An eating disorder is classified as a mental illness. In the Diagnostic and Statistical Manual of Mental Disorders (DSM) there are 5 eating disorder diagnoses, each determined by a set of defined criteria.

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• Anorexia Nervosa

• Bulimia Nervosa

• Binge Eating Disorder

• Avoidant Restrictive Food Intake Disorder

• Other Specified Eating and Feeding Disorder (OSFED)​

 

In the United States, there are 5 to 10 million women diagnosed with eating disorders with 6% of the population struggling with anorexia nervosa or bulimia nervosa. Binge Eating Disorder is the most commonly diagnosed. 

 

As dietitians, we don't diagnose eating disorders, but we are an important part of the treatment team (along with medical doctors, therapists, and psychiatrists).

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There is a common misperception that people with eating disorders or disordered eating are predominantly young and underweight, but people in larger bodies are at the highest risk of developing disordered eating. Of persons presenting for inpatient treatment, 25 to 45% are living in larger bodies.

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Risks

 

There is a biological basis for eating disorders with 50-80% of risk due to genetics, and the symptoms of eating disorders (poor body image, binging or purging, restriction) seem to run in families.

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Outside of a biological predisposition, other risks of eating disorders include: 

• dieting***

• perfectionism or cognitive rigidity

• poor body image or internalizing the thin ideal

• anxiety

• history of trauma

• weight stigma

• social isolation or depression

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*Dieting, although seen as a positive health behavior in diet culture, is one of the biggest risk factors for disordered eating- with some research suggesting 35% of dieters progress to pathological dieting and disordered behaviors.  

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Disordered Eating

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Disordered eating could include disordered thoughts or behaviors that can impact quality of life, health, and mental wellness. Disordered thoughts include preoccupation with weight, shape, body dissatisfaction, or having food rules or forbidden foods that cause stress and guilt. Behaviors could include restriction, avoiding preferred foods, binge eating, overexercise, or compensation for eating (laxatives, diet pills, purging).

 

Disordered eating is considered disordered vs an eating disorder if it doesn't meet the full DSM criteria. With two thirds of women trying to lose weight, it isn't surprising that disordered eating is common among moms and older women. Dieting often seems indistinguishable from disordered eating.

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Eating is on a spectrum, and eating behaviors can be fluid over a lifetime.

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Disordered eating interferes with pursuing a meaningful life. It is socially isolating, increases anxiety and depression, and it has dangerous side effects to your physical health- anorexia nervosa, for example, is the deadliest mental illness with a mortality rate of 10% in 10 years and 20% in 20 years. 

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Binge Eating

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Binge eating is typically accompanied by an unfortunate amount of shame or guilt. It is sometimes driven by dieting or not eating enough, and it can also be perpetuated by food rules and restraint around food. More often than not, there is an element of emotional dysregulation- in other words, it is about the food, and it's also not about the food at all!

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Emotional eating differs from binge eating in that it is any eating driven by an emotional state (boredom, fatigue, loneliness, stress, anger...), but there may not be an objectively large amount of food consumed or the same level of distress as a result. Yet, it can still be very stressful and cause a sense of feeling compulsively driven to eat to soothe emotions. It can also cause unwanted weight gain when done frequently which exacerbates the urge to diet or restrict and may also influence poor body image. 

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Not all emotional eating is problematic. Increasing awareness around our motivation to eat and opening up permission can be very helpful in healing the relationship with food.

 

Binge eating is defined as eating an abnormally large amount of food in a short period of time (like 2 hours, for example) and feeling out of control. There is often a sense of disassociation that occurs and it may be habitual or planned. 

 

 Binge eating is diagnosed as Binge Eating Disorder if it is occurring once a month for 3 months, has marked distress, and no other compensation is present.

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There is often a cycle of emotional eating and restriction that takes place, and these eating behaviors fall along the disordered eating spectrum. 

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Pregnancy

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Disordered eating in pregnancy is often an overlooked problem that is also associated with perinatal anxiety and depression. Proper screening is often not a part of prenatal care. Risks of disordered eating during pregnancy include intrauterine growth restriction or small for gestational age, preterm labor or premature birth, increased risk of c-section, complications during labor, low or high birth weight (depending on the eating disorder behaviors), miscarriage or stillbirth, maternal hypertension, and preeclampsia. 

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Treating disordered behaviors prior to getting pregnant can help decrease these risks, and there is an increased risk to baby up to 18 months of age, as feeding practices of the mom impact how baby is fed as well. 

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Moms and children

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Disordered eating or eating disorders in moms can also greatly impact their children. Children of individuals with a diagnosed eating disorder are 11 times more likely to develop an eating disorder as well as 6 times more likely to develop eating disorder patterns. They are also at higher risk of emotional and social dysfunction. 

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We also see low self-worth in children who have a care provider model body image distortion and food anxiety. 

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As we age

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Disordered eating or eating disorders in women in 40 or 50 years or older is increasing. We have personally worked with many women who have had children leave home and seen a resurgence in body dissatisfaction and disordered behaviors due to having less daily responsibilities to distract them from these concerns. Disordered behaviors are often used as a means to control that which can't be controlled. 

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There is also a strong impact on body image when we age due to changes in hormones and how our metabolism may function. 

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How we can help

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Dietitians support healing from chronic dieting, disordered eating, body image concerns, and eating disorders by helping to normalize eating to renourish the body and brain and also support understanding of what your body needs to function and thrive. 

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We also help challenge disordered thinking and beliefs and support adaptive emotional coping. We can work together to help develop a long-term plan for eating and movement while developing a more positive or neutral body image, moving away from body shame, embarrassment or distress. Part of this process is also discussing cooccurring other health concerns and gentle nutrition management and how to talk to our kids about it all.

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If you need help determine if you may have an eating disorder, please check out this screening tool. 

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We believe recovery is accessible for everyone, and we are here to help.  ​​