Eating Disorders vs. Disordered Eating
The Difference Between Eating Disorders and Disordered Eating — And Why the Distinction Matters
By Natalie Delgado, LPC (guest writer & collaborator)
All humans on earth have a relationship with food. We need food like plants need water and soil. Unlike plants, people have emotional responses to food. Whether we’re sharing a birthday cake with friends or a holiday meal with family, food is a social part of who we are. Certain dishes elicit comfort and nostalgia, and fire feel-good hormones in our brains including dopamine and serotonin. We need food for nourishment, and we are wired to enjoy it.
We also live in a society with biases toward specific body shapes and sizes, and bodies are treated like trends. As a result, body image distress impacts many people as they try to adhere to impossible and shifting beauty standards. The tension of seeing food as good and comforting vs. bad can complicate our relationship with the very thing our bodies need to survive. Some individuals develop rigid rules in an effort to balance the good feelings and nutrition that our bodies need with a desire to achieve a certain aesthetic or even general wellness.
Disordered Eating
Rigid food rules lend themselves to disordered eating, which is important to distinguish from the clinical diagnosis of an eating disorder. These rules can look like:
• Specific times/windows where food consumption is permitted (hello intermittent fasting!).
• Trying to “lose a few pounds” before an event.
• Labeling foods as good/bad
• Feelings of guilt or shame after consuming a “bad” food
• Cutting out certain foods or food groups for reasons other than allergies or intolerances. • The inability to skip a day of exercise in times of sickness, injury, or logistics
• Scrutinizing your body or others as a measure of worth
As a therapist specializing in eating disorders, one of my litmus tests for determining a person’s degree of flexibility with food is asking their level of comfortability to go to a restaurant with friends and find something on the menu they would enjoy eating, barring food allergies and religious restrictions. If a friend asked you to have dinner, would you stress over the ingredients, calorie content, or time of day you were eating? If so, a level of disordered eating may be present. Working with a dietitian and therapist can help you determine what your body needs, and challenge food rules and beliefs through therapeutic interventions.
Eating Disorders
Eating disorders are considered to be the most lethal of all mental health diagnoses, and treatment for them is essential. These diagnoses are outlined in the DSM-V and must be identified and treated by a multi-disciplinary team including a medical doctor, registered dietitian, therapist, and psychiatric provider for medication management.
Anorexia Nervosa
Anorexia is defined as an intense fear of gaining weight and restricting food intake to obtain a low body weight unsustainable for the individual’s true dietary needs. Anorexia has two subtypes, Restricting Type and Binge/Purge Type. The Restricting Type is the most well known, and most commonly portrayed in media. The Binge/Purge Type has the restriction element, with additional behaviors including binge episodes followed by attempts to rid the body of the energy consumed through compensatory behaviors including misuse of laxatives, vomiting, and/or exercise.
Bulimia Nervosa
Like anorexia, individuals with bulimia also have a high level of body image distress. They engage in binging followed by compensatory behaviors and engage in patterns of restriction. The difference is individuals with this diagnosis present at a normal or high weight for their body.
Binge Eating Disorder
Binge Eating is defined by consuming an amount of food that leaves the individual feeling uncomfortably full, and feeling out of control while doing so. BED does not have the compensatory behaviors that may be present in other diagnoses.
Avoidant Restrictive Food Intake Disorder (ARFID)
ARFID is commonly defined as “extreme pickiness” that goes beyond preferences. Individuals with ARFiD are not able to meet their daily nutritional needs and show signs of malnutrition due to taste and/or texture aversions or a fear of averse reactions (such as choking or an allergic reaction).
Other Specified Feeding and Eating Disorder (OSFED)
OSFED is the term used to define the presence of an eating disorder if the individual has a combination of symptoms from other diagnoses.
Unspecified Feeding and Eating Disorder (USFED)
This is often used in more emergency settings, or given by clinicians who do not specialize in eating disorders until the person can be seen by a ED specialist.
The Importance of the Distinction
Society is changing the way we talk about mental health. It’s no longer considered appropriate to say a person is “acting psychotic,” or “looks anorexic.” Diagnoses are no longer considered acceptable adjectives to toss around when someone is on our nerves. And while shifts in language can be challenging, this shift insures that when an eating disorder diagnosis is used, we all understand it’s meaning, and individuals can access the care they need to recover.
Natalie Delgado, LPC specializes in eating disorders and co-occurring mental health diagnoses. She is an outpatient therapist with The Emily Program in Atlanta, GA and enjoys sharing her passion for learning and mental health through writing and content creation.
