What's The Difference Between Eating Disorders and Disordered Eating?
By: Katherine Metzelaar, MSN, RDN, CD
When you are struggling with your relationship with food it can feel overwhelming and lonely.
And because of the dieting culture that you exist in, it can lead you to feel like there must be something wrong with you. If only you could figure out how to binge less, eat the “right foods,” follow the plan, get in control, jump back on the wagon, and cut out more food groups then things would feel better and things would improve.
This struggle around food often leads to feelings of shame (there’s something wrong with me) or guilt (I did something wrong) which only further perpetuate the challenging cycles with food that you may currently find yourself in.
You might feel like what you are experiencing is your fault and “it could be worse” when it comes to food. You might feel like you don’t want to go to the gym as much as you do because you’re missing out on social outings or time with your partner/friends, but you’ve convinced yourself that it’s healthy.
But even though you feel like most of the time you may be following the plan or you’ve got a handle on things, there is also a part of you that knows that things are not ok. And at times you’re wondering, do I have an eating disorder, disordered eating or nothing at all?
Why does it matter to know the difference between an eating disorder and disordered eating?
The normalizing of disordered eating and movement behaviors that is done by diet culture can lead many to not get the help and support that they need. So, when you can name what’s happening and define it, it can provide a tremendous amount of validation and relief. And despite the apprehension and ambivalence around changing your food and exercise behaviors, here are some reasons why being able to know the difference might be important to you:
I’m wondering: “Am I sick enough to deserve help?” Disordered eating is normalized in this culture and this leaves you feeling like no matter how bad things are it’s never “that bad” and that you don’t deserve help and support.
I want to be able to tell people that I’m not ok and feel validated. Some people are ignored when they say they aren't ok with food, others are put on diets, and others are told that they “look good” despite being very sick. Naming that things aren't ok, receiving some kind of validation in the form of naming the eating disorder or disordered eating can be very profound.
I don’t knowing how to share my experience with others and fear that people won’t take me seriously. Do I say I have an ED? Disordered eating? Messed up relationship to food? How do I tell people in my life that food isn’t going well so that they listen and don’t dismiss me?!
What Is An Eating Disorder and Where do they come from?
Eating disorders are defined as “serious but treatable mental and physical mental illnesses that do not discriminate and therefore can affect people of any age, body size, race, ethnicity, gender and sexual orientation.” The criteria to meet the clinical definition of an eating disorder is based on standards set by the DSM 5 (the manual used by mental health professionals for mental health diagnosing).
The development of eating disorders are believed to rise out of a trifecta of influence of biological, sociocultural, and psychological factors.
According to the American Psychological Association biological factors are “any physical, chemical, genetic, or neurological condition associated with psychological disturbances.” Some examples of biological factors that increase risk for developing an eating disorder are having a family member with an eating disorder, having a family member with a mental health condition, having a personal health condition such as type 1 diabetes, history of dieting, and not eating enough energy from food.
Sociocultural factors are “environmental conditions that play a part in healthy and adaptive behavior and well-being or in maladaptive behavior and development of a mental disorder.” Some examples of sociocultural factors that contribute to the development of an eating disorder are weight stigma, getting bullied or teased, internalized weight stigma and “ideal” beauty standards, loneliness/isolation, generational/historical trauma, and racism.
Psychological factors are “functional factors—as opposed to biological (constitutional, hereditary) factors—that contribute to the development of personality, the maintenance of health and well-being, and the development of mental and behavioral disorders.” Some examples of psychological factors that contribute to the development of an eating disorder are perfectionism, poor body image, personal history of an anxiety disorder, and behavioral inflexibility.
Some examples of types of eating disorders are:
Bulimia nervosa (with subtypes such as exercise bulimia)
Other specified feeding and eating disorder (OSFED)
Weight Stigma And Eating Disorders
Weight stigma is weight-based discrimination or assigned characteristics to a person based on their body size. In the case of eating disorders, many people are not assessed for eating disorders (or disordered eating) and are not diagnosed because of their body size. Those in the largest bodies experience the most discrimination and are most frequently overlooked. Weight stigma alone is known to contribute to increased risk for eating disorder development.
While weight stigma does not just occur for those that have eating disorders, it’s not necessarily a precursor to the development of an eating disorder. It is ubiquitous, ever present, and matters when talking about eating disorders and disordered eating. Weight stigma makes getting a proper diagnosis for an eating disorder that much harder. Not to mention, the same behaviors that allow someone to meet criteria for an eating disorder are the same behaviors that are promoted on diets.
What Is Disordered Eating?
The term disordered eating and eating disorders are often used simultaneously amongst clinicians or people that work in the eating disorder field, which can lead to a lot of confusion. This is confusion is especially true for those that are struggling with their relationship to food and are wondering, do I have an eating disorder? And if not, does what I am experiencing fall under the category of disordered eating?
While there are specific criteria for eating disorders because they are diagnoses, it gets more confusing when trying to understand if you’re experiencing disordered eating. This is partly due to the fact that eating disorders are a mental health diagnosis and disordered eating is a way of describing feeding and eating behaviors. Nonetheless, disordered eating is used to describe and categorize a range of eating and exercise behaviors that don’t always tick the boxes of meeting the criteria for an eating disorder, but still are considered disordered. An easier way to think of this is that not all disordered eating will fit the criteria of an eating disorder, but all eating disorders have disordered eating as part of them.
While experiencing disordered eating does not mean that you have an eating disorder, this doesn’t mean that you aren't suffering and that your behaviors don’t warrant support. More specifically, the main difference between diagnosing someone with an ED and someone experiencing disordered eating is severity, duration, and frequency of behaviors, and age.
In essence, the differential diagnosis is based on looking at eating and exercise behaviors on a spectrum. Eating disorders fall on one side of the spectrum and chronic dieting falls on the other. Then in between there is a range of severity, duration and frequency of behaviors.
Examples Of Disordered Eating:
Chronic or frequent dieting, which can include fasting, limiting foods or food groups, reducing calorie intake, and intentionally skipping meals
Weight cycling, which is the experience of gaining weight, losing it and gaining weight again over and over
Skipping meals
Self-induced vomiting
Use of dieting pills and supplement misuse
Very specific rules around food and food routines
Food and body size taking up a lot of headspace and time
Feeling like you can’t control yourself around food or specific food groups
Using food or exercise as punishment and/or as a means to “make up” for something that you ate
How do eating disorders and disorder eating overlap?
While there are some differences between disordered eating and eating disorder, there are more similarities than differences. Disordered eating casts a wider net and allows those that don’t meet specific eating disorder criteria to honor and get support and help in healing their relationship to food and their body. And, naming and defining disordered eating can allow for individuals to put words to their struggle and stop feeling shame and blame around their eating experiences.
Signs and symptoms of both disordered eating and eating disorders:
Chronic dieting
Punishing yourself for eating in a certain way by using exercise, food restriction, fasting or purging to “make up” for it.
Using water or voluminous foods like fruits and veggies to “trick” the body into feeling full
Fear around specific foods, food quantities, and good groups
Inflexibility and rigidity around food routines, plans, food prep
Feeling like there is something wrong with you because of the way that you eat or that you’re doing something wrong because of the way that you eat
Constantly thinking about food and exercise in a way that contributes negatively to your quality of life
Feeling out of control around specific foods and food groups
Significant weight fluctuations (weight cycling)
Is disordered eating harmful?
Existing in diet culture means that we assume that the way we interact, think about, and behave with food is normal when in fact for many often it’s very disordered. Dieting after all is a form of disordered eating. Not only this, disordered eating can lead to increased anxiety, social isolation, hormone disruptions, decreased bone density, significant weight fluctuations, fear around food, nutrient deficiencies, low energy, low sex drive, and much more.
While there are many that meet criteria for an eating disorder, there are many more suffering from disordered eating. Disordered eating is harmful because not only can it cause physiological problems like nutrient deficiencies and weight cycling, but it also causes you to be afraid of food and for food take up a lot of headspace. Disordered eating leaves you feeling like you need to “make up” for eating, cut out food groups in the name of “health”. It also disrupts your ability to experience spontaneity and freedom with food. It steals life from you.
Knowing the difference between eating disorders and disordered eating is important, but no matter where you are with your relationship to food, please know that you deserve support. You don’t have to have an eating disorder to be struggling and you don’t need anyone to give you permission to seek help. Disordered eating and exercise behaviors are so normalized in this culture that you may have suffered in plain sight. It’s never too late to start healing your relationship with food and your body!
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Do you suspect you’re experiencing disordered eating or an eating disorder and wonder if you should get support?
The caring dietitians from our Seattle, WA-based nutrition counseling practice would be honored to help you heal your relationship to food and your body and help food to stop taking up so much headspace. We offer a variety of services including support for eating disorders, body image, intuitive eating, bulimia treatment, anorexia treatment, and chronic dieting. We also offer a body image support group. For more information, please feel free to visit our blog, FAQ, resources page, or contact us now!