – to the point where there is little room to think or speak about anything else – there may be a problem.
Dramatic weight loss or weight gain, as well as other changes in appearance: bloating, puffy face, under-eye circles, brittle hair and nails – anything that indicates one is not receiving enough nutrients.
Constantly complains or worries about becoming “fat,” and the word fat seems to be synonymous with “disgusting.”
Obsesses over exercise or food planning, has food “rituals”, exercises immediately before or after eating, or goes to the bathroom after every meal – these can, in some cases, be big red flags – but also, can just be a way of life for some (body builders, for example).
Is withdrawn from friends, family, or is no longer enthusiastic about hobbies, has sudden “attitude problem” – these are especially important to look for in pre-teens and teenagers.
Any sudden changes in behavior in general (even a “happy” change – some may overcompensate for their down feelings but projecting fake-happiness) is something to look out for. [Back to Top.]
What leads to an eating disorder is highly subjective and unique for each individual. Eating disorders may stem from any one or combination of the following:
– Biological factors.
It is possible that eating disorders are genetic and run in families (nature and nurture are both shown to play a hand). It is also possible that they may be caused by a chemical imbalance. Plus, studies have been done showing the body’s desire to eat when stressed.
– Cultural factors.
This is where the media plays a hand. Society’s unrealistic expectations for both men and women take a toll on one’s self-esteem, causing one to take extreme measures in order to be “perfect.” Can also be caused by stress related to racial, ethnic, size/weight, or other forms of discrimination or prejudice.
– Psychological factors.
This includes low self-esteem; feelings of not being “enough”; the desire to be “in-control”; feelings such as anger, hostility, inadequacy, loneliness, and stress. Some may develop an eating disorder to avoid their sexuality. Sometimes one lacks a “sense of identity” or a sense of self.
– Social factors.
Surrounding oneself around people who are obsessive about their looks or their weight can contribute to the developing of an eating disorder. Eating disorders can often be triggered by bad relationships.
– Other factors.
Those who have experience with being teased or bullied, especially for their weight, are at high risk to develop an eating disorder. Others at risk include those with histories of abuse (emotional, physical, or sexual) and those who have a hard time being open about their emotions and feelings. [Back to Top.]
The biggest difference between “normal dieting” and disordered eating is the emotion behind the act. Disordered eating involves an abnormal relationship with food. Foods get labeled either “bad” or “good” with no in-between, and feelings of shame and/or guilt arise after consuming a “bad” food (and sometimes after consuming a “good” food too). Those with disordered food behaviors often feel extremely anxious around food. These people may excessively track calories and macros, exercise obsessively at the gym, or avoid social situations that centers around food. Individuals with eating disorders exhibit disordered eating, but not all disordered eaters can be diagnosed with a full-blown eating disorder. The difference lies in the frequency and severity of behaviors and the distress they cause to the individual.
Dieting is a slippery slope to disordered eating. The National Eating Disorders Association reports that approximately 35 percent of “normal dieters” develop a pattern of pathological dieting. It should be noted that if you do not have to eat a certain way due to a medical condition, but are forcing yourself to adhere to a strict diet anyway, you may develop disordered food behaviors. Examples include a gluten-free diet, veganism, or the Paleo diet. This is not to say that anyone who follows these rigid food rules has an eating disorder, though they are at higher risk of developing one. The social acceptability of these diets also makes eating disorders more difficult to detect in those who do struggle with them. [Back to Top.]
DISORDERED EATING – can indicate an eating disorder but does not necessarily mean an eating disorder. It is still highly dangerous. The most significant difference between an eating disorder and disordered eating is whether or not a person’s symptoms and experiences align with the criteria defined by the APA — that’s IT!
Examples of disordered eating include:
– Fasting or chronic restrained eating
– Skipping meals
– Binge eating
– Self induced vomiting
– Unbalanced eating (e.g. restricting a major food group such as “fatty” foods or carbohydrates)
– Laxative, diuretic, enema misuse
– Steroid and creatine use – supplements designed to enhance athletic performance and alter physical appearance
– Using diet pills
Note that many of these “symptoms” are common in the body building/fitness community. The online fitness community can be very, very triggering for those who are trying to recover. Again, disordered eating is not only symptoms but also EMOTIONS behind the act. Fasting is a common practice for body builders before a show. If they do this without anxiety and without guilt, and are able to eat normally afterwards, I would not necessarily consider them to have disordered food behaviors. It’s just that their sport requires them to sometimes engage in what are seen as unhealthy behaviors. I’m not saying it’s “right,” I’m just saying not to judge unless you know the motive! [Back to Top.]
ANOREXIA NERVOSA – “refusal to eat.” Criteria according to DSM IV: First a person must refuse to maintain body weight over a minimal normal weight for age and height or have a failure to make expected weight gain during a defined period of growth, resulting in a body weight 15% lower than expected. Second, the person must experience intense fear of gaining weight or becoming fat, even though underweight. Third, the person must have a disturbance in the way his or her body weight, size, or shape is experienced and also experience undue influence of body weight, or shape on self-evaluation, or denial of the seriousness of the current body weight. Finally, amenorrhea must be present. Amenorrhea is the absence of at least three consecutive menstrual cycles when otherwise expected to occur. [Back to Top.]
BULIMIA NERVOSA – “cyclical binging and purging episodes.” “Binging” is defined as the consumption of more food than most other people would eat in a similar circumstance over a discrete period of time accompanied by a sense of lack of control over the food consumption. Bulimia Nervosa exists when binging and compensatory behaviors occur on average 2 times weekly or more for a period of at least 3 months, when the behaviors are not exclusively those of Anorexia Nervosa, and when self-evaluation is unduly influenced by body shape or weight. Those with Bulimia are often very concerned about gaining weight and intensely fear getting fat. People with Bulimia may engage in a variety of either purging or non-purging behaviors such as vomiting, using laxatives, using diuretics, using enemas, fasting, or exercising excessively. Bulimic bingeing and purging cycles are often conducted in secret because of the shame and disgust associated with the process. [Back to Top.]
BINGE EATING DISORDER (BED) – characterized by recurrent episodes of binge eating that occur twice weekly or more for a period of at least six months. During binging, a larger than normal amount of food is consumed in a short time frame and the person engaging in the bingeing behavior feels a lack of control over the eating. In BED, binging episodes are associated with at least three characteristics such as eating until uncomfortable, eating when not physically hungry, eating rapidly, eating alone for fear of being embarrassed by how much food is being consumed, or feeling disgusted, depressed or guilty after the episode of overeating. These negative feelings may in turn trigger more binging behavior. In addition, although BED behaviors may cause distress by those affected, it is not associated with inappropriate compensatory behaviors such as those found in Bulimia Nervosa or Anorexia Nervosa. Therefore, people with BED often present as either overweight or obese because they consume so many extra calories. [Back to Top.]
ANOREXIA ATHLETICA – “compulsive exercising”. Contains a cluster of disordered behaviors on the eating disorders spectrum that is distinct from Anorexia Nervosa or Bulimia Nervosa. Although not recognized formally by the standard mental health diagnostic manuals, the term Anorexia Athletica is commonly used in mental health literature to denote a disorder characterized by excessive, obsessive exercise. Also known as Compulsive Exercising , Sports Anorexia, and Hypergymnasia, Anorexia Athletica is most commonly found in pre-professional and elite athletes, though it can exist in the general population as well. People suffering from Anorexia Athletica may engage in both excessive workouts and exercising as well as calorie restriction. This puts them at risk for malnutrition and in younger athletes could result in endocrine and metabolic derangements such as decreased bone density or delayed menarche. Symptoms of Anorexia Athletica may include over-exercising, obsession with calories, fat, and weight, especially as compared to elite athletes, self-worth being determined by physical performance, and a lack of pleasure from exercising. Advanced cases of Anorexia Athletica may result in physical, psychological, and social consequences as sufferers deny that their excessive exercising patterns are a problem. [Back to Top.]
ORTHOREXIA NERVOSA – a fixation on eating “pure” or “right” or “proper” food rather than on the quantity of food consumed. Orthorexia nervosa is not currently recognized as a clinical diagnosis in the DSM-5, but many people struggle with symptoms associated with this term. Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.” Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity. They become consumed with what and how much to eat, and how to deal with “slip-ups.” An iron-clad will is needed to maintain this rigid eating style. Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise). Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake. Eventually food choices become so restrictive, in both variety and calories, that health suffers – an ironic twist for a person so completely dedicated to healthy eating. Eventually, the obsession with healthy eating can crowd out other activities and interests, impair relationships, and become physically dangerous. [Back to Top.]
OVER-EXERCISE – a general term referring to exercising to the point of exhaustion. Over exercise can occur once in a while as when someone overdoes it on a single work-out, or it can be an habitual behavior. When over exercising becomes the norm, this may be an indication that a person is actually suffering from what is called Obligatory Exercising, Compulsive Exercising, or Anorexia Athletica. When someone over exercises to the point where it is a problem, he or she may experience physical, psychological and social consequences. [Back to Top.]
OVEREATING – not a specific diagnosis of any sort but may rather refer to a discrete incident of eating too much such as during holidays, celebrations, or while on vacation, or it may refer to habitual excessive eating. [Back to Top.]
NIGHT EATING – considered a constellation of symptoms of disordered eating characterized most prominently by a delayed circadian timing of food intake. Although not classified as one of the types of eating disorders, it is an emerging condition that is gaining increased recognition among medical professionals. Its clinical importance is in relation to obesity as many people who suffer from NES are overweight or obese and being overweight or obese comes with many negative health risks. People with NES tend to not eat in the morning and consume very little during the first half of the day. The majority of their calories are then consumed in the evening hours, so much so that sleep may be disturbed so that a person can eat. People with NES may be unable to get back to sleep after eating or may experience frequent awakenings throughout the night for feedings. However, people with NES are fully awake and aware of their eating episodes. It is distinct from bingeing disorders in that the portions consumed are generally those of snacks rather than huge meals. In addition, it differs from Bulimia Nervosa since there are no compensatory or purging behaviors present to offset increased calorie intake. [Back to Top.]
OSFED / EDNOS – “Other Specified Feeding or Eating Disorder”/ “Eating Disorder Not Otherwise Specified” for when you don’t fit the medical criteria for a specific disorder but have symptoms of one or more disorders. [Back to Top.]
MORE TO BE ADDED.