Disordered Eating: What Are the Symptoms and How Does it Differ From Eating Disorders?
As a dietitian that works with clients that exhibit disordered eating behaviors, I think it is important for more people to understand what exactly “disordered eating” is and how it occurs. There tends to be a fine, almost fluid line when it comes to dieting vs. disordered eating vs. eating disorders, so having more information on the matter is key. I myself have dealt with disordered eating patterns in the past and from experience I can tell you that it is slippery slope. Acknowledgement of the issue is KEY to preventing any further damage, both psychologically and physically. So let's dive into disordered eating and ways to begin a healthier relationship with food.
What is disordered eating?
According to the Academy of Nutrition and Dietetics, “disordered eating patterns describe a range of irregular eating behaviors that may or may not warrant a diagnosis of a specific eating disorder.” Disordered eating is a term to describe a large array of maladaptive behaviors that one may exhibit and can look different for different people. Examples include: preoccupation with food and your body, negative feelings like guilt, shame, or anxiety around eating certain foods, using “food rules” such as not being able to eat a banana as it has “too much sugar”, using exercise or restriction to make up for previous food choices or calorie intake, not being able to control oneself around certain foods, a history of chronic dieting, frequent weight fluctuations, and/or very rigid routines around meals and exercise.
What is an eating disorder?
To be classified behaviors as an eating disorder, the behaviors must “cause clinically significant distress and impairment” and the set of behaviors must collectively fall under a DSM-5 diagnosis. DSM-5 stands for the fifth version of the “Diagnostic and Statistical Manual of Mental Disorders", a reference book written by the American Psychiatric Association. An example of an eating disorder and diagnostic criteria would be anorexia nervosa with the following criteria: “restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health, an intense fear of gaining weight or becoming fat, even though underweight, and finally a disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.”
Within the overarching term of disordered eating, there is a clinical diagnosis known as OSFED. OSFED stands for other specified feeding or eating disorders and is technically an eating disorder, but tends to not meet all classification requirements of other eating disorders. For example the patient has an intense fear of gaining weight and a major disturbance in how they experience their body like with anorexia nervosa, but is not underweight.
The OSFED diagnosis makes up over half of all eating disorder diagnoses and is still a very serious risk to physical and mental health. According to the National Eating Disorders Association (NEDA), psychological warning signs of OSFED include: weight loss, dieting, and control of food becoming primary concerns, preoccupation with weight, food, calories, fat grams, and dieting, refusal to eat certain foods, progression to restrictions against whole categories of food (e.g., no carbohydrates, etc.), constant commentary about feeling “fat” or overweight despite weight loss, frequent checks in the mirror for perceived flaws in appearance, frequent dieting behaviors. While physical signs include “noticeable fluctuations in weight, both up and down, body weight is typically within the normal weight range; may be overweight, stomach cramps, other non-specific gastrointestinal complaints, feeling cold all the time, [and] sleep problems.”
What is the difference?
As you can see, of the eating disorders, OSFED and the overarching term “disordered eating” overlap and in fact “disordered eating” may require an eating disorder diagnosis depending on the severity and the impact on quality of life. It is a very slippery slope going from focusing on caloric intake or restricting certain foods to a dangerous eating disorder. Even if the behaviors are not impacting you physically, most likely these types of behaviors are already negatively impacting you mentally. For instance, you may be spending precious mental energy on your weight and diet, going out to eat with friends or family less often, practicing negative self talk, creating a superiority complex “they ate the dessert, they must not have enough willpower” and other false narratives, or majorly increasing your stress levels. Which, if you have been following me and reading other blog posts of mine, you know stress can wreak havoc on our health!
According to NEDA 35% of “normal dieters” progress to pathological dieting (meaning limiting or restricting food excessively), and of those, 20-25% progress to partial or full-syndrome eating disorders. And that statistic is from 1995! I would dare to say and that the issue is even more prevalent now and the line even thinner. Especially with the sneaky transformation of diet culture into “wellness” culture and the rise of “orthorexia” a proposed eating disorder where the person has an unhealthy obsession with “healthy” eating and have emotional distress around what they have mentally classified as “unhealthy” foods.
While disordered eating patterns don’t always turn into a full on eating disorder, they are a huge risk factor. If you think that you may be thinking too much about your weight or your intake, you probably are. Stop any diet you are currently on and try to find a dietitian specializing in intuitive eating if you are able. Having a therapist on your side to help you work through body image issues or your relationship with food is crucial as well. One assessment that you can take is called the “Eating Attitudes Test” to see where you fall on the spectrum. Find it here: https://www.eat-26.com/eat-26/.
What are behaviors that can lead to disordered eating?
Now you may think, “oh I am fine I am just doing xyz for my health.” As I have mentioned, it can be a slippery slope and continuously checking in with yourself is crucial. You can also ask friends, family, your dietitian, or therapist if your behaviors seem worrisome. It is important to be honest as well. Are you starting playing games with your calorie intake and numbers on the scale? Does your mood change depending on if you were “good” or “bad” with your eating? RED FLAG! Here are some behaviors that can lead to disordered eating:
Tracking calories or “macros”
Weighing yourself often (more than once a week)
Trying different diets often
Withdrawing from social activities to stay on your diet
Restriction of ingredients or certain food groups
Not listening to your hunger cues due to what you think is right for your health
Focusing only on weight and not your health behaviors
Trying to “make up” for eating with exercise
Fasting
Only choosing “whole foods” or “unprocessed foods”
Do you get the picture? If you are mentally hard on yourself for your intake or exercise, feel a sense of superiority for sticking to your “food rules” or have shame or guilt if you fall off them, these can all be signs that these behaviors are not healthy for you.
What are the consequences of disordered eating behaviors and restrictive dieting?
Mentally, disordered eating behaviors and restriction can cause “preoccupation with food and eating, increased emotional responsiveness and dysphoria, and distractibility.” Not only will it cause stress and unease with food and dieting, but it will seep into other areas of your life, causing general dissatisfaction. Physically, these types of behaviors can set us up to enter the restriction binge cycle. This cycle consists. of eating large portions of deemed “unhealthy” or “cheat foods” followed by a sense guilt and shame and then an urge to restrict or follow the previous food rules set strictly, only to fall off once we are given any freedom from our set rules. And then the cycle repeats.
A few things are at play that cause these issues:
First, we tend to enter the “what the hell” effect once we have already crossed the line of eating something deemed as “unhealthy”. In fact, there are multiple studies showing this phenomena one of which as almost 50 years ago. In the infamous “milkshake study” both normal eaters and dieters or “restrictive eaters” were given either 0, 1, or 2 milkshakes known as “preloads”. The participants were then told to taste test desserts after. The higher the preload size that the dieters were given correlated with higher amounts of dessert eaten post preload. For non-dieters, the opposite happened. They would eat less, listening to their fullness cues. As soon as restrictive eaters eat something off their list , they lean into and continue to eat more.
Second, hormonal changes arise. One of our key satiety hormones (feeling of fullness) is called leptin. Studies have shown that this hormone falls in both caloric restriction and fasting and even stays low once we are out of the restriction. This will cause a propensity to overeat and may be a major reason that diets fail in the first place. Humans are not meant to under eat for prolonged periods of time. Once we step out of the diet our physiological desire to increase intake will be so high that we cannot stop ourselves.
Third, dieting behaviors make it so that we cannot trust our own bodies. We start to ignore our true hunger and fullness cues and only go by the rules set out for us. Our relationship with food will be destroyed. Never will it be an easy task to eat out with friends or family. It will always be an inner monologue of “oh this has too many xyz” or “I already ate too much xyz earlier to have this” or “what the hell, I might as well just eat everything in sight.” When we distrust our bodies and ourselves around food, we go by the clock or food rules to tell us when and how to eat. We do not feel truly hungry anymore from long periods of ignoring our cues and as soon as we start to eat “off track” we cannot sense when to stop.
How do you get out of the disordered eating trap?
Eat enough: In order to get back to a stable, healthy place. You have to first eat enough. Enough calories, enough carbohydrates, enough of everything that you were skimping out on. Your body is SMART, smarter than you think. If you are depriving it of carbohydrates it can adjust hormonal signals to increase carbohydrate cravings. Having a salad with protein for lunch and no carbohydrates? Wondering why you can’t stay out of the cupboard when you get home? That is your body screaming at you to fuel more properly!
Eat consistently: This means eating a meal or snack every ~3 hours. You will not understand your true hunger and fullness cues at first from long periods of ignoring them. You will get these back, I promise. But first, you must eat around the clock until your body stabilizes.
Relearn hunger & fullness cues: From there you may relearn your internal cues (hunger, fullness, satiety, energy) to guide you to how much, when, and in what proportions to eat. But, make no mistake, it is essential to eat enough to start with. Continuing to skip meals or snacks or eating imbalanced will never allow you to fully recognize these feelings. Your body does not feel safe when in a starved or restricted phase. In order for it to feel at peace again and not feel like it needs to reserve all of the energy you give it, you just have to eat! Once you have stabilized yourself and provided your body with enough energy and nutrition, you will start to feel the magic of a true fullness cue. From there you can play around with different patterns of intake and balance throughout the day depending on exercise, lifestyle, and intuition. Working with a dietitian that specializes in mindful or intuitive eating is essential to guiding you through this process.
It is completely possible to trust your body and food again. Although not always a pretty, straightforward process, it is highly doable. I myself have gone through the process and have seen the amazing wonderful life that is on the other side of obsessing over your intake and body size. There are so many more important, crucial things that need your attention that do NOT include your weight or calorie intake. Not to mention, you can improve health, digestion, and metabolic markers without toxic diet behaviors, for good!
Do you want to learn more about intuitive eating and are ready to get off the “diet” or restrictive mindset ride? Apply here for a call with me!
