March is National Nutrition Month, when the Academy of Nutrition and Dietetics reminds everyone to return to the basics of healthy eating. It is also the time of year when the Academy celebrates expertise of registered dietitian nutritionists as the food and nutrition experts.
Yo-yo dieting and a pre-occupation with food are nothing new in our culture. But when does a fixation with what is consumed, calories and weight become a major health concern? When is it considered disordered?
Disordered Eating Defined
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-Text Revision), disordered eating is defined as "a wide range of irregular eating behaviors that do not warrant a diagnosis of a specific eating disorder."
Eating disorders, such as anorexia nervosa (AN) or bulimia nervosa (BN), are diagnosed according to narrow criteria. This excludes most people and the majority of people suffering with disordered eating.
Many individuals with disordered eating symptoms are diagnosed with Eating Disorder Not Otherwise Specified (EDNOS). However, similar to AN or BN, EDNOS has specific criteria that must be met in order for the patient to receive this diagnosis, and that criteria is narrowing.
In May 2013, the American Psychiatric Association (APA) released the DSM-5. With it came extensive changes to the eating disorder section in order to "minimize the use of the catch-all diagnoses" such as EDNOS.
Disordered Eating vs. Eating Disorder
The most significant difference between an eating disorder and disordered eating is whether or not a person's symptoms and experiences align with the criteria defined by the APA. Disordered eating is a descriptive phrase, not a diagnosis. Thus, while many people who have disordered eating patterns may fit the criteria for EDNOS, it is also possible to have disordered eating patterns that do not fit within the current confines of an eating disorder diagnosis.
Still, eating concerns falling short of a diagnosis deserve attention and treatment as they often turn into more problematic eating disorders and put the patient at risk of serious health problems.
Symptoms of Disordered Eating
Signs and symptoms of disordered eating may include, but are not limited to:
- Chronic yo-yo dieting
- Frequent weight fluctuations
- Extremely rigid and unhealthy food and exercise regime
- Feelings of guilt and shame when unable to maintain food and exercise habits
- Pre-occupation with food, body and exercise that causes distress and has a negative impact on quality of life
- Compulsive or emotionally-driven eating
- Use of compensatory measures, such as exercise, food restriction, fasting and even purging or laxative use to "make up for" food consumed
Harm Caused by Disordered Eating
Many people who suffer with disordered eating patterns either minimize or do not fully realize the impact it has on their mental and physical health. This lack of understanding may unnecessarily exacerbate the harm of disordered eating. Detrimental consequences can include a greater risk of obesity and eating disorders, bone loss, gastrointestinal disturbances, electrolyte and fluid imbalances, low heart rate and blood pressure, increased anxiety and depression, and social isolation.
Disordered eating is a serious health concern that may be difficult to detect since a person with disordered eating patterns may not display all of the classic symptoms typically identified with eating disorders. It's important to remember that even a person exhibiting disordered eating habits and behaviors may also be experiencing significant physical, emotional and mental stress.
Registered dietitian nutritionists are vital to the detection and treatment of disordered eating. Often, patients referred to dietitians for nutrition counseling are unaware that their eating patterns are problematic or harmful. If possible, working with a dietitian who has a background in counseling eating disorders is an important step in treating disordered eating and preventing it from progressing to an eating disorder.
For more information or guidance on finding support, visit The National Eating Disorder Association website.