Eating disorders vs disordered eating have some overlap, but they are not the same. Read on for a full breakdown of the key differences between an eating disorder versus disordered eating, side effects, treatment options, and valuable resources.
It is important to seek professional help if you or someone you know is struggling with disordered eating or an eating disorder, as both can have serious health consequences and require specialized treatment.
What are Eating Disorders?
An eating disorder is a serious mental health condition characterized by irregular eating habits and severe distress or concern about body weight or shape. It involves a persistent disturbance in eating behaviors, attitudes, and beliefs that significantly impact a person’s physical and psychological well-being.
The American Psychiatric Association defines eating disorders as behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.1
If you are suffering from an eating disorder, you likely feel consumed with thoughts about food, weight, and body shape/size. This obsession leads to significant levels of anxiety about eating, eating behaviors, and multiple health consequences. The extreme actions taken by those with an eating disorder tend to mimic those of an addict.1,2 Eating disorders have the second-highest mortality rate of all psychiatric disorders.2
There are several types of eating disorders, including:
- Anorexia nervosa: Individuals with anorexia nervosa have an intense fear of gaining weight and a distorted body image. They restrict their food intake, leading to significantly low body weight. They may also engage in excessive exercise and exhibit other behaviors to prevent weight gain.
- Bulimia nervosa: People with bulimia nervosa experience recurrent episodes of binge eating, where they consume a large amount of food within a short period, followed by compensatory behaviors to avoid weight gain, such as self-induced vomiting, excessive exercise, or the use of laxatives or diuretics.
- Binge eating disorder: This disorder involves recurring episodes of consuming large quantities of food within a short time, accompanied by a feeling of loss of control. Unlike bulimia, individuals with binge eating disorder do not engage in compensatory behaviors.
- Other specified feeding or eating disorders (OSFED): OSFED, previously known as “eating disorder not otherwise specified”, includes a range of eating disorders that don’t meet the full criteria for anorexia, bulimia, or binge eating disorder. This category includes conditions like atypical anorexia nervosa, purging disorder, and night eating syndrome, among others.
We will take a deeper look at these and better understand which criteria fits each.
Treatment of Eating Disorders vs. Disordered Eating
Eating disorders can have severe physical, emotional, and social consequences. They can lead to malnutrition, electrolyte imbalances, organ damage, cardiovascular problems, digestive issues, depression, anxiety, isolation, and even life-threatening complications.
The recovery rate in treatment is around 60% due to a lot of factors.5,2 The recovery time frame is highly individualized, but in general will entail a lengthy and complex process.
Treatment for eating disorders often involves a combination of medical care, nutritional counseling, psychotherapy, and, in some cases, medication. It’s important to seek professional help if you or someone you know is struggling with an eating disorder, as early intervention and comprehensive support can improve the chances of recovery.
Treatment for disordered eating is less acute and will require outpatient treatment by a dietitian and counselor.
Who is at risk for an eating disorder?
Some stats on eating disorder risk factors:
- While eating disorders do not discriminate, they are most common in women ages 12-35.1,3
- Higher rates of eating disorders are also prevalent in athletes, LGBTQ persons, and those with preexisting physical or psychiatric disabilities.2
- Individuals exposed to traumatic and/or stressful events early in life, in both the absence or presence of concomitant psychiatric disorders, are at increased risk for developing an eating disorder.3
- There may be a genetic component. Large systematic research reviews have shown a 7 to 12-fold increase in prevalence in relatives of ED sufferers, however it remains unclear how much of this increase is related to sharing a similar environment rather than genes alone.4
Types of Eating Disorders
Anorexia Nervosa
Considered by experts to be the most severe eating disorder, Anorexia Nervosa carries the highest mortality rate of all EDs. Those suffering from Anorexia Nervosa exhibit restrictive eating behaviors and significant body dysmorphia. Severe Anorexics are generally very underweight.
Anorexia Nervosa can be further divided into two subsets: Restricting type and Binge-eating/purging type. Restricting type anorexics engage in calorie restriction, fasting, and excessive exercise. Binge-eating/purging type anorexics engage in all of the behaviors of restricting types, as well as compensatory binge eating and/or purging.1,3
The official criteria for Anorexia Nervosa includes:
- Restriction of energy intake relative to requirements, leading to a significant low body weight in the context of the age, sex, developmental trajectory, and physical health (less than minimally normal/expected)
- Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain
- Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of seriousness of low bodyweight6
Multiple health problems can result from Anorexia Nervosa:
- Loss of menstrual period/infertility
- Bone loss
- Severe constipation
- Low blood sugar
- Dehydration and electrolyte abnormalities
- Vitamin and mineral deficiencies
- Heart rhythm abnormalities 1,4
- Sensitive to cold temperatures
- Slowed heart rate
Anorexia Nervosa is not to be confused with Anorexia, which is the medical terminology for loss of appetite/inability to eat. Nervosa, latin for “nervous”, distinguishes the two.
Bulimia Nervosa
Bulimia Nervosa is characterized by a vicious cycle of eating abnormally large quantities of food in a short period of time (known as binge eating) followed by subsequent compensatory behaviors to offset the calorie load. Intentionally making yourself vomit (known as purging), fasting/calorie restriction, excessive exercise and/or laxative abuse are some examples of these behaviors.
Binge behaviors are generally done in secrecy due to guilt and shame. Bulimics also exhibit a significant preoccupation with food, weight and body size.
Of note, the key difference between Bulimia Nervosa and Anorexia Nervosa binge-eating/purging type is weight status. The latter diagnosis is made when the individual is significantly underweight, whereas Bulimia Nervosa sufferers may be normal weight, slightly underweight, overweight or obese.1,5
The official criteria for Bulimia Nervosa includes:
- Recurrent episodes of binge eating, as characterized by both:
- Eating, within any 2-hour period, an amount of food that is definitively larger than what most individuals would eat in a similar period of time under similar circumstances.
- A feeling that one cannot stop eating or control what or how much one is eating.
- Recurrent inappropriate compensatory behaviors in order to prevent weight gain such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting or excessive exercise
- The binge eating and inappropriate compensatory behaviors occur, on average, at least once a week for 3 months
- Self-evaluation is unjustifiability influenced by body shape and weight
- The disturbance does not occur exclusively during episodes of anorexia nervosa 6,2
While Bulimia Nervosa is statistically less deadly than Anorexia Nervosa, there are many fatal complications, particularly associated with purging behaviors. Examples include: tears to the esophagus or stomach wall, heart arrhythmias, and pancreatitis.8 Some less fatal, but still dangerous complications of Bulimia Nervosa include dental decay, heartburn/acid reflux, dehydration, chronic sore throat, and chronic diarrhea.1,6
Binge Eating Disorder
Binge Eating Disorder is characterized by recurrent, frequent binge eating episodes. These episodes tend to feel like an “out of body” experience, and during these most people find they are unable to stop eating even when physically full.
The key difference between Binge Eating Disorder and Bulimia is that the former does not include compensatory behaviors such as purging or fasting.
Binge eating disorder is the most common eating disorder.5,3
The official DSM-5 criterion for Binge Eating Disorder is as follows:
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within a 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
- The sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
Binge-eating episodes are associated with three (or more) of the following
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of being embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty after overeating
- Marked distress regarding binge eating is present.
- The binge eating occurs, on average, at least 1 day a week for 3 months
- The binge eating is not associated with the regular use of inappropriate compensatory behavior (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa6,3
A severity grading scale for Binge Eating Disorder has been added to the DSM-5. It is as follows:
- Mild: 1-3 episodes/week
- Moderate: 4-7 episodes/week
- Severe: 8-13 episodes/week
- Extreme: 14 or more episodes/week 6,4
Binge eating disorder carries many health risks. Ongoing binge episodes tend to place the individual in a surplus of calories, which can lead to cardiovascular issues such as heart disease and hypertension, diabetes, gallbladder disease, gastrointestinal distress, and sleep apnea.9
Atypical EDs
Atypical Eating Disorders, or Other Specified Feeding or Eating Disorders (OSFED), occur when a person experiences significant ED symptoms but does not meet the full diagnostic criteria. Atypical EDs are more and more common as folks seek help and realize they don’t have to fit perfectly into one diagnosable box.
Examples of atypical eating disorders include:
- Atypical Anorexia Nervosa: All AN symptoms are present but the individual maintains a normal weight despite significant weight loss
- Bulimia Nervosa or Binge Eating Disorder of low frequency/limited duration
- Purging Disorder: Self-induced vomiting and/or laxative abuse in the absence of binge eating behaviors
- Night Eating Syndrome: Recurrent episodes of late-night eating10
Atypical eating disorders are not any less significant and still hugely impact your quality of life.
What is Disordered Eating?
Disordered eating, on the other hand, refers to a range of irregular eating behaviors or attitudes that may not meet the criteria for a specific eating disorder, but can still have negative effects on a person’s health and well-being.
Examples of disordered eating include skipping meals, fasting, using diet pills or laxatives, obsessively counting calories or weighing oneself, or feeling guilty or ashamed about food choices.
While disordered eating does not necessarily indicate the presence of a diagnosed eating disorder, it can still lead to similar physical and psychological problems over time.
Eating Disorders vs. Disordered Eating
Diagnostic criteria
An Eating Disorder diagnosis is made by a medical professional only, and the patient must meet the DSM-5 Criterion. On the flipside, disordered eating describes the behaviors but does not require a DSM-5 diagnosis.
Duration
The timeframe of eating disorders is chronic, whereas someone engaging in disordered eating may have short-lived behaviors. For example, if you overindulge far past the point of satiety once or twice, the behavior is disordered, but it does not meet the criterion for Binge Eating Disorder.
Severity
While the symptoms of both are similar, eating disorders are more severe and debilitating to your physical and mental health than disordered eating.
Eating disorders interfere with your ability to function, whereas someone with disordered eating habits may be able to function at their baseline despite the behaviors.11
For example, someone with an eating disorder may socially isolate or avoid responsibilities in favor of entertaining their eating disorder. Disordered eating can take away from your day to day life, but when functionality is impaired, it generally indicates an eating disorder.
Treatment of Eating Disorders vs. Disordered Eating
Treatment of eating disorders is individualized and depends on the particular disorder, severity and symptoms, but in general includes a combination of psychotherapy, medical monitoring, and nutrition education. Medication may be required in some cases. Weight restoration is required in eating disorders that lead to malnutrition, most commonly Anorexia Nervosa.
In comparison, treatment of disordered eating may be less comprehensive or minimal if the behavior is short-lived and not associated with any mental or physical health deficits. However, as with eating disorders, treatment is case-specific.
If you are struggling with disordered eating, you might be engaging in The Diet Cycle. Read more about what it is, and how to heal from it here.
Importance of Seeking Help
If you are struggling with an eating disorder or disordered eating, you may be resistant to seeking help due to guilt, shame, or fear.
In both cases, you may feel that you are “not sick” or “not sick enough” and may be afraid of being invalidated by a medical professional. You may also be in denial, afraid to relinquish control, or comfortable with your ED or disordered habits.
Regardless if you have an eating disorder or disordered eating behaviors, seeking help is pivotal. Continued disordered eating may lead to an eating disorder diagnosis, and eating disorders can lead to death if appropriate intervention is not taken.
If you are experienced an eating disorder or disordered eating habits and need to speak to someone, The National Eating Disorder Association (NEDA) helpline is an incredible resource: Eating Disorders Helpline | Chat, Call, or Text | NEDA (nationaleatingdisorders.org)
Takeaways: Eating Disorders vs. Disordered Eating
Whether you are suffering from an eating disorder vs. disordered eating, you are not alone. Regardless of which you are dealing with, your feelings and symptoms are valid and should not be ignored.
As always, if you’re interested in more 1-on-1 support, complete the form on my Work with Me page to schedule a free introductory call!
Sources
1. American Psychiatric Association. What are Eating Disorders? February 2023. Accessed May 2, 2023. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders#section_0
2. National Association of Anorexia Nervosa and Associated Disorders. 2023. Accessed May 2, 2023. https://anad.org/eating-disorders-statistics/
3. Solmi et al. Risk factors for eating disorders: an umbrella review of published meta-analyses. Braz J Psychiatry. 2021;43(3)314-323. doi: 10.1590/1516-4446-2020-1099
4. Berrettini W. The Genetics of Eating Disorders. Psychiatry (Edgmont). 2004;1(3)18-25. PMID: 21191522
5. Eating Disorder Referral & Information Center. Eating Disorder Statistics. Accessed May 2, 2023. https://www.edreferral.com/statistics#:~:text=Mortality%20and%20recovery%20rates,They%20maintain%20healthy%20weight
6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Press.
7. The Emily Program. Physical Effects of Anorexia Nervosa. August 2018. Accessed May 2, 2023. https://emilyprogram.com/blog/physical-effects-of-anorexia/
8. Walden Eating Disorders. 5 Medical Risks of Bulimia Nervosa. 2023. Accessed May 3, 2023. www.waldeneatingdisorders.com/blog/5-medical-risks-of-bulimia-nervosa
9. Walden Eating Disorders. Binge Eating Disorder Health Risks. 2023. Accessed May 4, 2023. www.waldeneatingdisorders.com/what-we-treat/binge-eating-disorder/binge-eating-disorder-health-risks/
10. NEDA. OSFED. 2022. Accessed May 4, 2023. www.nationaleatingdisorders.org/learn/by-eating-disorder/osfed
11. Zucker T. Eating Disorders vs Disordered Eating: What’s the Difference? 2022. Accessed May 2, 2023. https://www.nationaleatingdisorders.org/blog/eating-disorders-versus-disordered-eating
Written: Emily Ventura, RD, CNSC
Edited and revised: Caroline Thomason, RD CDCES
