If you struggle with your relationship to food, eating and body image you deserve support. Regardless of whether you have an official diagnosis or not.
Eating issues exist on a spectrum. Diagnosed eating disorders are on one end of the spectrum, and ‘normal eating’, aka a peaceful relationship with food, is on the other end of the spectrum. In between this is disordered eating.
I personally consider eating disorders to be biopsychosocial disorders, meaning that they arise at the intersection of socio-cultural, physiological, and psychological factors. In this mix, inherent political factors are embedded. To call eating disorders ‘mental illnesses’ is to make it too simplistic. Whilst this may be fairly accurate for some anorexia sufferers, it leaves way too many other factors and people left out.
Eating disorders often functions as well-founded coping mechanism, that works, until it doesn’t. And so does disordered eating.
There are different types of eating disorders
When most people think of eating disorders, they tend to think of Anorexia Nervosa (AN), a restrictive eating disorder often hallmarked by very low food intake and drastic reduction in body weight. You might imagine an emaciated young teenage girl. This is the stereotypical “look” of an eating disorder.
Whilst there are some who fit this stereotype, it is important to remember that eating disorders don’t discriminate. Any person of any weight, gender, age and ethnicity can have an eating disorder. They are not a choice. You do not have to be at a low body weight to have an eating disorder, or struggle with disordered eating.
Other diagnosable eating disorders
Apart from Anorexia Nervosa (AN), other eating disorder diagnoses are;
Bulimia Nervosa (BN) is restricting and purging or bingeing and purging. Or using other forms of compensation like over exercising and/or laxative use. Typically, there is not a major change in weight.
Binge Eating Disorder (BED) is eating a large quantity of food in a short space of time. Feeling out of control around food but not using compensatory behaviours. There may or may not be weight gain with BED.
Avoidant Restrictive Food Intake Disorder (ARFID) is an eating or feeding disturbance that shows up as; apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating (fear of choking). This can lead over long term to issues with malnutrition. ARFID is more common in autistic people than neurotypical people.
Other Specific Feeding and Eating Disorders (OSFED) is applicable to individuals who are experiencing significant distress due to symptoms that are similar to disorders such as Anorexia, Bulimia, and Binge Eating Disorder, but who do not meet the full criteria for a diagnosis of one of these.
It is worth noting that Binge Eating Disorder was placed under this category until as recent as 2013 when it got its own category.
Atypical Anorexia (AAN) also falls under the diagnosis of OSFED, though the physical symptoms, the impact of under nourishment and the eating disorder behaviours are the same as AN. The only difference is that the person does not meet the low BMI criteria. I would argue that we could call this anti-fat bias in action. There is nothing “atypical” about atypical anorexia. It is actually more common than Anorexia, but often missed due to weight bias in the medical system.
Orthorexia Nervosa is an eating disorder manifesting in an extreme focus on healthy eating. It does not yet have an official diagnosis in the DSM. There are many overlapping behaviours between Orthorexia and Anorexia Nervosa.
But not everyone who struggles with food have an eating disorder
I would argue that any eating behaviour / relationship with food that causes distress for a person falls under the category of disordered eating.
But what is disordered eating? Let’s look at some behaviours around food that can cause a lot of distress:
- Counting calories
- Weighing oneself daily and altering food intake accordingly
- Dieting and then bingeing, aka having “cheat days”
- Seeing food as “good” or “bad” and feeling “good” or “bad” depending on what you’re eating.
- Cutting out whole food groups for non-medical reasons
- Avoiding going to social gatherings because you don’t know what will be served
- Feeling out of control around food
- Needing to compensate for what you’ve eaten through exercise or restriction, or both.
- Avoiding socialising because of how you feel about your body
If your relationship with food and eating is causing you stress, then you deserve support. Much of what falls under the term disordered eating is often socially sanctioned by our thin-obsessed culture. But that doesn’t mean it is right. If anxiety and stress around food and eating takes from your overall quality of life, then know that it is possible for things to be different.
Because these behaviours are often culturally sanctioned, it can be so difficult to realise that there is a problem. Often people have internalised the shame and feel like it is a “me problem”, and not something that is rooted in coping. Then we overlay this with Diet Culture and the obsession with thinness. And you have the perfect storm.
These disordered behaviours (that can fit the diagnostic criteria if they are occurring often enough), are the same types of “Tips & Tricks” that are freely given out as weight loss advice.
Weight stigma plays a major role. Both as a potential barrier to access of support, but it also stops us recognising that the restrictive eating in form of dieting wreaks havoc with our relationship with food, eating and bodies.
You don’t need an eating disorder diagnosis to deserve help
I want you to know that you don’t need an official diagnosis to get help. Yes, it might be beneficial if you are trying to access support within the public healthcare system. Or if you need an official diagnosis for your insurance to cover treatment. But please don’t let that hold you back from getting support.
The vast majority of people I work with and have worked with over the years did not have an official diagnosis. Because they couldn’t get one (aka, they did not meet all the criteria), or never thought getting one was needed or possible.
If you struggle with restrictive eating, binge eating or purging or any compensatory behaviours, you deserve support to heal. Food does not need to be a thing that is all-consuming. Recovery is possible.
It is possible to get to a place where food has its rightful place in your life, as something to sustain you and your body. The road to get there can be long and windy, but it is a journey well worth undertaking.
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