On The Feed, we often focus on helping our readers better understand what eating disorders are, how treatments move people towards recovery, and which important questions our researchers are trying to answer through science.
The feeding and eating disorders outlined in the diagnostic manual of psychiatric disorders – the DSM-5 – include:
- anorexia nervosa,
- bulimia nervosa,
- ARFID,
- binge eating disorder, and a list of
- other specified eating disorders (including atypical anorexia nervosa).
Here, let’s turn our attention to what is not considered an eating disorder.
Dieting
It is estimated that approximately 45% of Americans are currently on a diet. And almost double that have dieted in their lifetime. Diets come in many flavors — the ketogenic diet, high protein diet, DASH diet for blood pressure, intermittent fasting, or veganism/vegetarianism – and share the common ingredient of restriction. Despite an abundance of information floating around online about them, most diets are not well-researched. And if they are, then the outcomes are typically misunderstood.
People who are not vulnerable to eating disorders commonly stop dieting soon after they start (or upon meeting some pre-determined goal for change), or experiment with different diets, trying to find one that works well and feels reasonable for their lifestyle.
Sometimes, diets become overly restrictive and limiting, ultimately becoming unhealthy rather than improving health as they are thought to do. While this could possibly lead to an eating disorder, diets in and of themselves are not considered an eating disorder. A diet may evolve into an eating disorder when the eating habits become restrictive and impact physical or psychological well-being.
Orthorexia
Orthorexia is a fairly new term, introduced around the end of the twentieth century. It refers to an obsession with healthy eating. Individuals with this preoccupation become overly concerned about food
- origins,
- quality, or
- ingredients.
Like dieting, orthorexia is not an eating disorder. But it can be a risk. If the over focus on “healthy” eating begins to cause significant distress and leads to someone’s body weight falling below their body’s needs for healthy functioning, it can be considered dangerous. In this scenario, a diagnosis of anorexia nervosa or atypical anorexia nervosa may make sense, especially if the food choices are associated with a fear of weight gain.
In some cases, orthorexia may lead to a later diagnosis of ARFID. This would apply if someone with orthorexia is highly specific about the foods that they consume, making a conscious effort to avoid a wide variety of foods, resulting in nutritional problems, low weight, or difficulty in social eating situations. If the eating behavior is unrelated to a concern about body shape or weight, ARFID is a more appropriate diagnosis than anorexia nervosa.
Diabulimia
This is a condition specific to individuals with Type 1 diabetes. It involves withholding insulin in an attempt to lose weight. Diabulimia can be very dangerous and lead to
- dizziness or fainting,
- electrolyte imbalance,
- fatigue,
- nausea and vomiting, or
- diabetic ketoacidosis, which can be life-threatening.
Although this is a very dangerous condition, it does not have its own distinct category in the DSM-5 because the symptoms fall under the umbrella of two other disorders.
If the misuse leads to someone becoming underweight and there is a fear of gaining weight, then this would be considered to be anorexia nervosa. If insulin misuse serves as a compensatory practice to induce vomiting after binge eating, a diagnosis of bulimia nervosa may be apt.
Obesity
Obesity is a medical condition defined by excessive body weight retention. Most commonly, individuals are obese due to high energy intake (calories) relative to physical exertion.
Obesity is not a mental disorder at all, and therefore certainly not an eating disorder. It is considered a medical issue because in some cases, it poses a risk to overall health. Biological, economic, behavioral, or environmental factors may all contribute to the presence of obesity.
Though many individuals with binge eating disorder do not have overweight or obesity, there is an association between obesity and this eating disorder. Binge eating may be a risk factor for weight gain and obesity. Parental obesity, childhood obesity, and other factors that increase the likelihood of dieting are risk factors for both bulimia nervosa and binge eating disorder. If someone with obesity also has binge eating disorder, targeting the eating disorder can be beneficial for their overall health.
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