As eating disorders and disordered eating specialists, we're asked a lot about relationships to food. One question we're always asked is: “how do I know if I have an eating disorder?” and “do I have an eating disorder?”
You might be here because you’ve Googled something similar. But Google isn’t always the best source of information. As experts in eating disorders and disordered eating, we can shed some light.
The thing with black and white answers to questions like “do I have an eating disorder?” is that they can sometimes be unhelpful. It would feel awful and invalidating to be told you don’t have an eating disorder, when you’re really struggling. That’s why we don’t agree that eating disorders should be put into a one-size fits all box.
No one person with an eating disorder believes, feels, or acts the same as someone else. So if you have ever felt invalidated by a professional, or some sort of article online; we believe that you’re struggling. And if you think you need support, then you do.
What is an eating disorder?
Firstly, what constitutes an eating disorder? That’s probably a pretty good place to start.
It sounds pretty simple, but actually I find this question a tiny bit difficult. If you’re looking for the clinical definition of an eating disorder it would be:
An eating disorder is a complex mental health condition where the controlling of food is used to cope with other situations.
But if you’re looking for a more “real-life version”, we think eating disorders are:
Behaviours and/or mental attitudes to food and body that are unhelpful, harmful, and uncomfortable.
This fits in more with what I see in my clients. All relationships to food are deserving of support, no matter the diagnosis, severity, or length of time they’ve been difficult.
How many eating disorders are there?
There are a range of eating disorders which are all described in the Diagnostic Statistical Manual for Mental Disorders (DSM-5). This is a tool used by clinicians to diagnose all mental health conditions.
Types of eating disorders
The current DSM includes these eating disorders:
1. Anorexia Nervosa (AN) centres on restriction of energy intake relative to needs which can lead to a lower body weight for age, sex, and physical activity.
Note: this is flawed in regards to the weight criteria. Those with AN may have an intense fear of gaining weight and so show persistent behaviour that interferes with weight gain.
AN is subdivided into AN restrictive type, and AN binge/purge type.
2. Bulimia Nervosa (BN) involves repeated episodes of binge eating (eating an amount of food in a defined time period that is larger than most individuals would eat under similar circumstances, coupled with a feeling of no control over overeating during the episode).
This is normally coupled with compensatory measures to make up for food, guilt, or to start anew.
Compensatory measures include self-induced vomiting, exercise, laxatives, diuretics, restriction, or going on a new diet.
3. Binge Eating Disorder (BED) is characterised by recurrent episodes of binge eating (see above for what this constitutes).
The episodes are associated with any of the following: eating quicker than normal, eating until uncomfortably full, eating a large amount when not physically hungry, eating alone due to embarrassment, or feeling guilt and shame afterwards.
4. Other Specified Feeding and Eating Disorders (OSFED) applies to symptoms that are characteristic of an eating disorder that cause distress or impair functioning. But the symptoms do not meet the full criteria for any other eating disorders.
Examples include atypical AN (Note: we will discuss the harm of this term in a future blog), BN of low frequency, purging disorder, and night eating syndrome.
5. Avoidant / Restrictive Food Intake Disorder (ARFID) is an eating or feeding disturbance causing a persistent failure to meet nutrient and energy needs. ARFID can be associated with significant weight loss, and nutrient deficiencies. People with ARFID may also be dependent on enteral feeding or nutritional supplements.
6. Unspecified Feeding or Eating Disorder (UFED) applies to symptoms that cause significant distress / impair functioning but do not meet the criteria for any disorders. Often used when there is insufficient information to specifically diagnose.
7. Body Dysmorphic Disorder is a preoccupation with perceived flaws in physical appearance that others may not see or that appear slight. The individual might perform behaviours like mirror checking, skin picking, reassurance seeking etc. repeatedly. This preoccupation causes significant distress or impairs function.
8. Orthorexia Nervosa (ON) is not clearly defined in the DSM-5 but has been proposed to refer to an obsessive focus on eating “healthy.” The definition of “healthy” which may vary among individuals. Any violation of self-imposed “rules” can lead to negative thoughts and feelings.
There may be a fear of disease, feeling impure, and guilt/shame. This can lead to malnutrition, weight loss, or medical complications. There is of course the phycological element which can be isolating and lead to poor mental health.
9. Pica is when there is a persistent desire to eat non-food stuff. Including paper, ice, dirt, soap, or clay. It is most common during pregnancy, autism spectrum disorder, and other conditions.
10. Night eating disorder is when someone has recurrent episodes of eating after waking up at night, or having excessive food intake after the evening meal. This causes distress and/or impairment in functioning.
How do eating disorders develop?
Now you can see just how many types of eating disorders there are, you might be wondering how they actually come around.
“How do eating disorders develop?” is such a common question I’m asked. It can be incredibly frustrating if you have no idea why. It’s tough to know the exact “why” because eating disorders are a biopsychosocial model. This is pretty fancy talk.
But it means that eating disorders develop with genetic, social and environmental influences coming together. Therefore the exact cause can be hard to pinpoint.
This is why no two people’s eating disorders will be the same. Everyone’s factors leading to an eating disorder aren’t identical, so there’s really no one size fits everyone.
Here is a little bit of insight into the genetic, social, and environmental factors that influence someone’s relationships to food.
Genetics: there have been numerous studies showing genetics play a part in the development of eating disorders. If you’re a first degree relative of someone who has, or has had, an eating disorder, you are 7-12 times more likely to develop a disorder. Another study also found that eating disorders can be attributed around 40-60% from genetic factors.
We want to make it super clear that just because you have a family history of eating disorders, it doesn’t mean you will one. It also doesn’t mean it’s anyone’s fault that someone has an eating disorder.
Social factors: Sociocultural expectations of thinness can be seen as a risk factor for all eating disorders. In regards to the media there are a few theories on eating disorder development – cultivation theory (the more an individual is exposed to the media the more they view it as realistic), social comparison theory (individuals compare themselves to their improved selves, others and those they deem themselves similar to) and objectification theory (the media objectifies women and bases their worth on appearance, young girls see and respond to this).
The social factors are probably the most spoken about, especially social media and other media.
Environmental factors: This is where genetics and social factors combine with things like upbringing, trauma, living arrangements. For example, one study found that a difficult upbringing with neglect was linked to around a 3x risk of eating disorder development (ref). Other environmental factors include parental influence, social isolation, and peer pressure.
The Loaded Gun Theory is a really great metaphor here. It’s where if someone is genetically predisposed to eating disorders, this is the “loaded gun.” Then their environment and/or social factors can come together to pull the trigger and lead to an eating disorder.
Signs of an eating disorder
Now that we’ve covered what an eating disorder is, types of eating disorders, and how they develop, it’s time to discuss the signs. As a keep repeating, there’s no list that every single person with an eating disorder will fit. There are loads of different eating disorders, and in people with the same type, they vary in symptoms.
The most common eating disorder symptoms we see are:
Spending a large amount of time worrying about your weight and/or body shape
Being preoccupied with food
Feeling like you can't cant stop eating
Avoiding situations where food is involved, especially social situations
Making yourself sick, taking laxatives, or diuretics after binge eating. Or after eating a small amount of food
Making up for food by limiting what you eat the next meal or day. Or feeling like you should - and often feeling guilty/a failure when you don’t
Exercising to make up for food. Or feeling like you need to exercise a set number of times/minutes per week
Feeling guilty for not exercising enough
Having strict habits and routines around food
Feeling like you need to find the next new diet
Spending time watching a lot of food videos including “what I eat in a day” videos or healthy recipe Tik Toks
Spending a lot of money on food
Feeling like you can’t live fully until your body has changed
Physically signs like heart racing, fainting, feeling faint, poor circulation, brittle nails and hair, dry skin, feeling cold and tired, digestive problems, amenorrhea (not getting a period).
Signs a loved one may have an eating disorder
I’m often contacted by parents, partners, or friends who want support to help their loved ones. The most common signs to look out for include:
They express concerns about their body shape or weight
They go to the bathroom after meals
They have outbursts of emotion around mealtimes
Always wanting to eat alone
Spending a lot of money on food, including from health food shops, online grocery shops, or takeaway
Avoiding social situations in which there is food, like family dinners. They might avoid celebrating holidays with food, like Valentines Day or Easter
There’s an increase in their exercising. Or anxiety when they cannot exercise. They might also try to fit in exercise when it seems a bit off, like waking up really early to go to the gym
They seem to have less energy and interest in activities they once enjoyed OR they become the opposite. They take on all activities and responsibilities and gives 100% - this is really common when it’s relating to food or body. An example might be picking up a new sport or gym routine/course
Ultimately it doesn’t matter how severe or how long something hasn’t felt right. If something feels off, your loved one probably needs some support.
Eating disorders are complex, this is why they need specialist support.
What does disordered eating mean?
Although there is a crossover between disordered eating and an eating disorder, they are separate things. Both deserve support, but the level of support will differ.
We often think of eating disorders as scary clinical conditions and pass off disordered eating. But the main difference is that eating disorders require additional medical monitoring, tend to need longer term support, and often need a multidisciplinary team.
Someone with disordered eating (depending on the severity) might require support from just one professional. This might be weekly appointments with an eating disorder nutritionist or dietitian, or with a therapist.
Whereas someone with an eating disorder might need weekly appointments with both their nutritionist/dietitian, their therapist, and they might need routine check-ups with their GP or other professionals.
Now onto some other commonly asked questions about eating disorders…
Are eating disorders just about weight?
A focus on weight is just a small component of some eating disorders. Very often controlling food intake is a way to cope with another situation. Some people may never experience a change in weight, or focus on their weight when experiencing an eating disorder.
If I were to ask a room full of everyday people what you imagine a person with an eating disorder would look and be like, I would probably get the answer: very thin, white young woman or teenager, who is very type A personality.
But this is really not true. This is what the picture of an eating disorder we’ve been painted. But people of all genders, skin colours, ethnic and cultural backgrounds, and personality types have eating disorders.
“Eating disorders only affect thin people” - Only around 6% of people with eating disorders have a BMI below ‘normal’. By focusing on an individual’s weight, the relationship with food and their own body may be glossed over as they’re not ‘thin enough’ to be suffering.
“Eating disorders are most common in white people” - In fact, Brown and Black people are at a higher risk of eating disorders. Studies also show that Black and Brown people have higher rates of bulimia, anorexia, and binge eating disorder. But they are less likely to seek support, and less likely to get support than white people.
“Only women experience eating disorders” – people who identify as men account for 25% of those in the UK suffering with eating disorders. Assuming someone’s gender affects their experience of a disorder may prevent them from seeking treatment. I also want to note that gender non-conforming people have some of the worst treatment for eating disorders, so if that’s you, I’m sending support.
“They’re not losing weight so they don’t have an eating disorder” – Someone can suffer from an eating disorder without losing weight. In fact, someone might gain weight.
“They’re too young to suffer from an eating disorder” – Eating disorders can develop at any age and there are increasing reports of children being diagnosed. The inverse is also true, eating disorders can affect you at any age. In fact, one study looking at people over 70 found that 40% of women reported bulimia behaviours.
“Once they gain weight their disorder is cured” – Weight restoration is a small part of some people’s recovery. Weight restoration is also a tiny part of recovery. I hope it’s clear from this blog that there are so many behavioural and mental symptoms of eating disorders. These don’t just disappear when someone's weight restores.
“Eating disorders are just diets gone wrong” – Although eating disorders can begin with dieting, they may not include restrictive eating. And dieting is a major risk factor for the onset of eating disorders. Eating disorders can also include behaviours deemed out of the individual’s control whereas a diet is a method of control. See our blog "what counts as an eating disorder" which explores a little more the differences between dieting and an eating disorder.
I think I have an eating disorder – what now?
Firstly, appreciate how much courage that takes to admit to yourself and take that courage with you as you face recovery. If you feel comfortable, you can confide in a friend or a family member who can support you.
And know that you’re not alone. Between 1.25 to 3.4 million people in the UK are living with an eating disorder right now.
Charities like Beat offer emergency support and signposting, but if you are looking for treatment I have provided more information below. Before I dive into treatment, here are answers to some questions you might have:
Do I need a diagnosis to seek help? – You don’t, and in fact eating disorder diagnoses are not super common. Any eating disorder professional can help you without a diagnosis.
Although you may want a diagnosis to give a name to what's going on. It can be difficult getting a concrete diagnosis, and once diagnosed your condition may change with many individuals experiencing a spectrum of eating disorder symptoms crossing over diagnoses as they move through recovery.
How do I find someone to help? – Eating disorders are a specialist area meaning many individuals working in this area will only work there. Beware of those with many specialities, who view eating disorders as a kind of “add-in” rather than their core speciality.
Online vs. in person support? If you are someone who prefers to speak face to face you can find in person support. But there is an increasing shift to online. It allows you to have appointments at times that suit you. Not being in the same room as the individual may also help to open up and share how you are feeling.
HAES aligned? The HAES approach focuses on eliminating the effect of weight stigma on psychological, behavioural and physical health. It will be hard to change your mindset toward your body without dismantling beliefs about weight and health. As HAES-aligned eating disorder professionals, we really believe all eating disorder professionals must be HAES-aligned.
How does an eating disorder nutritionist help?
An eating disorder nutritionist can help you restore a healthy relationship with food. They specialise in this area so are best equipped with how to approach recovery and support you during/after.