There are many different types of eating disorders and, within each one, there is a scale of severity. It is a myth that you can tell how much someone is suffering based solely on their appearance; eating disorders are mental illnesses, of which changes in weight can be a symptom. All eating disorders are dangerous and all eating disorders can destroy lives, which is why everyone deserves support. Whether you have have a formal diagnosis or not, whether you have received treatment before or not, whether you have struggled for years or months, you deserve the help you seek.
The main diagnostic categories of eating disorders are explored below. It is important to remember that sometimes people can be suffering with a serious eating disorder and, for a number of different reasons, not meet all the diagnostic criteria for one particular illness. Sometimes people straddle 2 different disorders, sometimes people move from one to another… no matter what your story is, you deserve help.
Anorexia Nervosa (AN)
People with anorexia struggle with obsessions about food, weight and body shape. Weight loss becomes of primary importance, often to the exclusion of everything else. These weight and shape concerns may lead to frequent weighing, body checking (e.g. taking photos, looking in mirrors etc), intense fears of becoming “fat”, dietary restriction and/or excessive exercise. For someone struggling with anorexia even slight fluctuations in weight can dramatically impact their mood and they may take more and more extreme measures to lose weight. These may include persistent restriction of energy intake, meticulous tracking of food intake, avoidance of particular foods, or even entire food groups, skipping meals or fasting, compulsive exercise, or purging behaviours (e.g. self-induced vomiting). People with anorexia may experience disturbances in the way they perceive their bodies and therefore not recognise the seriousness of their illness and the risk their behaviours and/or low body weight poses to their health.
Bulimia Nervosa (BN)
Bulimia often starts following a period of attempted weight loss. Off the back of caloric restriction, the person may experience strong urges to binge eat, which is defined as eating a larger than normal amount of food in a short (usually <2hours) time period whilst experiencing a perceived lack of control. Binge eating may then be followed by intense feelings of guilt and fears of weight gain which leads the person to engage in compensatory behaviours. These may include self-induced vomiting, laxative abuse, fasting, dietary restriction and/or excessive exercise. While these behaviours may begin from a place of weight control, they can quickly become a stress management tool, a way to suppress unwelcome emotions and cope with life. Once the cycle of binging and compensating which often characterises bulimia is established it can be incredibly difficult to stop. As with other eating disorders, we typically see a sufferers self evaluation becoming unduly influenced by body shape and weight, obsessions developing around food and weight and, outside of episodes of binge eating, rigid dietary patterns and rules taking over their lives. Bulimia can also have a wide range of significant health implications due to the dietary restriction, binge eating, and/or compensatory behaviours (such as frequent vomiting).
Binge Eating Disorder (BED)
Like bulimia, binge eating disorder is characterized by episodes compulsive overeating. During a binge episode the sufferer may consume a large amount of food, usually in a relatively short time period, while feeling out of control and powerless to stop. Following the binge, the person may feel extremely distressed, ashamed or guilty about what they have done. They may also feel physical discomfort due to extreme fullness. The person may make attempts to hide their binge from those around them, however, they do not usually engage in compensatory behaviours such as over-exercise or purging. As with other eating disorders, food becomes a way of avoiding difficult emotions and coping with stressful situations in life. Someone struggling with binge eating disorder may feel compelled to binge eat when upset in much the same way someone with anorexia may feel driven to restrict their intake. There are often far more similarities than differences across all types of eating disorders because, ultimately, they are not truly about the food, but the feelings underneath.
Other Specified Feeding and Eating Disorders (OSFED)
OSFED can sometimes be considered a catch-all category for presentations that don’t fit into the above diagnostic categories. As mentioned above however, this does not make it any less serious. Those who do not clinically meet all the criteria for one of the above diagnoses may be suffering just as much, be at just as high a risk of physical health complications, and deserve as much help, as someone with any other diagnosis. Examples that may come under the OSFED heading include:
● Someone who meets the criteria for anorexia but their weight remains within or above normal range, potentially despite significant weight loss.
● Someone who meets the criteria for bulimia or binge eating disorder but with a lower frequency or shorter duration.
● Someone struggling with purging disorder, which is where purging behaviour (e.g. self-induced vomiting) is used regularly as a means of controlling weight or shape without a preceding episode of binge eating.
● Someone with night eating syndrome, whereby they experience recurrent episodes of overeating solely at night