The most commonly used diagnostic manual (DSM-V) describes two main eating disorders, Anorexia Nervosa and Bulimia Nervosa, with a third category which goes by the rather unwieldy name Eating Disorder Not Otherwise Specified or ED-NOS, which is a category  used for eating disorders of clinical severity that do not meet the criteria for either Bulimia or Anorexia Nervosa.

 

Criteria for eating disorders

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The main criteria for a diagnosis of Anorexia Nervosa are persistent restriction of dietary intake leading to significantly low body weight, intense fear of gaining weight or becoming fat with sustained patterns of behaviour that prevent weight gain, and body image disturbances such that weight and shape have undue influence on the sufferer’s self-evaluation. This is complicated by the fact that sufferers fail to recognise the serious implications of their low body weight, and commonly feel that those around them are worrying unnecessarily.

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The main criteria for Bulimia Nervosa are body image disturbance and an overvaluation of weight and shape as in Anorexia Nervosa, along with recurrent episodes of binge eating not seen in Anorexia. During binges an objectively large amount of food is eaten and the sufferer experiences a distressing sense of loss of control. Individuals with Bulimia engage in extreme weight control behaviour in attempts to compensate for the binge eating, such as dietary restriction, self-induced vomiting and/or laxative and diuretic misuse.

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We see overlap in these sets of diagnostic criteria, and in all types of eating disorders the core problem is the body image disturbance and over-concern with weight and shape. This is to be distinguished from body shape dissatisfaction which is a common experience in the population, and does not result in extreme behaviours to control weight and shape.

 

Common eating disorder behaviours

 

The over-concern with weight and shape is largely responsible for the range of behaviours we associate with eating disorders.

 

Weighing and Body Checking. Many people weigh themselves excessively and then over-interpret insignificant changes in weight through the day or from one day to the next, allowing these weight changes to dictate eating and exercise patterns. Other sufferers may avoid weighing altogether although they remain preoccupied with thoughts about their weight. Shape or body checking is similar, with people being intensely preoccupied with the shape and apparent size of particular body parts, commonly stomach and thighs, which leads to repeated and excessive checking of their appearance.  Comparisons with others are common, as are distressing experiences generally described as “feeling fat”.

 

Dietary Restriction. Body image disturbance and over-concern with weight and shape also has a profound effect on eating habits, resulting in sustained attempts to limit dietary intake. This dietary restriction is often the most obvious feature of all of the eating disorders, and can have profound and far-reaching effects. Commonly, sufferers have a large number of dietary rules concerning what, when and how much food they can eat, and these rules result in rigid and restricted eating patterns.  People often prefer to eat alone, may count calories, struggle with deciding what to eat, avoid eating food of uncertain content, and find their concentration affected by intrusive thoughts about food.

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The effectiveness of attempts at dietary restriction vary of course, with some sufferers becoming extremely underweight. Being significantly underweight obviously has very serious medical consequences, and in addition affects psychological functioning. A person who is underweight and under-eating becomes very preoccupied with food and eating, tends to withdraw socially and becomes increasingly obsessional and rigid in their thinking.

 

Compensatory Behaviours. These are behaviours designed to pre- or post-compensate for perceived or actual episodes of over-eating, and are common across all the eating disorders. Excessive exercise is used as a compensatory behaviour, with sufferers being unwilling to eat unless they have completed a certain amount of exercise, or being unable to resist a strong urge to exercise heavily after eating or over eating. Avoiding food during the day prior to a dinner out with friends is a common example of using dietary restriction as a pre-compensatory behaviour, while not eating until lunch time on the day after the dinner out is a form of so-called post-compensation. Purging behaviours like self induced vomiting and misuse of laxatives also reflect attempts to compensate for perceived or actual over-eating or binge eating.

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Other problems associated with eating disorders

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All eating disorders are associated with a range of medical and psychological consequences. In addition, social and family relationships are highly likely to be affected, as are people’s ability to function in recreational, academic and occupational spheres. Depression and anxiety often co-occur with eating disorders.

 

Often sufferers of eating disorders feel considerable shame and embarrassment about their food and eating behaviour, and this can be a significant barrier to seeking help. If you or someone close to you experiences difficulties with disordered eating please consider making an appointment with me, in the knowledge that you will receive compassionate and experienced psychological help.  While I understand that you may feel distress or anxiety coming to your initial appointment, I encourage you to try to keep in mind that I have worked with many people with eating disorders, and that many of my clients describe problems very similar to those you may be having.