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In how many ways can eating be disordered? Anorexia and bulimia are familiar terms, and you might have heard of binge eating disorder. What about orthorexia, rumination disorder, muscle dysphoria, drunkorexia, or night eating disorder? Some are clinical diagnostic terms; some have been coined in the community. These and other terms reflect the broadening recognition that disordered eating, eating disorders, and body image issues can manifest in many different ways—including out-of-control eating, obsessive weight-training, cutting out food groups, abusing certain medicines, skipping meals before drinking alcohol, and more. Often, these behaviors both reflect and reinforce emotional health challenges.
How self-criticism can harm us
In many cases (but not all), disordered eating is related to an urge to more closely resemble a popular physical type. “People often feel that peace with your body is conditional: ‘I’ll accept my body when I lose weight or when I exercise more often,’” says Dr. Megan Jones, clinical assistant professor at Stanford University and chief science officer at Lantern, an evidence-based program for improving body image and reducing disordered eating behaviors.
“However, research shows that when you are less self-critical and improve your body image, you’re actually more likely to do the things necessary to optimize your emotional and physical well-being.”
What do many people with eating disorders have in common?
Body image & shame
Negative body image
Thoughts and behaviors might include:
- Body-checking: Obsessively checking the mirror, scrutinizing parts of the body, or holding/pinching skin folds
- Self-scrutiny: Criticizing your own body, in your head or out loud
- Constant comparison: Comparing one’s own shape and size to that of others
Shame and guilt
Shame and guilt often follow the act of eating. People with eating disorders may feel unworthy of food as a source of nourishment, pleasure, or recovery.
- Shame is a feeling of being inherently flawed: “I am bad/wrong.”
- Guilt is feeling regretful about an action or behavior: “I did something bad/wrong.”
Black & white thoughts
Cognitive distortion: Black-&-white thinking
Cognitive distortions are destructive beliefs and self-judgments; these can reinforce eating disorder behaviors. Often, these are learned early in life.
Black-and-white (polarized thinking) is an “all or nothing” mentality that leaves no room for middle ground.
- Food choices are categorized as “good” or “bad”, “safe” or “unsafe”.
- Black-and-white thinkers tend to alternate between extreme behaviors specific to food and exercise (all or nothing).
- Typical thought: “I already blew it by eating that cookie with lunch… Now I’m just going to eat whatever I want for the rest of the day and start over again tomorrow…”
Personalization, mind-reading, and blaming
- Constantly measuring one’s worth by comparing oneself to others
- Typical thought: “I’m the biggest person in this room.”
- Making assumptions about what others think of us without substantial evidence
- Typical thought: “I hate grocery shopping because when I have lots food in my shopping cart, everybody around me is thinking I’m a fat pig, and I can’t handle that.”
- Taking the victim role: e.g., “They made me feel bad about my body so now I don’t care; I’m just going to binge on whatever I want.”
- Blaming ourselves: e.g., “My ex broke up with me because I’m not good-looking enough.”
Over-generalization and catastrophic thinking
- Taking a small piece of evidence or a one-time event and jumping to conclusions about “always” or “never”
- Typical thought: “I gained weight this weekend… I will keep gaining weight every weekend for the rest of my life.”
- Worrying about worst-case scenarios
on a regular basis
- Typical thought: “What if I lose control around food? If I’m alone then it’s possible, and since I will be alone later then it will definitely happen to me…”
Rigidity & isolation
- Calorie-counting and setting a daily
- Strictly measured portions
- Food rules: cutting out certain types of food
- Limited variety; lack of flexibility: eating the same foods or food combinations every day
- Avoiding social situations centered around food, such as restaurants, birthday celebrations, and holiday parties
- Stems from fear of being judged or feeling pressured to eat a food that makes them anxious
“When people [manipulate] the natural way their bodies function with [eating disorder behaviors], it changes their personality, values, and attitude.”
—Randi P., fourth-year undergraduate at Pittsburg State University, Pennsylvania
Official eating disorders & related diagnoses: old & new
In 2013, the American Psychiatric Association updated its categories of eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new diagnostic criteria are intended to support more individualized treatment approaches and achieve better outcomes.
These descriptions are abbreviated; they do not include information on the frequency and duration of relevant behaviors. Eating disorders should be diagnosed by a health care professional with relevant expertise and qualifications.
- Anorexia Nervosa: Restriction of energy intake (calories) leading to a significantly low body weight, with intense fear of gaining weight and often denial of the seriousness of low body weight; “subthreshold” anorexia nervosa involves similar behaviors with a normal body weight
- Avoidant/Restrictive Food Intake Disorder: Restrictive eating patterns ranging from feeding problems in infancy to restrictive eating in a young adult afraid of choking or vomiting; the causes are psychological but do not involve distorted body image or weight concerns
- Binge Eating Disorder: Binge eating not followed by compensatory behaviors; “subthreshold” binge eating disorder involves similar behaviors with less frequency
- Body Dysmorphic Disorder: Extreme preoccupation with a perceived flaw in appearance, interfering with daily life; not an eating disorder per se, but may accompany one
- Bulimia Nervosa: Binge eating (eating abnormally large amounts of food, past the point of feeling full, and feeling out of control while eating) followed by compensatory behaviors, e.g., self-induced vomiting, abuse of laxatives and diuretics, or excessive exercise; “subthreshold” bulimia nervosa involves similar behaviors with less frequency
- Muscle Dysmorphia: Extreme preoccupation with the desire to have a muscular physique; not an eating disorder per se, but may accompany one
- Night Eating Syndrome: A pattern of eating very late in the evening or in the middle of the night
- Pica: Repeatedly eating non-food substances, e.g., dirt, clay, chalk, or laundry detergent; most often seen in pregnant women or people with iron-deficiency anemia
- Purging Disorder: Compensatory purging behaviors without binge eating
- Rumination Disorder: Regurgitating food, then re-chewing, re-swallowing or spitting it out; may be present with anorexia or bulimia
Eating disorders VS Disordered eating
- Eating disorder refers to a serious psychiatric illness involving intrusive thoughts and actions related to food and weight that interfere with physical, social, and emotional health. “People don’t realize how disturbing [eating disorders] can be until there are dire consequences,” says Jen Rego, a licensed psychotherapist in Marlborough, Massachusetts, who specializes in eating disorders. Eating disorders have the highest mortality rate out of any emotional illness, according to the American Journal of Psychiatry (2009). Causes of death include heart failure and suicide.
Eating disorders vary; they tend to involve behaviors like these:
- Restricting food intake
- Binge-eating: consuming large amounts of food in a relatively short time frame, to the point of feeling out of control and uncomfortably full
- Purging: self-induced vomiting, abuse of laxatives, or diuretics
- Use and abuse of diet pills
- Compulsive exercise with the goal of burning calories: More info
Engaging in multiple methods of compensatory behaviors (efforts to purge or offset calories from food) is associated with more severely disordered eating.
- Disordered eating is a broader term that describes an unhealthy relationship with food. All eating disorders involve disordered eating. But someone with disordered eating does not necessarily have a full-blown eating disorder.
Signs of disordered eating include:
- Abnormal, quirky behaviors and patterns related to food and eating
- Changes in eating patterns due to temporary stressors, high-pressure events, or an injury or illness
- Obsession and extreme rigidity around food choices
- Anxiety related to eating certain foods or eating in certain situations, e.g., with a large group of people
- Attempts to offset the calories from alcohol consumption (e.g., avoiding food or exercising obsessively)
What are “orthorexia,” “drunkorexia,” and other unofficial eating disorders?
Restricting the type (but not the amount) of food to the point that it negatively affects quality of life: “healthy eating” taken to an extreme. Research suggests “orthorexia” may be related to obsessive-compulsive disorder and may be more prevalent in men than women.
“I have seen a lot of people become ‘gluten-sensitive’ as a reason to remove grains from their diet. Many people see food as an enemy and focus on removing it from their life instead of focusing on making good choices that help energize their body.”
—Jessica T., first-year graduate student, Emory University, Georgia
Restricting food or exercising obsessively to compensate for calories from alcohol. Research shows a strong association between heavy drinking, high levels of physical activity, and disordered eating in college students, according to a 2012 study in the Journal of American College Health. “Drunkorexia” is more prevalent among women than men and is motivated by concerns about body weight, according to a 2014 study in the same journal.
Pregnorexia refers to a resistance to gaining weight during pregnancy.
Diabulimia refers to behaviors in people with insulin-dependent (Type 1) diabetes who restrict their insulin to manipulate their weight.
What contributes to disordered eating?
Disordered eating likely reflects a combination of risk factors. Researchers are exploring many of these influences:
- Certain personality traits; e.g., anxiety, perfectionism, competitiveness, hyperactivity, and compulsiveness
- Emotional health issues; e.g., traumatic experiences, addiction, depression, and stress
- Environmental influences:
- Idealized media images reinforce
a narrow definition of attractiveness
- Dieting in early life is related to eating disorders and obesity later
- Social pressure and judgment (“body shaming”) contribute to eating disorders and obesity
- Life transitions can increase exposure to possible triggers
- Performance pressure—e.g., among athletes—can contribute to stress relating to body weight and shape
- Idealized media images reinforce
How to get along better with your body & your food
Here’s how Marci Anderson, MS, CEDRD (Certified Eating Disorder Registered Dietitian) in Cambridge, Massachusetts, breaks it down:
- Mindful eating: using the five senses to fully experience foods
- Self-care: nourishing the body and mind with a range of nutrients
- Self-worth: feeling worthy of food, health, and happiness
- Intuitive eating: being in touch with our hunger and fullness cues
- Flexibility and variety: choosing different foods and meals from day to day, without stress or anxiety
Why body shaming fails and how you can counteract it
Body shaming (criticizing your own looks or someone else’s) can reinforce destructive self-beliefs and drive disordered eating behaviors, according to research. “Body shaming is a huge issue right now. Instead of encouraging people to have the ideal body, we need to encourage the ideal of loving the body you have,” says Sara A., a first-year graduate student at the University of North Texas.
Focus less on weight and body shape in your conversations. You may think you’re complimenting someone by saying, “Have you lost weight?” or “You look like you’ve been working out.” But you’re actually reinforcing the stereotype that thin means beautiful or that muscular means good looking.
Discuss the health and emotional benefits of healthy eating and physical activity, rather than their impact on appearance. For example, ask your friend whether the dance classes are helping him feel stronger or sleep better.
- Resist criticizing your own body. If your friend or family member criticizes theirs, say, “You know I love you, and it hurts me to hear you say that about yourself.”
- Worried about your friend’s disordered eating? Here’s how to talk to them about it.
How and why to tune out some of that media stuff
In a recent Student Health 101 survey, nearly 70 percent of respondents said the media’s portrayal of unrealistic body images affects the way they feel about their own body. Research has shown benefits from interventions that help people become more aware of the influence of the media on their body image, according to an analysis published in BMC Psychiatry (2013).
- Photoshop® and lighting are extensively used to make actors and models appear thin, chiseled, and flawless. Sometimes, they take things too far. For examples, search online for “Photoshop mistakes.”
- Many actors dedicate considerable time and energy to diet and exercise, especially if their roles require a certain body type. That’s their job. It’s probably not yours.
- The media play to our insecurities in order to sell us something—like miracle creams and get-buff-quick products (which don’t work).
“The thing that we have to understand and accept is that those images are unobtainable. Guys will not have flawless bodies with perfect abs, pecs, arms, etc. Similarly, girls will not have thin waists, large busts, larger butts, etc. Eating disorders can happen to anyone… boys too.”
—Michael D., first-year undergraduate, Southwest Minnesota State University
Hang out with people who nourish your self-belief
- If a friend or family member comments on your weight (positive or negative): “Thank you, I care about my health, but I try not to let my weight be a focus.”
- When you’re tempted to compare your own looks to someone else’s, try to think about their—and your—positive traits that aren’t related to appearance. What do you admire about their personality? What might they admire about you?
“Being a black woman in a predominately white culture has taken a toll on my self-image. I still have my struggles about how I look, but having friends who do not emphasize highly unrealistic standards of beauty, and who embrace themselves, has really helped.”
—Third-year undergraduate, Rollins College, Florida
“The way to overcome a negative body image is to be around people who support you and make you feel good about your body. Once you are around people who love you no matter what you look like, you can really start to love yourself and love your body.”
—Chaminie D., fourth-year undergraduate, San Diego State University, California
How to disempower your inner critic
- “I like that I can dunk a basketball.”
- “I’m really good with kids and can’t wait to finish my degree in elementary education.”
- “I’m a pretty darned good computer programmer, if I do say so myself!”
- “I’m a supportive and loyal friend.”
“Silencing the inner critic is a key step in the process [of accepting your body]. But it also involves being willing to let go of that critic.”
—Dr. Megan Jones, chief science officer at Lantern, a program for improving body image and eating behaviors
“Make a list of things you like about yourself that aren’t related to what you look like. Everyone has strengths; what are yours?”
—Dr. Rebecca Puhl, deputy director of The Rudd Center for Food Policy and Obesity and professor at the University of Connecticut
“Whenever possible, challenge yourself to think about your body in terms of what it can do instead of in terms of how it looks. For example, if you find yourself feeling bad about how your legs look, remind yourself of all the things those legs do for you. They move you around in the world. They let you dance. Focusing on the functions of your body is a great way to treat your body with more kindness and respect.”
—Dr. Engeln, psychology professor, Northwestern University, Illinois
Get active to help your body and mind support each other
Almost any type of regular physical activity can help people feel better about their bodies, regardless of the effects on their fitness and body shape, according to a 2009 meta-analysis of studies by researchers at the University of Florida.
“As someone who has struggled with disordered eating and body image since my early teens, I understand the temptation to punish my body. It is very easy to hate yourself in a world that trains you to critique and loathe your body for what it isn’t instead of appreciate it for what it is. Physical exercise forces you to come to terms with the fact that your body is a miracle, and can lead to positive body image and an increased sense of accomplishment and self-worth.”
—Second-year undergraduate, Mount Allison University, New Brunswick
When exercise isn’t working
If you find yourself exercising compulsively or punitively to compensate for what you’ve eaten or drunk, this may be a symptom of disordered eating.
Try a self-guided online intervention
Some internet-based interventions appear successful in preventing and/or treating eating disorders, according to studies. For example, Student Bodies™, an eight-session program developed for college students at risk of eating disorders, is based on cognitive-behavioral therapeutic techniques. Inquire at your campus counseling center about accessing an online (or other) intervention.
Get help or find out more