18.11 Body Dissatisfaction: Eating Disorders

Eating disorders are a group of mental health disorders that describe an individual’s struggle with internal arguments about food and eating, and in most cases, altered perception of their bodies. Eating disorders are complex disorders with both physical and psychological components. Although they are manifested through attitudes and behaviors surrounding food and the body, at the core, they have relatively little to do with food, eating, appearance, or beauty. Rather, they often co-occur with other mental illnesses such as depression, anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, and addiction disorders. In fact, alcohol and other substance use disorders are four times more common among people with eating disorders than in the general population (Harrop, & Marlatt, 2010). Like these other illnesses and disorders, eating disorders can be diagnosed only by a health care provider following specific diagnostic criteria.

Expert Perspectives: Definition of Eating Disorder

Video Transcript

Commonly Known Eating Disorders

Bulimia Nervosa is characterized by:

• eating abnormally large amounts of food in a relatively short period of time;
• feeling guilty for having eaten so much food and frustration over losing control; and
• purging in an attempt to alleviate these feelings, compensate for the food intake, and prevent weight gain.

Methods of purging include vomiting; abuse of enemas, laxatives, diuretics, or insulin; excessive exercise; and fasting or restrictive eating.

Anorexia Nervosa is characterized by:

• Extreme concern with body weight and shape
• Fear of gaining weight and losing control
• Self-starvation
• Excessive weight loss
• Feeling fat or overweight despite dramatic weight loss or low weight
• Denial about the problem

People with anorexia have a distorted perception of their bodies, viewing them as larger than they really are or in other negative ways and tend to associate their self-worth and value with body size and shape. Complete food restriction is rare; most people with anorexia do eat. However, they tend to eat small portions or low-calorie foods. Anorexia may also involve purging behaviors.

Binge eating disorder is characterized by recurring episodes of uncontrollable, impulsive, or continuous eating beyond the point of feeling full, generally followed by feelings of guilt, embarrassment, shame, or self-hatred. Most of us overeat now and then, but binge eating is different from typical, occasional overeating. It involves eating an amount of food larger than what most people would consume during a similar, specified amount of time and circumstance, feeling a lack of control over eating during the binge, and marked distress afterward. Unlike people with bulimia, people with binge eating disorder don’t purge, and they are often overweight or obese (Davis, 2015).

Other Eating Disorders

You may have heard of these more commonly known eating disorders, but several other eating disorders exist. Someone who exhibits signs, but does not meet the full criteria for anorexia, bulimia, or binge eating disorder, may be diagnosed with Other Specified Feeding or Eating Disorder—or OSFED—particularly if the disturbed eating behavior causes distress or impairs social, occupational, academic, or other important aspects of functioning. Further, it’s common for individuals with an OSFED diagnosis to progress symptomatically and be diagnosed as another eating disorder.

Orthorexia is another type of eating disorder characterized by an obsession with healthy or righteous eating. While the focus is on being healthy and it may appear to be healthy, orthorexia has an obsessive and rigid quality to it that can actually be unhealthy. People with orthorexia have developed strong beliefs about what is healthy and what is not and then become obsessive and restrictive according to those rules. They may measure all of their food, spend a significant amount of time thinking about and preparing food compared to participating in other activities, or avoid eating out or eating foods prepared by others as a way to maintain control over the foods they consume. The strict control they maintain over their diet may be related to efforts to control their weight or shape, but not necessarily.

Diabulimia is a non-diagnostic term describing the eating disorder behaviors of individuals with type 1 diabetes, which requires regular regulation of insulin via injection or pump. People with diabulimia manipulate the amounts of insulin they take for the purposes of weight control.