Cultural pressures prime us to be conscious about how much we consume and how good it would be if we developed some self-restraint. The pendulum swings from shopping, scrolling, and snacking—to saving money, snoozing notifications, or skipping meals.
This tension between binge and restriction is so internalized that it can be hard for some to notice the tell-tale signs of eating disorders (EDs) and body image challenges in themselves or their loved ones. Often, symptoms go undetected because cultural norms around food, body, and dieting lead people and even some care professionals to believe that people are not suffering.
Gaining an awareness of warning signs, how EDs are diagnosed, and when to seek help can lead to better treatment outcomes and increase your ability to support loved ones who may be struggling.
What are the signs of an eating disorder?
EDs are serious mental health issues that revolve around irregular and harmful eating patterns and rituals with food and a preoccupation with food and body. EDs can cause major social, emotional, and physical damage in the long term. Left untreated, they can even be life-threatening.
It can be hard to identify the line between troubling behaviours pushed by diet culture and more serious symptoms that require intervention. People experiencing EDs typically demonstrate early warning signs, including but not limited to:
Extreme preoccupation with food and body image
Changes in behaviour around food and exercise
Noticeable fluctuations in mood, withdrawal from friends and usual activities
Physical signs such as weight change, fatigue, muscle weakness, fainting
How are eating disorders diagnosed?
Typically, the DSM-5 (Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition) is used by healthcare professionals to diagnose EDs. It breaks them down into a few categories:
Anorexia nervosa
Characterized by intense restriction of food intake and fear of weight gain that leads to significant weight loss and malnutrition.
Bulimia nervosa
Characterized by recurring episodes of compulsive binge eating, often accompanied by feelings of guilt or shame, and consequent purging behaviours such as intentional vomiting or excessive exercise to prevent weight gain.
Binge eating disorder (BED)
Characterized by recurring episodes of compulsive binge eating, often linked to their distress levels. In BED, binge eating episodes are not followed by purging behaviours.
Rumination disorder
Characterized by the repeated regurgitation of previously swallowed food, which may be re-chewed, re-swallowed, or spit out. These behaviours are not accompanied by symptoms of nausea, involuntary retching, or disgust, and cannot be explained by another existing ED episode.
Pica
Characterized by the recurring ingestion of non-food substances that is persistent enough to require clinical intervention.
Avoidant/restrictive food intake disorder (ARFID)
Characterized by food restriction and avoidance for reasons that do not have to do with fear of weight gain. Instead, this behaviour is often accompanied by food-related distress due to the sensory qualities of food (such as texture). It may also be based on a conditioned response to certain foods, such as trauma.
Other specified feeding and eating disorder (OSFED)
Characterized by cases where many but not all of the symptoms of a specific eating disorder are met.
An example of an OSFED diagnosis could be atypical anorexia nervosa, in which almost all criteria for anorexia are met, but the individual’s weight is within or above the normal range.
Unspecified feeding and eating disorder
Characterized by cases where symptoms do not align with those of another specific disorder. Often, the clinician has not specified the reason that the criteria are not met for a specific ED—or there is insufficient information to make a more specific diagnosis.
An example could be orthorexia nervosa, defined as an unhealthy obsession with “clean” eating and fixation on the quality of food intake rather than the quantity. It is an informal definition that is not included in the DSM-5, so associated behaviours might fall under a UFED diagnosis.
DSM categories and the gaps they leave behind
To some extent, the DSM handbook helps clinicians speak a common language and even inform treatment strategies. But breaking down eating disorders into separate diagnoses with rigid criteria can affect how people view EDs, or worse, prevent them from receiving timely support.
There are many criticisms of the DSM’s strict categories for poorly reflecting clinical realities, including:
Higher prevalence of “unspecified” or “other” ED diagnoses
Most people with eating disorders don’t fit neatly into one specific disorder in the DSM. In fact, many people tend to fall into the residual OSFED or UFED categories because they don’t meet the criteria or present atypical symptoms. This pattern raises questions about the usefulness and validity of this categorical view of EDs.
Likelihood of diagnostic crossover
Since ED symptoms and their severity fluctuate over time, individuals are likely to receive multiple different diagnoses over the course of their life. This phenomenon raises questions about the longterm legitimacy of categorical ED diagnoses.
Inadequate empirical backing
Disorder types and criteria listed in the DSM tend to have poor experimental evidence supporting them. These rigid definitions often inadequately reflect the nuanced realities of those living with disordered eating.
So, when should you seek help for your eating disorder?
As we’ve learned, EDs can be deeply nuanced internal battles. Symptoms exist on a spectrum and often fluctuate in their severity and presentation depending on the individual.
We at the Kyla Fox Centre believe that a lack of formal diagnosis should not discourage someone from seeking care if it is preventing them from feeling safe in their body and around food. A diagnosis is not always the first step (or even a necessary step) for recovery.
If you or a loved one are struggling in your relationship with food and body, it’s never too early to reach out for help. It may be worth exploring your experiences with an expert—even without a formal diagnosis.
A note from our team
The Kyla Fox Centre helps treat the entire spectrum of eating disorders and disordered eating through an individualized approach. This includes working with individuals who are not diagnosed with an eating disorder and those who have a clinical diagnosis. We invite you to reach out to us to ask questions, share part of your story, and determine if this is the right place for support.
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Sources and additional reading
National Eating Disorders Association. (2023). Warning signs and symptoms. https://www.nationaleatingdisorders.org/warning-signs-and-symptoms
Canadian Mental Health Association Ontario. (2023). Understanding and Finding Help for Eating Disorders. https://ontario.cmha.ca/documents/understanding-and-finding-help-for-eating-disorders/
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Klausner, S. D. (2016). Reconceptualizing Eating Disorder Diagnosis: A Hybrid Categorical-Dimensional Model. Retrieved February 1, 2023 from https://scholarworks.calstate.edu/downloads/nz806244x
Luo, X., Donnellan, M. B., Burt, S. A., & Klump, K. L. (2016). The dimensional nature of eating pathology: Evidence from a direct comparison of categorical, dimensional, and hybrid models. Journal of abnormal psychology, 125(5), 715–726. https://doi.org/10.1037/abn0000174
Hay P, Girosi F, Mond J. (2015). Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. Journal of Eating Disorder; 3:19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408592/