Different Eating Disorders

Eating disorders are a very interesting type of mental health disorder – these diagnoses look very simple from the outside, but diagnosing folks experiencing disordered eating will often be much more complicated in real life.  It is uncommon for eating disorders to be diagnosed easily or in a straightforward way.  There are a lot of reasons for this, but most often it’s because eating disorders have existed for a very long time and individuals have built their lives around them in certain ways.  From drinking alcohol and binge eating every weekend, to prioritizing extensive workouts every morning above all else and only eating “safe” foods.  Eating disorders oftentimes can be quite difficult to identify!  However, they all share one big feature – repetitive, difficult-to-control behavior and thinking patterns regarding food, eating, and weight.

Because eating disorders can be tough to identify, I think it’s worth giving a brief overview of many of the disorders most commonly seen in adults.  While diagnosing disorders and understanding the “core” of what makes each disorder unique is quite complicated, I’ll do my best to remove technical details that don’t matter too much unless you’re a therapist.  Hopefully, you’ll walk away from this post with a solid basic understanding of what makes each diagnosis unique, and it may give some insight into symptoms you or someone you know may be experiencing.   

Anorexia Nervosa.  This is what most people think of when we discuss eating disorders.  The biggest feature of AN is restricted food intake that has led to very low body weight.  To be diagnosed with AN, people must have a very low BMI (and don’t get me started on how much BMI sucks as a metric, but it’s the simplest one we have so it’s what’s used).  But why are people low weighted in the first place?  Well, because under everything there is a big fear of gaining weight, and people who are diagnosed with AN suffer from constant thoughts about the weight and shape of their body.  People diagnosed with AN oftentimes believe they can never be too thin or small enough, and sometimes they cannot even see their own body realistically.  Oftentimes folks with AN will constantly think they are fat without any understanding of how small they truly are.

Binge Eating Disorder.  From the outside, BED looks like the opposite of AN.  But this isn’t as different from Anorexia Nervosa as you might think.  Just like AN, the underlying primary concern of many people with BED is how their body looks, what their weight is, and how big they feel.  However, even though that’s a big part of the mental components of this disorder, it’s only a small part of getting diagnosed.  To be diagnosed with BED, a person has to have regular binge eating episodes while also eating alone, feeling shame and guilt, and a few other things that we are on the lookout for.  No behaviors that compensate for overeating can be present, like vomiting, fasting, or taking diuretics.  If people do anything to compensate for overeating, the diagnosis will not be BED!

Bulimia Nervosa.  Think of BN as Binge Eating Disorder plus regularly doing things like vomiting, fasting, and intense exercise to offput the calories of binge eating and you’ll basically have it.  People need to regularly binge eat, followed by regular use of behaviors to compensate for overeating.  And hey, unsurprisingly, we also are looking for overconcern about body shape and body weight.  Because without being concerned about body weight, binge eating followed by compensatory behaviors would be quite rare.

Avoidant/Restrictive Food Intake Disorder.  This is a new diagnosis that didn’t exist in prior editions of our therapy manuals or psychological assessment materials.  The primary characteristic of ARFID is a “disturbance” in eating that leads to low food intake.  It could be due to having no appetite, being disgusted by foods/tastes/textures, or a bunch of other reasons, but never due to a medical illness or another mental disorder.  Basically, people diagnosed with ARFID just plain aren’t eating enough, and it’s led to some pretty negative outcomes like significant weight loss, nutrient deficiencies, or other concerns.

So that’s our whirlwind trip through the most common eating disorder diagnoses!  But I want to expand beyond these, because you may be asking yourself things like: “what if I am doing everything listed for Anorexia Nervosa but my BMI is 25?” or “What if I binge eat and vomit irregularly, sometimes once to twice a month, but most months not at all?”

You would be right to ask, and this is something that is very confusing for most people who experience some sort of disturbance in eating.  We have two additional diagnoses that people are oftentimes unaware of, but account for a pretty high number of all diagnoses.

Other Specified Feeding/Eating Disorder.  We lovingly call this one OSFED.  This is diagnosed when a person meets nearly all criteria for a disorder, but are missing one specific thing.  In the case of Anorexia Nervosa, this would be having a very low BMI.  In Binge Eating Disorder, this would be binge eating frequently each month.  In Bulimia Nervosa, it would be not binging or compensating for that eating frequently enough to get the diagnosis.  The list goes on – but if someone meets all but one criteria for an eating disorder diagnosis, they’ll likely be diagnosed with OSFED.

Unspecified Feeding/Eating Disorder.  This one is rarely diagnosed when you visit a therapist, because it’s mostly reserved for times when a full assessment isn’t able to be conducted, like when people go to an ER or at a brief medical visit.  If you see a psychologist, you’ll rarely (if ever) be diagnosed with an Unspecified Disorder, because your symptoms will fall under one of the other categories or you will not meet criteria for any eating disorder.

And now you know some of the basics about many of our eating disorder diagnoses for adults!  There are others that I have not covered here, but I hope this post gives more background on what a professional may be on the lookout for during therapy sessions, intakes, and consultations.  If you or someone you know experiences anything similar to what’s presented above, it may be worth taking a look at providers who have a knowledge base or training background in this area.