What is an eating disorder?

Severe disturbances in eating patterns, attitudes, emotions, and thoughts characterize an eating disorder. These disorders are mental illnesses that can impair one’s physical and mental health.¹ 

Disordered Eating vs Eating Disorders

Disordered eating is an aspect of eating disorders, however, suffering from disordered eating doesn’t inherently suggest the presence of an eating disorder. Disordered eating is a disturbance in eating patterns that does not meet the diagnostic criteria for an eating disorder. Disordered eating includes a range of concerning eating behaviors and distorted beliefs regarding appearance, weight, shape, and food. The severity involved in disordered eating can vastly differ. However, what keeps behaviors under this classification compared to an eating disorder is the frequency, duration, and psychological criteria that are required for diagnosis. 

This does not mean that disordered eating behaviors should be overlooked. Receiving treatment when experiencing disordered eating symptoms serves as an early intervention, since disordered eating is a risk factor for developing a diagnosable eating disorder. This type of early intervention from professionals aids in the improvement of treatment outcomes and in preventing the progression toward chronic symptoms.^2,3  

Signs and symptoms of disordered eating may include, but are not limited to^4,5,6,7:

• Frequent dieting
• Anxiety associated with specific foods
• Skipping meals
• Chronic weight fluctuations
• Rigid rituals and routines surrounding food and exercise
• Feelings of guilt and shame associated with eating
• Preoccupation with food, weight and body image that negatively impacts quality of life
• A feeling of loss of control around food, including compulsive eating habits
• Using exercise, food restriction, fasting, or purging to “make up for bad foods” consumed

Risk Factors of an Eating Disorder^8,9,10

• Family history of eating disorders/genetics
• Food insecurity
• Experienced trauma/sexual abuse
• Underlying mental health conditions such as anxiety or OCD
• Participating in activities where weight or body size is a factor(swimming, cycling, gymnastics, etc.)
• Childhood forced dieting
• Going through major live events or changes
• Type 1 Diabetes
• Having a driven personality that strives for perfection
• Age: many eating disorders begin in adolescence and early adulthood

When do eating disorders appear? 

While there is no specific time that eating disorders occur, they frequently appear in the teen years and early adulthood which means the collegiate population is at high risk.⁴ 

What are the most common types of eating disorders?^11,12,13 

Anorexia Nervosa (AN)

Definition: Anorexia Nervosa is primarily characterized by heavy restrictions on calories. Intense fear of gaining weight and distorted body image are the driving factors that are a large part of this eating disorder. Only 6% of people with an eating disorder are considered clinically underweight. 

Signs and Symptoms

• Self-starvation
• Extreme dieting 
• Intense fear of weight gain 
• Excessive Exercise
• Skewed beliefs about body/distorted body image
• Avoidance of social situations (to avoid food)
• Denial of hunger
• Rituals around food
• Binging and Purging (in some cases)

Bulimia Nervosa (BN)

Definition: Bulimia Nervosa involves episodes of binge eating followed by compensatory measures (purging, excessive exercise, laxatives, etc.) to prevent weight gain. A binge eating episode consists of feelings of a lack of control resulting in eating a large amount of food in a short period. This disorder also involves a distorted body image with self-evaluation relying on weight and body shape. 

Signs and Symptoms

• Rapid consumption of excessive amounts of food
• Feelings of loss of control
• Weight fluctuations
• Restricting, then binging “bad” foods
• Compensatory measures:
  • Inducing vomiting
  • Misusing Laxatives, Diet Pills, Diuretics 
  • Excessive exercise 
• Avoidance of eating in front of others/Secretive eating
• Discoloration of teeth/Poor dental health
• Making visits to the bathroom after meals 
• Heartburn/Acid reflux

Binge Eating Disorder (BED)

Definition : Binge Eating Disorder, similar to Bulimia Nervosa, involves episodes of binging excessive amounts of food. However, there are no compensatory measures that occur as a result of the binge eating episode. These episodes are associated with all or some of the following: eating much more rapidly than normal, eating till uncomfortably full, eating large amounts even if not hungry, eating alone out of embarrassment for how much food is being consumed, and feelings of disgust or guilt afterward. There is a large amount of distress associated with these binge eating behaviors. Clinical diagnosis of eating disorders in individuals with a higher body weight is half as likely.

Signs and Symptoms

• Out-of-control feelings with food
• Restricting, then binging large amounts of food
• Self-soothing with food

• Feelings of embarrassment and shame
• Secretive eating

Avoidant/Restrictive Food Intake Disorder (ARFID)

Definition: Avoidant/Restrictive Food Intake Disorder is a disturbance in eating patterns that results in inadequate nutrition. Unlike AN, these eating patterns are not the result of efforts to change one’s body, but rather an avoidance of food due to a lack of interest, aversion, or fear of the consequences of eating food. 

Signs and Symptoms

• Significant weight loss
• Avoidance of food/Lack of interest in food/Anxiety around certain foods
• Nutritional deficiencies/dependence on supplementation 
• Food habits impact everyday functioning
• Being extremely particular with food choices
• Refusing foods because of an adverse experience/Sensory issue
• Lack of appetite 

Other disordered behaviors: Orthorexia (obsession with only “healthy” eating), bigorexia (body/muscle dysmorphia), compulsive exercise, relative energy deficiency-sport (RED-S), binge-restrict cycle. 

How to prevent eating disorders:

Review your social media use: time spent and content viewed.  

While social media has its good and bad, it can often make us feel worse. It can lead to comparison, feelings of inadequacy and unhappiness. It is important to remember that with face filters and the tendency to show only the best parts of life online, they are often untrue, unsustainable, and often harmful to our physical and mental health.  Unfollow accounts that make you feel bad about yourself.

Avoid the diet cycle.¹⁴

Dieting can be the first step in someone developing an eating disorder. With a strong genetic component, we do not know for sure if it is weight loss itself that triggers an eating disorder or something else. Diets are meant to fail. Do not get caught in the cycle.  

Focus on mental and emotional health.

Eating disorders and disordered eating aren’t about food, they are medically and psychologically complex. Counseling is a great place to start. Practice self kindness and notice how you talk about your body. Change the narrative. Do not focus on the scale; instead, focus on how you feel physically and emotionally.

Educate yourself. 

Basic Nutrition Education. Meet with a Registered dietitian for help with mindful eating, meal planning, and meal and snack ideas that are balanced and full of nutrients. Eating and food should not cause anxiety and guilt. It is necessary for survival!   

Intuitive Eating.¹⁵ Intuitive eating is a mindful approach that steers away from diet culture and into more sustainable eating habits. We were born with internal cues for hunger and fullness, that we have strayed from while growing up due to external influences. It is made up of 10 principles that encourage awareness of your unique body’s hunger/fullness cues, body respect, coping with emotions, finding satisfaction, movement, and nutrition for your body.  

Health at Every Size® (HAES®).¹⁶ Health At Every Size® advocates for a weight-neutral approach to health. This idea advocates for body acceptance and appreciation rather than weight-based discrimination. 

Treatment Options for Diagnosed Eating Disorders

Treatment for an eating disorder involves mental health therapy plus nutrition/medical stabilization. 

Levels of Care^17,18

Outpatient.This is the most common type of treatment for individuals who are struggling with an eating disorder, especially in the state of Idaho. It consists of seeing a therapist, dietitian, and other members of the treatment team on a weekly or bi-weekly basis. 

Intensive Outpatient (IOP). This type of treatment can vary depending on the individual, but generally, individuals will meet with their providers 2-3 days a week for 3-5 hours per day. Intensive outpatient can include services such as individual therapy, family therapy, group therapy, meal coaching, nutritional counseling, and a structured meal. 

Partial Hospitalization Program (PHP). PHP is a more intensive day program that occurs 5-7 days a week for 6-10 hours a day. Similar to intensive outpatient, this program can offer individual therapy, family therapy, group therapy, meal coaching, and nutritional counseling. Individuals are able to meet with therapists, psychiatrists, nutritionists, and medical monitoring is available. This level of care also provides structured eating sessions. 

Inpatient Hospitalization. This can take place in a medical, psychiatric, or eating disorder unit in a hospital setting. This level of care usually lasts less than 3 weeks or until a patient is deemed medically stable, and then they will be moved to a lower level of care (see above). This level of care is important for situations such as:

• Significant Weight Loss/ Malnutrition 
• Altered Vital Signs
• Abnormal Laboratory Findings (electrolyte balance, EKG changes, etc.)
• Worsening eating disorder symptoms and possible suicidality

This type of care allows for medical monitoring in a safe environment that provides assistance in normalizing eating patterns. 

Residential Care. This is the highest level of care available for eating disorders. This is a long-term treatment option for those who are medically stable but need more constant care. In this setting, there can be constant medical supervision and monitoring. Many educational opportunities and therapies can be offered. This includes groups for psychoeducation, psychotherapy, coping skills, nutrition, and body image. Different therapies can also include art, dance, music, and equine. The average length of residential care ranges from 30-90 days. Residential care has an extensive staff that can include psychiatrists, psychologists, nutritionists, physicians, social workers, nurses, and more. 

Worried you might have an eating disorder or disordered eating? 

Ask yourself “how much time do I spend thinking about food, weight and body image?” If it interferes with your happiness or ability to function, you should consider seeking help. 

• Free eating disorder screening here.

• National hotlines

• Crisis text line: text NEDA to 741741

• National Association of Anorexia Nervosa and Associated Disorders 1-888-375-7767

• National Eating Disorder Association: 1-800-931-2237

Resources at Boise State University:

• University Health Services for medical services 
• Individual Counseling
• Group Counseling
• Dietitian services on campus
• Wellness Services for additional support on campus
• Healthy Body, Healthy Mind (1 Credit Course)

Boise State Online Mental Health Resources

• 8 Dimensions of Wellness

• Coping Skills

• Building Resilience

• Rethinking Stress

• Mindfulness Meditation   

Additional Resources

• National Association of Anorexia Nervosa and Associated Disorders (ANAD)

• The Body Positive

• National Eating Disorder Association (NEDA)

• American Psychological Association (APA)

Books

• The Body is Not an Apology (by Sonya Renee Taylor)
• Intuitive Eating (by Evelyn Tribole and Elyse Resch)
• Health at Every Size (by Linda Bacon)
• Body Kindness (by Rebecca Scritchfield)
• The F*ck It Diet (by Caroline Dooner and Harper Wave)
• Anti Diet (by Christy Harrison)
• Self-Compassion: the proven power of being kind to yourself (by Kristen Neff)
• More than a Body (by Lexie Kite and Lindsay Kite)
• Home Body (by Rupi Kaur)
• The Beauty Myth (by Naomi Wolf)
• The Adonis Complex (by Harrison Pope, Katharine Phillips, Roberto Olivardia)

References

1. Sim, L. A., McAlpine, D. E., Grothe, K. B., Himes, S. M., Cockerill, R. G., & Clark, M. M. (2010). Identification and treatment of eating disorders in the primary care setting. Mayo Clinic proceedings, 85(8), 746–751. https://www.mayoclinic.org/diseases-conditions/eating-disorders/symptoms-causes/syc-20353603#:~:text=Eating%20disorders%20are%20serious%20health%20conditions%20that%20affect,ability%20to%20function%20in%20important%20areas%20of%20life.
2. Pereira, R. F., & Alvarenga, M. (2007). Disordered eating: Identifying, treating, preventing, and differentiating it from eating disorders. Diabetes Spectrum, 20(3), 141–148. https://doi.org/10.2337/diaspect.20.3.141
3. Alhaj, O. A., Fekih-Romdhane, F., Sweidan, D. H., Saif, Z., Khudhair, M. F., Ghazzawi, H., Nadar, M. S., Alhajeri, S. S., Levine, M. P., & Jahrami, H. (2022). The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression. Eating and weight disorders: EWD, 27(8), 3215–3243. https://doi.org/10.1007/s40519-022-01452-0^[11] Oldham-Cooper, R., & Semple, C. (2021). Prevention and early help for eating disorders in young people with type 1 diabetes. Clinical child psychology and psychiatry, 26(3), 656–668. https://doi.org/10.1177/1359104521994172
4. https://www.eatright.org/health/health-conditions/eating-disorders/what-is-disordered-eating
5. https://www.nimh.nih.gov/health/topics/eating-disorders
6. Levinson, C. A., Hunt, R. A., Christian, C., Williams, B. M., Keshishian, A. C., Vanzhula, I. A., & Ralph-Nearman, C. (2022). Longitudinal group and individual networks of eating disorder symptoms in individuals diagnosed with an eating disorder. Journal of Psychopathology and Clinical Science, 131(1), 58. doi:https://doi.org/10.1037/abn0000727 
7. Patton, G. C., Selzer, R., Coffey, C., Carlin, J. B., & Wolfe, R. (1999). Onset of adolescent eating disorders: Population based cohort study over 3 years. BMJ, 318(7186), 765–768. https://doi.org/10.1136/bmj.318.7186.765 
8. https://my.clevelandclinic.org/health/diseases/4152-eating-disorders
9. Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74
10. Nagata, J. M., Chu, J., Cervantez, L., Ganson, K. T., Testa, A., Jackson, D. B., Murray, S. B., & Weiser, S. D. (2023). Food insecurity and binge‐eating disorder in early adolescence. International Journal of Eating Disorders, 56(6), 1233–1239. https://doi.org/10.1002/eat.23944
11. https://www.mccallumplace.com/eating-disorder/risk-factors-stats/
12. https://www.allianceforeatingdisorders.com/the-definitive-guide-to-all-types-of-eating-disorders/DSM-5
13. https://www.nimh.nih.gov/health/topics/eating-disorders 
14. https://nedc.com.au/eating-disorders/eating-disorders-explained/disordered-eating-and-dieting
15. https://www.intuitiveeating.org/about-us/10-principles-of-intuitive-eating/
16. https://asdah.org/
17. https://anad.org/levels-of-care/
18. https://www.eatingdisorderhope.com/treatment-for-eating-disorders/outpatient