Eating disorders can be hard to spot, which can be especially true in societies that have a pervasive diet culture, such as in the US. It can be tricky to understand when disordered behaviors in eating spiral into a full-blown eating disorder.1 In this article we explore the difference between disordered eating and eating disorder, including signs and symptoms, who is most at risk, and treatment options.
WHAT’S THE DIFFERENCE?
Put simply, “normal” eating is the mindful consumption of food when the body sends “hungry” signals to the brain, the ability to stop eating when the body sends “full” signals, and the ability to incorporate a balanced variety of food into the diet without experiencing major anxiety about what is being consumed. Conversely, the term disordered eating describes a range of irregular eating behaviors that may or may not warrant a diagnosis of a specific eating disorder. It’s worth noting that the term disordered eating is a descriptive phrase, not a diagnosis.2
Disordered eating does not always mean the person is unhealthy or at risk of developing an eating disorder.3 It is possible for a person to have a positive relationship with food but have atypical eating habits, such as eating when they’re bored, packing the same thing for lunch every day, or avoiding certain food groups.1,3 These habits could be linked to any number of factors ranging from atypical work schedules or other unusual lifestyle factors, to societal pressures to avoid certain foods, to preoccupations with nutrition. One of the most significant differences between disordered eating and an eating disorder is that an individual with disordered eating habits is typically able to maintain these behaviors without suffering major negative effects on their health or quality of life.4 They can find foods they’re comfortable eating and have no desire to further change their habits. However, though atypical eating habits may fall short of an eating disorder diagnosis, they still deserve attention and possibly treatment. This is because disordered eating behaviors puts some people at greater risk of developing destructive eating patterns that can result in serious health problems.1,5
The line between disordered eating and an eating disorder is crossed when a person’s symptoms and experiences align with criteria defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)1,6,7 Measures may include body mass index (BMI), number of calories consumed daily, and duration and frequency of certain symptoms.8,9 The clinical eating disorder diagnoses in the DSM-V include anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorder (OSFED). These diagnoses exclude a majority of people with disordered eating, though some individuals with disordered eating symptoms are diagnosed with OSFED. OSFED encompasses individuals who do not meet the strict diagnostic criteria for AN, BN, or BED but still have eating patterns that cause clinically significant distress and impairment.8,10 OSFED still has specific criteria that must be met in order for an individual to receive this diagnosis.10 Despite sometimes being thought of as a “catch-all” diagnosis that might be seen by some as less serious than the other eating disorder diagnoses, OSFED can be a life-threatening condition, as can all eating disorders.
HOW COMMON ARE EATING DISORDERS?
While it’s difficult to precisely measure the prevalence of eating disorders, they may be more common than you think. A 2019 review in The American Journal of Clinical Nutrition (AJCN) reported the lifetime prevalence of eating disorders in the US between the years 2000 and 2018 to be roughly 5.7 percent in women and 2.2 percent in men.11 This number could be conservative because not all people seek treatment and thus don’t receive a recorded eating disorder diagnosis. The reviewed studies in the AJCN article revealed that the overall prevalence of eating disorders has increased from 3.5 percent in the years 2000 to 2006 to 7.8 percent in the years 2013 to 2018. Another study estimated that nine percent of the US population will develop an eating disorder during their lifetime.16
There are many myths and misinformation surrounding eating disorders, which can be harmful for people struggling with eating issues, and can even undermine these individuals’ progress toward recovery. Below are some of the most common misconceptions.
MYTH or FACT? Eating disorders are a choice and a cry for attention.
MYTH! Eating disorders are not a choice. They are bio-psycho-social diseases, which means genetic, biological, environmental, and social elements each play a role in the development of an eating disorder.17 Societal and environmental factors, such media-driven bullying and unrealisted images of beauty, have been associated with increased risk of developing an eating disorder. Additionally, biological predispositions, such as family history, can make some individuals more vulnerable to developing an eating disorder than others.3,6,17
MYTH or FACT? Only women develop eating disorders.
MYTH! Eating disorders can affect anyone, regardless of their gender identity, biological sex, race, ethnicity, or age.4,6,16–18 Though eating disorders are more common in biologically female individuals, researchers and clinicians are seeing a growing number of biologically male individuals and non-binary individuals seeking help for eating disorders.16,18 This trend is especially concerning among transgender individuals. About 32 percent of transgender people report using their eating disorder to modify their body without hormones, and gender dysphoria and body dissatisfaction are often cited as key links to eating disorders in this group.18–20
MYTH or FACT? A person does not have to be underweight to be diagnosed with an eating disorder.
FACT! A major misconception is that people diagnosed with eating disorders always appear very thin, gaunt, or unhealthy, but eating disorders can affect all body types and can manifest differently, individual to individual. Not all people with eating disorders are medically diagnosed as underweight. In fact, a 2011 study found that less than six percent of people with eating disorders were medically diagnosed as underweight.21 Another study found that young adults with a weight status classified as overweight or obese were more likely to report disordered eating behaviors than those with a weight status classified as underweight or normal.23
MYTH or FACT? Eating disorders are not that serious.
MYTH! Eating disorders and substance use have the highest mortality rates of any psychiatric illness.17 Those who have a family history of addiction can actually be predisposed to develop an eating disorder.23 In the US, there are roughly 10,200 deaths each year as a direct result of an eating disorder.16 That’s about one death every 52 minutes. Besides medical complications from binge eating, purging, starvation, and overexercising, suicide is common among individuals with eating disorders.6,11,17 Indirect health consequences related to eating disorders include heart attack, kidney failure, osteoporosis, and electrolyte imbalance.
MYTH or FACT? Frequent dieting should not be considered a normal part of daily life.
FACT! While most people recognize that eating disorders are harmful, many people consider dieting for the purposes of weight loss to be a normal part of every day life. While moderate, sustainable changes in diet and exercise for the purposes of improving or maintaining health are safe, serious health consequences can occur from extreme or unhealthy dieting practices.24 Teenagers are especially vulnerable to societal pressures to diet, which can increase the risk of engaging in disordered eating behaviors. Puberty is a time of great change biologically, physically, and psychologically, so weight gain is natural and expected.4,7 Research shows that young people who engage in unhealthy dieting practices are almost three times more likely than their peers to score high on measures assessing suicide risk.24
WHERE TO SEEK TREATMENT
Some people with severely disordered eating may minimize or not fully realize the impact their behavior has on their mental and physical health.2 The behaviors may seem innocuous at first but can quickly turn into something more serious. This lack of understanding can exacerbate the harm of disordered eating and potentially push the person toward a full-blown eating disorder. These behaviors have also been linked to a reduced ability to cope with stressful situations and increased frequency of mental health struggles.7 This is why disordered eating is a serious health concern.
Seeking help early is one of the most effective preventative measures in this area, and there are a number of paths one can take when it comes to changing disordered eating patterns. It usually requires a multidisciplinary approach. Practitioners with specialized knowledge in health and nutrition are on the front lines in the detection and treatment of disordered eating and eating disorders.
Dietitians. A registered dietitian (RD) or registered dietitian nutritionist (RDN) works with clients to develop a safe, realistic, and long-term eating plan.25 Notably, anyone can call themselves a nutritionist, but only RDs and RDNs have completed multiple layers of education and training established by the Accreditation Council for Education in Nutrition and Dietetics. They are experts in explaining the use of food and nutrition to promote health and manage disease. They also can advise and help clients achieve specific health-related goals. Many people who are referred to dietitians for nutrition counseling may not be fully aware that their eating patterns are problematic or harmful.2 Working with a dietitian who has a background in counseling is an important step in treating disordered eating and preventing it from progressing to an eating disorder. Registered dietitians are helpful in correcting unhealthy behaviors but may not delve into the psychological causes of such behaviors.
Doctors. Primary care physicians (PCPs)/general practitioners (GPs) are important for monitoring your long-term health and providing general medical expertise. Although they may not be expertly trained in recognizing or treating eating disorders, they are a good “first base” option if you have concerns about your own or someone else’s eating patterns.26 GPs can help identify the signs and symptoms of eating disorders, provide additional resources and information, and refer you to a specialist for help. GPs can be instrumental in eating disorder recovery by managing your care and monitoring your progress. Anyone with an eating disorder should have a GP they can trust and talk to involved in their care. Similar to dietitians, doctors may be helpful in understanding and treating physiological symptoms of disordered eating but are not likely to be trained to delve into the psychological aspects behind the behaviors.
Psychologists/psychiatrists. Psychologists and psychiatrists are commonly involved in the treatment of patients with eating disorders and can be crucial in helping those with eating disorders stay in recovery. They provide counseling, guidance, and in some cases will recommend/prescribe medication. They also can conduct diagnostic assessments, develop psychological treatment plans that address mental and emotional issues associated with eating disorders, educate loved ones, and advocate for you. Clinical psychologists are required to have completed high-level postgraduate training in order to gain the needed expertise in their field.26 Psychiatrists are medical doctors who specialize in the diagnosis and treatment of mental illness and can recommend and prescribe medication. Psychologists and psychiatrists who specialize in disordered eating and eating disorders may be more effective than general psychologists/psychiatrists. Psychologists who specialize in eating disorders are heavily focused on understanding and explaining the psychological aspects of the eating disorder or disordered eating as opposed to treating physical symptoms.
Our relationship with food can be complicated—it’s important to be mindful of one’s eating habits and recognize what disordered eating can look like. When disturbed eating behaviors arise, consult with your primary care physician first. He or she may refer you to a licensed dietitian and recommend that you also seek treatment from a mental health professional who is specifically trained to address the psychological aspects of eating disorders.
1. Zucker T. Eating disorders vs. disordered eating: what’s the difference? 2018. National Eating Disorder Association website. https://www.nationaleatingdisorders.org/blog/eating-disorders-versus-disordered-eating. Accessed 30 Mar 2021.
2. EatRight website. What is disordered eating? 26 Oct 2018. https://www.eatright.org/health/diseases-and-conditions/eating-disorders/what-is-disordered-eating. Accessed 30 Mar 2021.
3. Linardon J, Phillipou A, Castle D, et al. Feeling fat in eating disorders: testing the unique relationships between feeling fat and measures of disordered eating in anorexia nervosa and bulimia nervosa. Body Image. 2018;25:163-167.
4. Samuels KL, Maine MM, Tantillo M. Disordered eating, eating disorders, and body image in midlife and older women. Curr Psychiatry Rep. 2019;21:70.
5. Hagan E. Eating disorders or disordered eating: what’s the difference? 24 Feb 2014. PsychologyToday website. https://www.psychologytoday.com/us/blog/contemporary-psychoanalysis-in-action/201402/disordered-eating-or-eating-disorder-what-s-the. Accessed 30 Mar 2021.
6. Parekh R. What are eating disorders? Jan 2017. American Psychiatric Association website. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders. Accessed 30 Mar 2021.
7. National Eating Disorders Collaboration website. Disordered eating and dieting. https://nedc.com.au/eating-disorders/eating-disorders-explained/disordered-eating-and-dieting/. Accessed 30 Mar 2021.
8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Washington, DC: American Psychiatric Association; 2013.
9. Knoll S, Föcker M, Hebebrand J. Essstörungen [Changes to the classification of Eating Disorders in DSM-5]. Z Kinder Jugendpsychiatr Psychother. 2014;42(5):361–368.
10. National Eating Disorders Association website. Other specified feeding or eating disorders (OSFED). https://www.nationaleatingdisorders.org/learn/by-eating-disorder/osfed. Accessed 1 Apr 2021.
11. Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. Am J Clin Nutr. 2019;109(5);1402–1413.
12. National Eating Disorders Association website. Anorexia nervosa. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia. Accessed 1 Apr 2021.
13. National Eating Disorders Association website. Bulimia nervosa. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia. Accessed 1 Apr 2021.
14. National Eating Disorders Association website. Binge eating disorder. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed. Accessed 1 Apr 2021.
15. The Emily Program website. Eating disorders vs. disordered eating: what’s the tipping point?28 Aug 2018. https://www.emilyprogram.com/blog/disordered-eating-vs-eating-disorders-whats-the-tipping-point/. Accessed 30 Mar 2021.
16. Deloitte Access Economics. The social and economic cost of eating disorders in the United States of America: a report for the strategic training initiative for the prevention of eating disorders and the Academy for Eating Disorders. June 2020. Harvard T.H. Chan School of Public Health website. https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
17. National Eating Disorders Association website. Busting the myths about eating disorders. https://www.nationaleatingdisorders.org/busting-myths-about-eating-disorders. Accessed 1 Apr 2021.
18. National Association of Anorexia Nervosa and Associated Disorders. Eating disorder statistics. https://anad.org/get-informed/about-eating-disorders/eating-disorders-statistics/. Accessed 7 Apr 2021.
19. National Eating Disorders Association website. Eating disorders in LGBTQ+ populations. Updated 2018 Feb 21. https://www.nationaleatingdisorders.org/learn/general-information/lgbtq. Accessed 2021 Apr 7.
20. Muhlheim L. Eating disorders in transgender people. 20 Jun 2020. VeryWell Mind website. https://www.verywellmind.com/eating-disorders-in-transgender-people-4582520. Accessed 2021 Apr 7.
21. Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):
22. Nagata JM, Garber AK, Tabler JL, et al. Prevalence and correlates of disordered eating behaviors among young adults with overweight or obesity. J Gen Intern Med. 2018;33:1337–1343.
23. Muhlheim L. Eating disorders and substance abuse. 2019 Mar 18. VeryWell Mind website. https://www.verywellmind.com/eating-disorders-and-substance-abuse-4585199. Accessed 2021 Apr 7.
24. National Eating Disorders Collaboration website. Myths. https://nedc.com.au/eating-disorders/eating-disorders-explained/myth/. Accessed 2021 Apr 7.
25. EatRight website. 10 reasons to see an RDN. Mar 2021. https://www.eatright.org/food/resources/learn-more-about-rdns/10-reasons-to-visit-an-rdn. Accessed 2021 Apr 7.
26. Eating Disorder Referrals website. Who are the professionals who treat eating disorders? https://www.edreferral.com/treatment-team. Accessed 2021 Apr 7.