When does disordered eating become an eating disorder?

‘Eating Disorder’ vs ‘Disordered eating’ – though these terms are often used interchangeably, where to draw the line can be a decision that is difficult to make. So when does ‘disordered eating’ become an ‘eating disorder’? And how do you distinguish disordered eating from normative dieting behaviours that seem to be so prevalent in today's society?

Disordered Eating vs. Eating Disorders

To put it simply, eating behaviors exist on a spectrum whereby a healthy relationship with food is located at one side and eating disorders are at the opposite side of the spectrum, leaving disordered eating somewhere in between the two.

Unfortunately, in our culture, there exists an increasingly prevalent obsession with size and weight, diet and exercise, meaning that many people may see their disordered relationship with food as ‘normal’. There remains a huge number of people with disordered eating who never seek help for their difficulties and the tendency to see these behaviours as ‘common’, ‘normal’ or even ‘healthy’ may contribute to this. 

Eating disorders are on the rise, and it is now thought that at least 50% of the population demonstrate a problematic or disordered relationship with food, exercise or their body image.  In part this can be seen as the result of the extreme appearance-focus held in our society, and the normalisation of dieting behaviours.  Other Specified Feeding or Eating Disorders (OSFED) has been reported as the most prevalent ED with around 6% of the population meeting criteria for this subgroup of Eating Disorders. People suffering from OSFED present with symptoms of other better known eating disorders such as anorexia, bulimia or binge-eating, but do not meet all of the criteria for these diagnoses.  Consequently, it is likely that a large number of people with ‘disordered eating’ would meet the criteria for OSFED. Falling into this category does not mean that a person has a less significant problem with food, or that their difficulties exist without physical or emotional risk. It is a diagnosable and potentially severe eating disorder that warrants the same levels of support as all other eating disorders.

So what are the symptoms of disordered eating?

Symptoms of disordered eating may include the kind of behaviours that are commonly associated with the other three categories of eating disorder: 

• rigid dieting or frequent limitation of the amount or type of food eaten

• binge eating (frequent or occasional loss of control of eating that causes guilt shame or distress)

• purging (extreme attempts to get rid of calories e.g. via self induced vomiting, excessive exercise, or use of diet pills and/ or laxatives).  

However, disordered eating might also include:

• body weight and shape being central to self esteem or self worth

• negative body image or disturbance in perception of body image (thinking that you look bigger than you really are)

• rigid exercise routine combined with extreme guilt or anxiety if this routine is not followed

• obsessive calorie counting or ‘rules’ around calories e.g. ‘I can eat this only if I've exercised first’

• anxiety about or avoidance of certain foods or food groups

• a rigid approach to eating, such as only eating certain foods, inflexible meal times, refusal to eat in restaurants or outside of one’s own home

• rigid ‘rules’ around eating such as ‘I will eat that only if I know I can go to the gym later’

• recurrent episodes of night eating

• distress or anxiety associated with food

• distress or anxiety related to the change of any aspect of your current eating pattern
  

But is it an eating disorder?

What distinguishes disordered eating from a diagnosable eating disorder is mainly about the degree and amount of distress that changes to eating, weight or behaviour evokes.  If someone engages in ‘disordered eating behaviours’ on a majority of days; or experiences distress and anxiety when they are unable to use these behaviours or when they have chosen not to, it is likely that they may be diagnosed with an eating disorder.  In our experience it seems that many people with ‘disordered eating’ would not view themselves as having an eating disorder, and would rarely even consider themselves to have disordered eating.  It is more likely that they will see themselves as ‘getting it right’ or ‘being healthy’.  However when food choices are made due to anything other than hunger and appetite, when food preferences are held with more importance than other things like attending social events, and when eating has the ability to evoke strong negative emotions – we would very much argue that this is an eating disorder and should therefore be taken seriously.

So if it's NOT an eating disorder, are there any risks to disordered eating

Many people see these behaviours as common, normal or healthy.  However, whilst the behaviours might be increasingly prevalent in today's culture, they are certainly not healthy.  Disordered eating puts people at high risk of developing other physical and mental health conditions including more severe eating disorders.  Other consequences may include:

• Concentration and ability to focus – people describe spending a huge amount of time thinking about or planning food and exercise – time that could (or should) often be spent focusing on other things. 

• Social life – socialising is often limited due to anxiety about eating out in restaurants or prioritisation of exercise. 

• Coping skills – diet and exercise often starts to become a way of ‘coping’ with difficult life events.  Whilst this may feel like an effective strategy in the short term, it actually prevents people from using healthy ways of coping with emotions meaning that stress can build up over time. 

• Difficult emotions – thoughts about food and weight often start to become anxiety provoking, putting people at risk of depression or chronic anxiety 

How do I know if I need help to address my disordered eating?

If your eating is causing you distress, or starting to have a negative impact on any areas of your life it is probably time to seek help.  Many people avoid seeking help as they fear that their problem isn’t serious enough, or they feel anxious about what help will involve.  If you want to, then it is never too soon to get help with what may become a significant problem the longer you allow it to continue.  

If any of the above sounds familiar to you, or you have any concerns about how ‘healthy’ your relationship with food or your body is, it is worth talking to someone who really understands the difference between healthy eating, disordered eating, and eating disorders.  

Please contact info@thelondoncentre.co.uk for more information or to book an initial assessment with one of our Highly Specialist ED Clinicians.