I'm a Dietitian & This Is What I Wish People Knew About Eating Disorders

We are all exposed to diet culture that can promote unhealthy habits or correlate your sense of self-worth with your body size. While this phenomenon doesn't affect all of us in the same way, it can certainly impact your relationship with food and, over time, could increase your risk of developing an eating disorder. 

The root cause of an eating disorder doesn’t always have much to do with what you eat, despite that one of the main symptoms is experiencing stress around diet and/or body image. Eating disorders are complex, life-threatening illnesses that affect people of all genders, ages, races and sizes, says Caroline Young, M.S., RD, LD, RYT, owner of Whole Self Nutrition. There is no one “look” or stereotype that reflects all folks who have eating disorders—or disordered eating habits, a broader term that is used to describe having stress and overwhelmed feelings around food without having the diagnostic qualifiers for an eating disorder. 

I spoke with other dietitians who specialize in eating disorder treatment to better understand the differences between eating disorders and disordered eating, risk factors and treatment options. Here are a few things we, as  experts. wish people knew about eating disorders and disordered eating habits.

Things I Wish People Knew About Eating Disorders

It's a Specific Medical Diagnosis 

I spoke to eating disorder dietitian Victoria Whittington, RDN, who explains how an eating disorder presents itself: “An eating disorder is a mental health condition that is characterized by a severe and persistent disturbance in eating behaviors and is associated with distressing thoughts and emotions. An eating disorder is a clinical diagnosis.”  Eating disorders are diagnosed based on criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—the standard classification guide for mental health disorders used by mental health professionals in the U.S.—following a physical and psychological evaluation.

She comments that some of the most common eating disorders include: 

• Anorexia nervosa 
• Bulimia nervosa
• Binge eating disorder
• ARFID (avoidant/restrictive food intake disorder) 
• OSFED (other specified feeding or eating disorder), which is lesser known but includes significant eating disorder behaviors that may not otherwise align with other eating disorders

Vandana Sheth, RDN, CDCES, FAND, a registered dietitian nutritionist specializing in eating disorders and disordered eating, shares, “Eating disorders involve persistent and severe disturbances in eating behaviors and are often associated with physical, emotional and social impairments. Treatment typically requires professional intervention including therapy, medical monitoring and, in severe cases, hospitalization.”

Treating eating disorders requires a full medical team including a physician, a psychiatrist, a therapist and a dietitian. Each member of the treatment team should have experience treating eating disorders.

They're Not a Choice or a Lifestyle Preference—They're a Mental Health Disorder

Although eating disorders are classified as a mental illness, they have a significant impact on both one’s physical and psychological health. They can manifest in many ways and cannot be simply stopped through an individual’s willpower. Folks with eating disorders might experience various health problems like nutrient deficiencies, depression, anxiety, insomnia, anemia, social isolation and obsessive food thoughts. Other physical manifestations of an eating disorder can include loss of periods, low blood pressure, gastrointestinal issues, brittle hair and nails, dry or yellow skin, poor bone health and multiple organ failure, says Young.

This further reinforces that eating disorders are serious illnesses with specific diagnoses. They are not a choice or personal preference of the person afflicted. This is part of why an interdisciplinary care team is so important, as these illnesses can impact several aspects of health. 

There Is No Stereotypical “Look” to an Eating Disorder

You won’t be able to tell if someone has an eating disorder by looking at them. Eating disorders affect people from all backgrounds, ages, genders and body types. Contrary to common misconceptions, struggling with food and body image is not always visible. Folks might maintain a normal-appearing weight, be underweight or have a larger body while struggling with an eating disorder. Understanding that eating disorders transcend external appearances is crucial to fostering empathy and providing support to those who need it, aside from how they may outwardly appear.

Simply "Eating More" Is Not the Solution 

Eating disorders are multifactorial and complex, but they are defined by a set of eating behaviors that harm one’s health and disrupt one’s ability to function, says Cara Harbstreet, M.S., RD, LD, of Street Smart Nutrition. They require a multidisciplinary team working together with someone for as long as needed. The treatment methods are dynamic and can change throughout the course of treatment,  and they can vary from case to case. Not to mention, eating disorders can differ in type and severity, and there’s no universal solution. It’s crucial to acknowledge that an eating disorder is a mental health disorder that may be out of an individual’s control. So simply suggesting that someone “eat more” is not only unhelpful but may do more harm than good by negatively triggering an individual. 

Things I Wish People Knew About Disordered Eating

Alternatively to eating disorders, disordered eating refers to an abnormal eating pattern that does not meet the criteria for clinical diagnosis of an eating disorder. But disordered eating habits may include similar symptoms to an eating disorder that occur less frequently or severely, explains Whittington. 

It's Not a Specific Diagnosis

Disordered eating encompasses a wide range of abnormal eating behaviors or attitudes towards food, weight and body image. These behaviors may not meet the diagnostic criteria for a specific eating disorder. However, disordered eating can still significantly affect an individual's mental health.

Disordered eating behavior exists on a spectrum, and symptoms may vary from mild to severe. Common symptoms of disordered eating can include:

• Chronic dieting: Engaging in repetitive or extreme dieting behaviors, often accompanied by feelings of guilt or shame when deviating from strict dietary rules.
• Preoccupation with food and/or body weight: Spending a significant amount of time thinking about food, calories, weight or body shape to the point that it interferes with personal daily activities and relationships.
• Rigid food rules: Adhering to strict rules about what and when to eat, often leading to anxiety or distress when unable to follow these rules.
• Unhealthy weight-control behaviors: Using unhealthy methods to control weight, such as fasting, skipping meals, purging or excessive exercise.
• Distorted body image: Perceiving one's body inaccurately, often viewing oneself as overweight or having a distorted perception of body size and shape.
• Feelings of guilt, overwhelm or shame: Experiencing negative emotions—such as guilt, shame or self-loathing—related to food or body image.

“Disordered eating is harder to define because the spectrum of eating and lifestyle behaviors is much broader,” adds Harbstreet. “They range from physical (like fluctuations in weight or body composition) to behavioral (skipping meals or avoiding certain foods or food categories) to mental and emotional (high anxiety and low self-esteem).”

It Can Masquerade as "Someone Who Cares About Their Health" 

Disordered eating behaviors may include skipping meals, fasting, restriction of certain foods, binge eating, chronic dieting or laxative misuse or abuse, Whittington adds. These behaviors  can develop into a full-blown eating disorder over time.

Disordered eating might be harder to detect, as some of these behaviors are normalized in our society. For example, the line between intermittent fasting and restrictive eating that is causing harm is all too easy to cross and can be hard to notice when it becomes problematic. 

As a dietitian, it's not uncommon to see folks adopting dietary and exercise practices that seem health-supportive at first, but may actually be driven by underlying disordered eating patterns. Under the pretext of making healthy behavior changes, folks might downplay the harmful effects these behaviors have on their stress levels and mental health. They may justify restrictive eating habits or intense exercise routines as necessary for achieving optimal health while ignoring signs of malnutrition, fatigue or emotional distress.

One’s mental health status, trauma history, dieting history and environment all play a role in whether or not these behaviors can escalate into a full-blown eating disorder. Help and support from your health care team can be an important step in identifying and reducing your risk. 

Eating Disorder vs. Disordered Eating: What’s the Difference? 

“Eating disorders are medically compromising, life-threatening illnesses, which consume people's lives in every way (physically, mentally and emotionally). They often require long hospital stays and/or long-term treatment with teams of doctors, dietitians, therapists and psychiatrists,” Young explains. 

Disordered eating, while still serious, is typically not as severe or as dangerous as an eating disorder. Still, it can cause similar issues like anxiety, food preoccupation and nutrient deficiencies, she continues. That said, disordered eating can certainly lead to an eating disorder if left unchecked. While these behaviors can begin seemingly innocently, they can escalate quickly and severely. 

Risk Factors

Many of the risk factors are the same for disordered eating and eating disorders, including: 

• History of dieting 
• Food and/or exercise obsession 
• Trauma history 
• Significant weight changes 

Eating disorders usually have several compounding causes, such as genetics and childhood trauma, and they are often developed as a way to cope with difficult feelings and life situations, Young adds to reinforce their complexity.

Diagnostic Criteria

Your primary health care provider or a mental health professional is exclusively responsible for diagnosing an eating disorder, and you must fulfill the DSM-5 criteria for such a diagnosis. In contrast, disordered eating pertains to the unhealthy behaviors one is engaging in without meeting the criteria for a DSM-5 diagnosis. Though disordered eating habits and behaviors may not indicate an eating disorder, research supports that they can progress into a diagnosable eating disorder.

Disordered eating falls somewhere on the spectrum between normal eating and an eating disorder, Whittington adds. She gives examples of restrictive dieting—like "eating clean" during the week and having "cheat days" on the weekends—which could be a disordered eating habit for some.

Duration

Eating disorders typically persist over an extended period of time, while disordered eating behaviors may be more brief or temporary. For instance, overeating on one or two occasions qualifies as disordered behavior but doesn’t meet the criteria to diagnose binge eating disorder. 

Though disordered eating behaviors may be less intense and persistent, they can still cause harm and require support to overcome.

Severity

The greatest difference between an eating disorder and disordered eating is the frequency and severity, Harbstreet explains. Although the symptoms may overlap, eating disorders are significantly more detrimental to both physical and mental well-being compared to disordered eating habits. Eating disorders significantly disrupt one's ability to function, whereas individuals with disordered eating habits may still maintain their baseline functioning despite the behaviors. 

For instance, someone grappling with an eating disorder might choose social isolation or neglect responsibilities to prioritize their disorder. On the other hand, disordered eating may impact day-to-day life without necessarily impairing overall daily functioning. 

Harbstreet elaborates: “This isn’t to say that disordered eating can’t be disruptive, or that some people don’t find a way to cope with their eating disorder. This nuance and complexity is part of what makes treatment and recovery so challenging.”

Treatment Options

Treatment options are another huge differentiating factor between eating disorders and disordered eating. Diagnosed eating disorders often require intensive care and a multidisciplinary support team to make a full recovery. In-patient treatment and hospital stays might be necessary when treating eating disorders. 

Disordered eating is often best treated in a counseling-style outpatient setting with both a registered dietitian and a counselor for support. As an eating disorder dietitian, Whittington finds that practicing an "all foods fit" mindset is one of the best ways to achieve or maintain a healthy relationship with food. “I like to encourage balance and variety in the diet and remove the morality often associated with food choices, weight or body shape and size. The sooner you can reframe negative thoughts around food and body image, the sooner you can be free from dieting and disordered eating,” she shares. 

The Bottom Line

The line between disordered eating and an eating disorder can be blurred. What initially may begin with an innocent effort to improve your health can transform into a profound mental illness. Risk factors, diagnostic criteria, duration and severity all differentiate an eating disorder from disordered eating patterns. Timely intervention and seeking help for disordered eating can potentially help avert the development of a diagnosed eating disorder. Remember, achieving complete recovery from an eating disorder is possible with appropriate support and a dedicated medical team around you. Always talk to your health care provider if you or someone you love needs help.