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Updated: May 10

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, 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