Types of Eating Disorders
Eating disorders are complex and often misunderstood. I want to share with you the various types of eating disorders and the characteristics of each. After each of these descriptions, I also share a little bit about where eating disorders come from/how they develop. Happy learning!
Anorexia Nervosa
Anorexia Nervosa (AN) is characterized by food and emotional restriction. People with AN have an intense and ongoing fear of gaining weight or getting fat. There are two types of AN— a restricting type and a binge/purge type. Someone with the binge/purge type has or regularly engages in binge/purge behaviors, vomiting, or laxative use. The onset of AN is often during adolescence or the young adult years. AN has a high mortality rate, due to medical complications from the disorder itself or suicide. Often clients have obsessive exercise routines and focus intensely on calories.
Traditionally, the severity of AN is measured using the Body Mass Index (BMI). BMI is literally bullcrap. Here’s why:
It was created by Adolphe Quetelet in 1832. He was a mathematician and statistician, and he designed the BMI (OG: “Quetelet Index”) to measure general weights in different populations. Then in the 1900s, Ancel Keys started using it to assess a person’s individual health status, despite research proving how flawed it was. Both of these dudes didn’t think the measure was good, and both advised against using it to measure individual health status.
Why is this measure so problematic? It boils down to validity, a term used in research. If a measure is “valid”, it’s said to measure the variable that it was designed to measure (i.e.: if a test designed to measure personality turns out to actually measure intelligence, the test would be invalid). When the BMI started being used to measure individual health status, it became an invalid measure because it was being used to measure individuals even though the tool was created to measure populations.
Another big issue with BMI— it was based on data from exclusively white men (*shocker). This means that generalizing these findings to other genders, ages, or races decreases its validity.
The BMI has created arbitrary categories, like “underweight” and “overweight”. It doesn’t take into account a person’s muscle mass or bone density, nor does it consider other factors that we KNOW impact health like exercise, SES, access to healthcare, trauma, sleep, or relationship with food.
It also stigmatizes and pathologizes people. Do you really think a label like “obese” is going to encourage someone to engage in health-promoting behaviors? Nah. What it does is perpetuate shame, discouraging people in fat bodies from seeking medical care. This ins’t just my opinion, FYI, it’s incredibly well-documented in the research.
Your BMI tells you nothing about your health. It’s a flawed measure. It’s invalid. It doesn’t promote health. This is why I like to call it the Bullshit Measuring Index.
Okay, so that was an obvious digression. But it’s a really important one. Because you cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling with anorexia and you can be malnourished at any weight. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against people in fat bodies. Weight suppression, how many pounds a person has lost from their highest- ever weight to their current weight—is a more accurate measure of severity. So, if you’re like, “Oh, that person can’t have anorexia— they don’t look ‘sick enough’”, you need to check yourself. Being malnourished can happen at any weight.
Anorexia is characterized by perfectionism, low self-esteem, and relational difficulties. People with AN typically lack self-compassion and are very self-critical. Control is a central issue for people with AN. This desire for control is typically linked to past trauma; trauma robs a person of control, and someone with AN often use their ED behaviors to gain it back. AN behavior also functions as a means of escaping or numbing out negative emotions. If you want to read more about that, you can reference a few of my previous posts!
Bulimia
Bulimia Nervosa (BN) is characterized by recurrent binge eating and compensatory behaviors like self-induced vomiting or the use of laxatives for the purposes of preventing weight gain. Like AN, bulimia can have serious medical complications (esophageal lacerations, gastric ruptures, cardiac arrhythmias). A history of sexual abuse is a risk factor that is involved in the development/maintenance of bulimia. This doesn’t mean that sexual abuse causes bulimia, it just means that based on the research, there is a significant correlation or association between sexual abuse and BN. Purging symptoms, in general, have been significantly associated with trauma; often they serve as a way to deal with overwhelming emotions and, in a sense, to physically get them out of the body.
Binge Eating Disorder
Binge Eating Disorder (BED) is actually the most common ED and is highly misunderstood and stigmatized. BED is characterized by eating large amounts of food in a short period of time. The person struggling feels totally out of control during the episode. They feel like they can’t stop. They feel a deep sense of shame, guilt, and self-loathing over the behaviors. People struggling with BED often struggle with depression, low self-esteem, a preoccupation with weight/shape/food.
So, what exactly is a binge episode? This can be hard to understand in a culture where people sometimes confuse normal fullness with “binging”. Overeating is not binging. During a true binge, a person eats a large amount of food in a short period of time. Eating is fast and is often done alone or in-secret.
Binge eating is typically driven by emotions. Binging is a way to cope with negative emotions. When we eat, our brain releases mood-enhancing neurotransmitters that almost instantly make us feel better, providing relief from emotional pain.
Contrary to popular belief, dieting and food restriction are factors that most typically lead to binge eating. The binge + restrict cycle is ruthless. It looks like this: a person experiences a binge eating episode and feel guilty; they feel like they’ve failed. This shame and regret lead to food restriction (eating less than normal or only certain types of foods), which then leads to obsessing about food (because this is what our brains do when they’re hungry), which leads back to the binge. Eventually, biology overrides “willpower”. (*Hint— this is why diets don’t work)!
Orthorexia
Orthorexia is characterized by a fixation or desire to eat only “healthy” or “clean” foods or to avoid entire food groups entirely/only eat foods prepared in a certain way. The literal meaning of the word orthorexia is “proper appetite.” It’s often prompted by the desire of achieving a good and healthy lifestyle, but oftentimes spirals and leads to malnourishment, medical complications, and even OCD. There is typically an avoidance of “bad” foods and an obsession with being thin or fit. I could write a whole blog post just on this topic, but I’ll just say this: our culture has normalized eating patterns and diets that are actually DISORDERED. Let me repeat— our culture has normalized eating patterns and diets that are actually DISORDERED, like calorie counting or random food rules like not eating past a certain time at night.
Other lesser-known ED’s include:
Pica (PIE-KAH): characterized by continual ingestion of nonedible substances
Rumination Disorder: characterized by regurgitation and rechewing of food
Avoidant/Restrictive Food Intake Disorder (AR-FID): manifests in a total disinterest in food and difficulty eating certain foods due to sensory issues; ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size or fears of becoming fat.
Other Specified Feeding or Eating Disorders (OSFED): known previously as Eating Disorder not Otherwise Specified (EDNOS) in past editions of the DSM. The category was developed to encompass those individuals who did not meet strict diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder.
Where ED’s come from
Okay, so something you’re likely wondering is where do eating disorders come from? What causes them?
Eating disorders are biopsychosocial mental illnesses. They are not a choice. No one would choose the hell that is living with an eating disorder. What “biopsychosocial” means is that there are biological, genetic, psychological, and social/environmental factors that all influence whether someone will develop an ED or not. Some people are genetically predisposed to having an ED, and if that’s the case, and they are also exposed to several environmental triggers, they might develop an ED. Some of those environmental triggers might be: trauma, growing up in a dysfunctional family system, poor body image, dieting/family with a lot of food rules, ridiculous beauty and size standards, etc. We can’t say that there is just one thing that causes the onset of an ED; it’s never just one cause but from a complex interaction of causes.
Also, it’s important to note that people struggling with eating disorders are often struggling with other kinds of mental health struggles. Some common ones include anxiety, depression/mood disorders, OCD, PTSD, and personality disorders. ED’s rarely stand alone.
So many people struggling with eating disorders don’t get help. This isn’t just because of the social stigma. It’s also because people who don’t fit the “anorexic stereotype”, people who don’t appear “sick enough”, don’t receive help. But why?
A lot of this is perpetuated, shockingly, from our medical system. And I’m not throwing doctors totally under the bus here, but what I will tell you is that unless an MD specializes in eating disorders, they’re usually not eating disorder informed. They still operate and practice out of many old and false assumptions about health/wellness. Many MD’s (and people in general) still believe that you have to look emaciated to have anorexia or fat to struggle with BED. The research disproves this ENTIRELY. You cannot tell if a person is struggling with an ED just by looking at them, and you can be malnourished at any size.
Why isn’t common knowledge? Because of the diet-industry and their quest for your dollars, as well as weight stigma— two things I’ve talked a lot about in previous blog posts.
Even though the BMI has been totally disproven as an accurate measure of health, it’s STILL used in doctor’s offices. Even though we have extensive research to prove that FITNESS (not fatness) is associated with health and longevity, our medical system still oppresses people in larger bodies, prescribing disordered eating behaviors (i.e.: diets) to people in larger bodies in the name of “health”, despite EXTENSIVE evidence that diets don’t work and actually lead to weight GAIN.
My adolescent clients tell me horror stories about what they’re being taught in their health classes in school. Last week one of my clients struggling with disordered eating shared with me that she learned about calorie counting in health class that day. I’ve had clients eating as little as 400-500 calories a day tell me stories about ER doctors and other medical professionals saying to them that they “don’t look emaciated enough to have an ED.” I wish these stories were exceptions to the norm, but they’re not. They ARE the norm. And this is part of why I’m so passionate about eating disorder education.
I could continue this rant…these topics get me fired uppp. But my point in naming this here is this— if you are struggling, you deserve help and you deserve recovery. If you have a difficult relationship with food, your body, and with exercise, and if it is interfering with your life, you are sick enough and you deserve to heal.
Period.