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Written by Jocelyn Lebow PhD, LP
Eating disorders are serious illnesses. Not only do they impact every system in the body, they also cause major changes to mood, personality and behaviors. If left untreated, they can cause lifelong impairment, or even death. Though most people might think they have an idea of what an eating disorder looks like, thanks to Netflix specials and made for TV movies, in actuality, eating disorders don’t always look like the stereotypes. Because of this, it’s good to be aware of the different types of eating disorders- what they are, and what they aren’t.
Anorexia Nervosa (AN) involves restrictive eating habits and/or weight loss. It’s important to know that anorexia is not determined by a specific weight cutoff- to have the illness, all someone needs is to be at a low weight based on their personal growth history. This means, for people who have a history tracking in a higher weight range, their BMI could be considered “normal” or even “overweight” based on the CDC guidelines, and they would still meet criteria for anorexia. For kids, this can also mean that they didn’t lose any weight at all, but just failed to gain as expected as they got older. People with anorexia sometimes have fears about gaining weight, lots of worries about their shape or weight that can impact their self-worth, and/or behavior that gets in the way of eating enough. For example, they might say they want to gain weight, but routinely skip meals because they’re “too busy”, or decide to make non-medically necessary exclusions from their diet. Finally, many people with anorexia struggle to recognize just how serious their symptoms are, even when getting advice about their eating from medical professionals, coaches or parents. This is why, if left untreated, anorexia can be dangerous and persistent.
Bulimia nervosa is characterized by binge eating and purging. While the terms bingeing and purging are often used in casual conversation, they actually have pretty specific definitions. Bingeing is eating, within a 2 hour stretch, an amount of food that’s unusually large compared to other people in the same situation (this means, for a child or teenager, you should be comparing their eating to same-aged peers with similar activity levels and growth patterns). Binge eating is also marked by a feeling of losing control- that you couldn’t stop eating if you wanted to. Purge behaviors include any inappropriate and unhealthy behaviors used in order to prevent weight gain, like making oneself vomit, misusing laxatives or diuretics, fasting, or excessive exercise. Other purging behaviors might include smoking or abusing medications, including those prescribed, like stimulants or insulin, to try and curb one’s appetite. Like with anorexia, people with bulimia also have self-worth that’s heavily influenced by how they view their shape and weight, which can lead to significant feelings of shame and depression.
Binge Eating Disorder (BED) occurs when a person has episodes of binge eating, but does not use purging behaviors to compensate. There’s a common misconception that people with BED are always overweight and, while this is possible, binge eating can be present in patients with lower BMIs as well. During binges, people might eat more quickly than usual, eat until they’re uncomfortably full, eat despite not feeling physically hungry, and/or eat alone because they’re embarrassed. People tend to feel very distressed or disgusted with themselves after binge episodes. If a person is eating large amounts, but doesn’t feel upset about it, this wouldn’t meet criteria for BED.
Avoidant/Restrictive Food Intake Disorder (ARFID) is diagnosed when a person isn’t meeting their nutritional needs, which can be marked by weight loss or failure to achieve expected weight gain, stalled growth, nutritional deficiencies, dependence on tube feeding or nutritional supplements, and/or impaired functioning. This last criterion is met when a person with ARFID can’t do everything they want to do because they’re not getting enough nutrition. For example, this might include a kid who lacks the energy or stamina to keep up with friends during recess, or a teen who is limited in their ability to travel or eat out with friends because of concerns about finding foods they can eat. Some people with ARFID have always been extremely picky eaters- limiting their food choices to a very small list of things that are often highly specific (e.g. only certain brands, or certain preparations). In some cases this is related to sensory characteristics of food items- the texture, color, or flavor. Sometimes people with ARFID are worried about negative consequences of eating- this can include worries about stomach pain, nausea or constipation/diarrhea, or worries about choking or vomiting among other things. What makes ARFID different from other eating disorders is that these symptoms occur without any body image concerns.
Other Specified Feeding and Eating Disorder (OSFED) is diagnosed when a person presents with eating issues that cause distress or impairment in social, academic, or other important areas of functioning, but does not meet criteria for one of the other diagnoses. One of the most dangerous misperceptions about eating disorders is the idea that OSFED is somehow a milder disorder. OSFED is not less physically or psychologically severe than anorexia or bulimia and can also be life threatening.
While the specific criteria of eating disorders matter, it’s also important to remember this: if your child’s eating habits are so unusual, rigid, dys-regulated, or limited that they lead to difficulties in their ability to have a normal or fulfilling life, they likely have an eating disorder, regardless of whether you can check off all the “official symptoms”. In other words, if eating habits or body image are keeping your child from doing anything they value, or if they’re only able to do these things with a massive amount of effort or distress, then their symptoms need attention and they likely have an eating disorder, even if it doesn’t fit into any of the exact diagnostic profiles described.
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