What is the difference between eating disorders and disordered eating?
Nowadays, eating disorders are on the rise. When food is made out to be the enemy, it is easy for people to develop an unhealthy relationship with it. As a result, food becomes a source of fear or allure, leading to disordered eating and eating behaviours.
It is estimated that 1.25 million people in the UK suffer from an eating disorder [1]. There is disordered eating that occurs in people with eating disorders, but not everyone who eats disorderly will be diagnosed with an eating disorder. A difference between them lies in the frequency and severity of behaviours, and how distressing they are for the individual.
What is non disordered eating?
To begin with we should look at the characteristics of non-disordered eating in order to fully understand the concept of disordered eating. Variety, flexibility, regular food intake and fun are the four main components of non-disordered eating. To be more specific, variety refers to eating a wide range of meals from each dietary group, including “treat” foods for fun. The capacity to adjust to variations in routine is referred to as eating flexibility and it is comparable to being adaptable in social life and altering plans on the spur of the moment. While regularity entails snacking and eating often throughout the day (for most individuals this means eating every three hours, with three meals and two to three snacks each day) and lastly fun refers to eating for pleasure, commemorating special occasions with food, and enjoying what we eat in general.
Additionally, when one consumes food mindfully when hungry and is able to stop when full, this is referred to as normalised, non-disordered eating. However, it is important to note that many people who claim to have a great relationship with food may still qualify as disordered eaters in some ways: they can eat out of boredom, they might have the same thing for lunch every day or cut out a major food group. People may alter their food intake due to social standards and pressures, as well as concerns about weight loss and exercise. Many people can find food they are comfortable with in any restaurant, and change is not required. However, for others, this kind of eating can be a precursor to a full-blown eating disorder. It can be difficult to distinguish between disordered eating and eating disorders.
What is disordered eating?
The definition of disordered eating is engaging in abnormal eating patterns or eating behaviours on a regular basis. However, this would not apply to some people, whose health depends on adhering to a particular diet due to intolerances or health conditions.
Disordered eaters often turn to their behaviour as a way of coping with unpleasant emotions. In order to divert themselves from feeling inadequate in other areas of their life, or with the idea that achieving their goal weight will finally bring them happiness, they may begin focusing on their weight and caloric intake. Often the case is that once the target weight has been reached, a lower one will be set. That, in essence, can be the underlying cause of eating disorders. In some cases, for instance emotional eating may lead to binge eating, resulting in binge eating disorder or bulimia nervosa. This does not imply that all individuals who engage in disordered eating will develop an eating disorder. Instead, it is intended to remind us to reflect on and support those around us about who we are concerned about [2].
Whether or not they meet the diagnostic criteria for an eating disorder, people with disordered food behaviours are often anxious when it comes to eating. Those individuals might count every calorie that they consume, exercise obsessively, or start avoiding social situations where food will be present.
Common characteristics of disordered eating:
- Following unhealthy ways to lose weight such as: skipping meals, fasting, using diet pills, vomiting after eating, and abusing laxatives
- Body image distortion
- Exercising excessively to lose weight
- Many foods are restricted, or food categories are eliminated.
- Guilt and shame caused by a failure to maintain healthy eating and exercise habits
- The fundamental measure of self-worth is body shape or weight.
- Feeling out of control when it comes to food
- Consuming excessive amounts of food late at night
- Consuming food not for hunger, but for comfort
- Having a poor quality of life because of obsessions with food, exercise, and body image
What is an eating disorder?
An eating disorder is a serious mental condition that requires long-term therapy and care. Eating disorders can affect anyone, regardless of their background, age, sex, size, or race. In addition to genetic, biological, environmental, and social influences, many other factors can contribute to the development of an eating disorder.
The American Psychiatric Association developed the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a diagnostic tool. Healthcare practitioners use this tool to support the diagnosis of eating disorders. Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Other Specified Feeding and Eating Disorder (OSFED) and Avoidant/Restrictive Food Intake Disorder (ARFID) are the five eating disorders included in the DSM-5. There is a specific set of criteria developed by extensive research for each eating disorder [3,5].
Anorexia Nervosa
Anorexia Nervosa is defined by a prolonged restriction of food intake that results in a severely low body weight. The individual experiences an extreme fear of weight gain and acts in a manner that interferes with the process of gaining weight. Anorexia Nervosa patients’ self-worth is frequently linked to their weight, shape, or ability to regulate their eating. Individuals frequently have a skewed perception of their bodies, feeling they are overweight while they are actually dangerously underweight.
It is divided into two categories: The Restricting subtype and the Binge/Purge subtype. Individuals with the restricting subtype drastically control the amount and type of food they consume or engage in other weight loss practices such as over-exercising. Extreme restriction is also present in the binge/purge subtype, but it is followed by periods of binge eating and compensatory purging.
Bulimia Nervosa
Bulimia Nervosa is defined by recurrent binge eating episodes that are followed by compensatory behaviours. To be more specific a binge eating episode involves consuming big quantities of food in a short period of time while feeling unable to stop and out of control. Compensatory behaviours, on this other hand, could mean various ways that the individual might try to regulate weight. Vomiting, abusing laxatives or diuretics, fasting, strenuous exercise, or abusing over the counter or prescription drugs for weight loss are all examples.
Weight fluctuates due to the huge amount of food taken during a binge and the relative lack of effectiveness of most compensatory behaviours, yet many individuals with bulimia stay within a healthy weight range or even put on weight. Bulimia sufferers are often caught in a cycle of binge eating and compensating. As a result, one may feel guilty, ashamed and embarrassed, as well as preoccupied with food, body image and fear of gaining weight. Therefore, individuals often keep their eating patterns and compensatory behaviours very secretive, which makes the disorder hard to detect by friends and family members.
Binge Eating Disorder
The core characteristic of binge eating disorder is frequent binge episodes. Binge Eating Disorder is different from Bulimia Nervosa because it involves no compensatory behaviours (such as vomiting, laxative use, fasting, etc.). As a result of feelings of shame and guilt, individuals who suffer from this disorder eat alone or in secret. People who suffer from binge eating disorder are often overweight or obese.
OSFED
In individuals with OSFED, some of the symptoms of other eating disorders (Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder) are present but do not meet all of the criteria. OSFED is the most often diagnosed eating disorder among adolescents and adults, and it is no less dangerous than other eating disorders.
ARFID
An ARFID diagnosis denotes a disorder in which an individual struggles to consume enough food to fulfil nutritional requirements in the absence of the fear of weight gain and/or concern with weight or body shape that defines other eating disorders such as Anorexia, Bulimia or OSFED. Weight loss results from disturbances of eating, such as lack of interest in food, insatiable appetite, or aversion to certain textures or foods (that are not related to weight or body shape).
An eating disorder can have many adverse health effects, including damaging to the cardiovascular, nervous and gastrointestinal systems [4]. Although they are not clinically diagnosable eating disorders, disordered eating behaviours can still negatively affect your health. As a result, patients may suffer from bone loss, low blood pressure, gastrointestinal issues, as well as issues with hormonal function, skin, hair, and kidneys. They might also experience fatigue, headaches, and have difficulty concentrating, as well as increased anxiety and depression. All of which can lead to social isolation too. Eating disorders can develop from disordered eating, so it’s crucial that signs of disordered eating are identified early, and that people seek treatment immediately from qualified professionals. Obtaining a diagnosis without the help of a professional is not recommended, and perhaps the information provided in this article will shed light on the types of warning signs that may appear, as well as start further discussions around this important distinction. If you or someone close to you is showing signs of an eating disorder, consult your doctor or contact one of our dietitians to assist you immediately.
by Anastasia Gkegka
Eating disorders specialist, Registered dietitian
References
- BEAT-Eating disorders Statistics for Journalists .Beat.https://www.beateatingdisorders.org.uk/media-centre/eatingdisorderstatistics/?gclid=Cj0KCQjw4PKTBhD8ARIsAHChzRLdl5xxuBb4fo_gYMboeeLKHj8bxHpnI4k_6VCZPys1ILx_ukv_aoaAiiUEALw_wcB
- Centre for Clinical Interventions, & Fleming, K. (2018, January 25). Regular eating for recovery. Retrieved April 30, 2022, from https://www.cci.health.wa.gov.au/-/media/CCI/Mental-Health-Professionals/Eating-Disorders/Eating-Disorders—Information-Sheets/Eating-Disorders-Information-Sheet—23—Regular-Eating-for-Recovery.pdf
- Centre for Clinical Interventions, & Fleming, K. (2018, January 25). Normal eating vs. disordered eating. Retrieved April 30, 2022, from https://www.cci.health.wa.gov.au/-/media/CCI/Mental-Health-Professionals/Eating-Disorders/Eating-Disorders—Information-Sheets/Eating-Disorders-Information-Sheet—22—Normal-Eating-vs,-d-,-Disordered-Eating.pdf
- org.uk. 2022. Eating disorders: recognition and treatment. [online] Available at: <https://www.nice.org.uk/guidance/ng69/resources/eating-disorders-recognition-and-treatment-pdf-1837582159813> [Accessed 12 May 2022].
- Shisslak, C. M., Crago, M., & Estes, L. S. (1995). The spectrum of eating disturbances. International Journal of Eating Disorders, 18(3), 209-219.
