What is disordered eating?
Just because I specialize in eating disorders does not necessarily mean that all of my clients meet the clinical definition of having one. In fact, a large portion of my caseload more appropriately fit the description of suffering from “disordered eating” instead. What does this mean, and what’s the difference between disordered eating and having a fully diagnosable eating disorder?
The biggest factor in diagnosing an eating disorder (besides looking at the symptoms clients are reporting) is the level of dysfunction the behaviors are causing in the life of a client. For clients with eating disorders, they are often arguing more with their parents, spouses, or children around food and exercise; they are unable to exhibit any kind of flexibility in their routines, even when this negatively impacts those around them. They may be starting to experience negative physical side effects from poor nutrition (and this applies to all eating disorders, not just anorexia) - fatigue, difficulty concentrating, changes in hunger/fullness, poor sleep, swelling, dizziness and lightheadedness, headaches, GI issues, and low heart rate, just to name a few. They may be noticing that their quality of work is slipping at their jobs or in school, or it takes significantly more effort to maintain the same level of performance. Internally, they often have a very low self-esteem and sense of self-worth and may be experiencing a co-occurring mood disorder, like anxiety or depression, or sometimes something deeper like PTSD.
Now, that’s not to say that someone struggling with disordered eating may not experience some of these issues too. However, in my experience, there is a level of awareness that the rigidity is not healthy, that these patterns are covering up some kind of deeper issue. Clients struggling with disordered eating may recognize that they’re exhausted from trying to maintain all their rigid rules all day. They may feel guilty about certain mealtime experiences, but they will usually at least attempt to fit in with the world around them, knowing on an intellectual level that, for example, skipping cake at their child’s birthday would be weird and unhealthy. They often are not reporting that their relationships are suffering or they are having difficulty working, but internally, they feel a very high level of stress as they try to seem “normal” to the world around them.
I have found that most people, women in particular, have experienced some kind of disordered eating in their lives. For some, it stays in their heads, meaning they shame themselves for what they eat or how they exercise (or how little they do), but they do not necessarily act on changing any of their behaviors. For others, they may have dieted on and off or tweaked their food and exercise routines during certain life transitions or major life events, like the lead up to their wedding, following the “freshmen 15,” postpartum, or with the onset of menopause. When this happens, they may not meet the criteria for anorexia, bulimia, or binge-eating disorder, but for some, they may meet the criteria for Other Specified Feeding or Eating Disorder (OSFED), which basically means they are experiencing significant distress around their relationship with their bodies, food, and exercise but do not meet the definitions of the aforementioned eating disorders. And guess what? Even without the OSFED diagnosis, someone can still benefit from meeting with an eating disorder specialist (both a therapist and a dietitian) if they want to feel healthier.
What would healthier look like? No guilt or anxiety around food and exercise. Keeping nutrition in mind while making choices around food but not making that the primary focus with every single meal, every single day. Using mealtimes to connect rather than count calories or macros. Exercising in ways that feel good, not because some influencer online said it helped her lose 20 pounds. Being flexible when plans around food change. Believing that foods don’t fall under “good” or “bad” but understanding that moderation is important from a nutritional perspective. Having full access to hunger and fullness cues and honoring them when possible (because yes, life gets in the way sometimes). Having more brain space to get creative, love, connect, and rest without guilt or shame or self-criticism.
If anything in this post resonates with you, reach out for a free 15-minute consultation call to see how therapy can help you!
