Disordered eating vs. eating disorder

It’s important to learn about the differences between disordered eating and an eating disorder, what to look for, and when to get help, because disordered eating can progress to full-blown eating disorders, and eating disorders are very serious, complex mental illnesses that can have dire medical complications. And living in a culture in which eating disordered behaviors are socially acceptable makes it that much harder to recognize when disordered eating behaviors progress do evolve into eating disorders.

What is disordered eating?

There are many types of disordered eating (DE) behaviors and characteristics. They include: (1,2)

• Engaging in what are called unhealthy weight control behaviors (UWCBs), such as:

1. Restricting food intake in any way, including intermittent fasting, skipping meals, “cutting calories,” or cutting out certain foods, food groups, or ingredients in foods
2. Purging through vomiting, laxatives, diuretics, or excessive exercise
3. Using medications to control appetite

• Increased food consumption and decreased food consumption
• Engaging in rigid, odd, obsessive, or elaborate food or eating rituals
• Fear of gaining weight
• Negative body image
• Dissatisfaction with or distorted perception of body shape, size, or features (body dysmorphia)
• Both negative and positive weight talk, both self-directed and directed at others
• Attaching value to food and labeling food as “good,” “bad,” “healthy,” “unhealthy,” etc.
• Avoiding social gatherings that involve eating
• Hiding or hoarding food
• Using food substitutes

Unfortunately, many UWCBs have become socially acceptable, almost normal, among athletes and young adults. Disordered eating behaviors are often rigid and create feelings of guilt, anxiety, and shame, while normal eating is pleasurable and flexes around feeling hungry, someone’s schedule, and proximity to food. 

While food planning is necessary, thoughts about food should not dominate someone’s life. For example, an athlete who misses a work-out may feel guilty, and thus undeserving of a meal that day. This becomes disordered eating when they only allow themselves to eat if they exercised that day, despite feeling hungry. (2) It can further progress into an eating disorder if the person loses a dangerous amount of weight, suffers bodily harm from starvation, feels guilty at every meal, and can only eat “good” food. Exercising excessively to compensate for food eaten is also a disordered eating behavior.

Disordered eating leads to nutrient deficiencies and excessive, rapid times of weight gain or loss. (2)

Disordered eating and weight loss methods can cause you to feel: (3)

• Distressed
• Incompetent
• Alone
• Isolated
• Hopeless, helpless,
• Trapped or like a personal failure
• Suicidal ideation 

What causes disordered eating?

Some healthcare professionals and researchers have been well aware of the ongoing sociocultural pressure to have an idealized body shape. (4) But what pushes someone over the edge? Many things can steadily nudge someone toward disordered eating, such as: (5)

• Stress
• Uncertainty
• Worry
• Hopelessness
• Social Isolation
• Extreme loss, such as the loss of a job or a loved one

All these things can make someone feel out of control. While most people experience many unfortunate things in life and learn more helpful ways to cope, disordered eating behaviors can also be a way to cope and can progress into an eating disorder. 

Recent research during the pandemic found the following to be some of the greatest triggers for disordered eating: (1)

• Food insecurity
• Depressive symptoms
• Financial difficulties
• High stress
• Abrupt schedule changes

For younger children around age 13, a significant association was found between social media accounts (Instagram, Facebook, etc.) and disordered eating. Strict exercise regimens and skipping meals were the most commonly reported behaviors. (6)

How do I treat disordered eating?

Studies have shown increasing benefit in mindfulness, acceptance-based approaches, and yoga in treating disordered eating. (7) Several psychotherapeutic approaches have been found to be effective, as well, including cognitive behavioral therapy (CBT). (8)

Comparing disordered eating vs eating disorders

An eating disorder (ED) is characterized by severe, persistent disordered eating patterns that significantly impair health and functioning. Some examples include bulimia nervosa (BN), anorexia nervosa (AN), or binge eating disorder (BED). 

Another key distinction of an eating disorder is the duration of symptoms. For example, a diagnosis of anorexia nervosa requires that someone have a BMI less than 18 with symptoms persisting daily for a minimum of three months. 

Binge eating disorder requires having episodes of bingeing at least once a week for three months. Disordered eating behaviors may not be as consistent, with varying times of intensity, based on mental and environmental factors. (2,8)

While these are the criteria that currently exist, we must point out that evaluating health and illness using body weight and BMI is inaccurate, because weight is not a measure of health, and eating disorders are very complex, with symptoms presenting differently in each person. And growing awareness of the role weight stigma, implicit bias, and privilege play in determining diagnostic criteria for eating disorders and other illnesses, as well as disordered eating and eating disorders themselves, is slowly initiating a change in diagnosing and treating eating disorders. 

But any severe preoccupation with body image, weight, and food can lead to serious medical complications, bodily injury, and even be fatal. Medical intervention may be needed and inpatient help required to restore the body and mind with close medical supervision and intensive counseling. (8) Eating disorders do not go away on their own without highly specialized, multi-disciplinary treatment. However, full recovery is possible.