Different Eating Disorders

Up until now we have focused primarily on Binge Eating.  However, we have to acknowledge that there are several eating disorders that are diagnosed in adults, and I want to explore these briefly in today’s blog post.

A bit of warning before we dive right in – 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!

Anorexia Nervosa.  This is what most people think of when we discuss eating disorders.  It’s characterized by some very specific concerns and behaviors.  The biggest is that restricted food intake has led to significantly 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).  But why are people low weighted in the first place?  Well, because they also have a significant fear of gaining weight, and they also have to be overconcerned with their body weight and body shape.  Sometimes we will also see symptoms of body dysmorphia, wherein people cannot accurately experience their body shape in an objectively realistic way.  But that’s a topic for another post in the future.

Binge Eating Disorder.  This isn’t as different from Anorexia Nervosa as you might think.  There is a very large part of this disorder that is driven by overconcern about body shape and weight, just like in AN.  However, that’s not a big part of the diagnostic process.  To diagnose BED, we are looking primarily for the presence of regular binge eating episodes and some associated behaviors and emotions (eating alone, shame, guilt, and others).  No compensatory behaviors allowed for a diagnosis of BED!

Bulimia Nervosa.  Think of BN as Binge Eating Disorder plus compensatory behaviors and you’ll basically have it.  People need to regularly binge eat, followed by regular use of compensatory behaviors (see the second blog post for much more detail on what these are).  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 other concerns, but never due to a medical illness or due to another mental or eating 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 basic 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, anywhere from 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 significant 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 AN, this would be the low weighted criterion.  In BED, this would be the frequency or number of times per month binged criterion.  In BN, it would be not binging or compensating frequently enough to get the diagnosis.  The list goes on – but if you meet all but one criteria for an eating disorder diagnosis, you’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, such as at an ER or at a brief medical visit.  If you see a psychologist, you’ll rarely (if ever) be diagnosed with this disorder, because your symptoms will fall under one of the other categories or you will not meet criteria for an eating disorder.

And now you know some of the basics about all of our eating disorder diagnoses for adults.  There are others, but I personally have not worked with them or seen them as a clinical psychologist, so I couldn’t go into detail on them.  However, if you’re looking for a really interesting one (that I hope you don’t experience), you should take a look at the Wikipedia entry for Pika.