Does your eating disorder have a name?

When I read this piece in the New York Times today about a new category of eating disorder not encapsulated by traditional definitions of anorexia and bulimia, it reminded me of the classes I taught on body image when I was an adjunct professor at two colleges in Oregon.

After making my way through many studies, texts, student papers, and other research for those classes, I came to the sweeping conclusion that too many women fall within the bounds of categorized eating disorders and all women have, to some degree, disordered eating and distorted body image. It is a big statement, I know. But with messages from the media, our families, our peers, and the nagging voices so many of us have in our own heads, how is it to be avoided?

My frustration in teaching, within my friendships (every single one of my college roommates had an active eating disorder while we lived together) and also in my own struggles to come to peace with food and with my belly, is that there were not enough words to describe what was going on when women manifested all those weird and secretive and destructive ways of controlling the numbers on the scale and the food on the plate.

Those frustrations, however, may finally be over. Or at least, there are at least a few more ways to encapsulate exactly what bulimia without the binge or anorexia without the emaciation really is.

The American Psychiatric Association produces a reference manual, The Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), that is used by doctors, counselors, clinicians, case workers, health insurance and pharmaceutical companies, and many others who assist people in need. In its current edition, contains a diagnosis for  Ednos, which stands for “eating disorder not otherwise specified.” This definition covers a wide range of eating disorders that do not specifically fall under the guidelines for anorexia or bulimia, including night eating syndrome, overly picky eating, binge eating, and others.

The concern by some medical professionals is that the definition is too wide open and will be overused in diagnoses. The APA is reacting by assigning a work group to study “traditional” eating disorder definitions and potentially reconfigure the diagnostic criteria for Ednos, which will be published in the D.S.M.-5 edition in 2013. The New York Times cites statistics from the National Eating Disorders Association that say 4% of American women are diagnosed with Ednos each year. This diagnosis outnumbers those for anorexia and bulimia, making Ednos the most common eating disorder in this country.

A study published last year in the International Journal of Eating Disorders reported that Ednos is commonly the mid-point as a woman goes from having a well-cultivated eating disorder into recovery, or from normalized eating to delving deep into an eating disorder.

Some doctors say that patients feel the need to have a concrete diagnosis before they will seek treatment for an eating disorder, which makes the Ednos category an important tool in helping women. And even though anorexia, for example, is not necessarily indicated by a starved-looking body, some women note they’ve been ignored or dismissed by doctors if they appear normal or overweight and have been engaging in anorexic behavior.

This disconnect is one reason eating disorder specialist and founder of Health at Every Size Dr. Deb Burgard says weight standards should be lifted from definitions of eating disorders.

“I have worked with plenty of restricting average-sized and fat patients who really should be diagnosed with anorexia nervosa. But there is confusion based on the current D.S.M. whether they meet the criteria for the diagnosis if they are not at a low B.M.I. — even if their current weight is extremely low for them individually and they’re showing signs of starvation,” she told the New York Times.

What does count in the category of Ednos? Psychologists say that the eating and behavior related to eating has to be disordered. For example, if work or social life are impacted, then that person could fall under the Ednos guidelines. Signs might include severe chronic dieting, compulsive exercising, purging, or overeating at night.

Just as I did when I passed out packets of articles and projects filled with definitions, statistics, and anecdotes about treatment and recovery to my students years ago, what the inclusion of new and reworked definitions of eating disorders will mean for women personally.

Will it mean that more women will get the help they need to eat healthier, feel better in their bodies, and find peace that can so easily be disrupted on a scale, at the kitchen table, in intimate situations, or in a dressing room?

Will it mean that many of us, maybe even most of us, are now diagnosable, or at least could have been during dark or tumultuous or stressful parts of our lives?

What are your thoughts on the broadly-defined eating disorder category of Ednos?

Is there, as there could be for all of us who struggle with food and weight, more work to be done?

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7 Responses to Does your eating disorder have a name?

  1. MelissaG says:

    Would “being a gigantic fat a$$ who can’t seem to stop cramming more unhealthy food into one’s mouth and who makes all kinds of ridiculous excuses about it” be a category under these rules? I think that’s more a sign of mental illness than people who are “picky eaters” or “compulsive exercisers.”

    OK, that was pretty harsh. But as someone who has battled anorexia, bulimia, and now is healthy, I think these new Ednos guidelines are missing a large group of unhealthy people because it’s not PC to tell fat people they’re fat, and to do help them do something about it. Don’t doctors ever tell people these things? It could save their lives.

  2. Joy in Seattle says:

    I agree with MelissaG. There is another category of eating disorders that are rampant in America and that is overeating. My friend hates it that she’s fat, yet she keeps gaining weight because she can’t stop herself, can’t regulate herself, and completely refuses to pay attention to nutrition&calories.

    I don’t think we should all be stick skinny, but when you get above 250 it’s time to worry about what mentally is keeping her from physically being healthy.

  3. MelissaG says:

    I don’t think they liked the way I phrased my first comment so I will rephrase:

    If fat people are eating unhealthy things/never exercising/and are in denial, risking obesity, heart disease, diabetes onset, and so on, shouldn’t a healthcare professional tell them to do something about it, just as much as they’d tell an anorexic or a bulimic?

    Nobody tells fat people they’re fat because it’s so un-PC to do so. But I think that group of the population must have some pretty messed up relationships to food and weight and body image. Don’t they deserve a label and professional help?

  4. jamil says:

    MelissaG-Wow I wonder why there are so many “gigantic fat asses who can’t seem to stop cramming more unhealthy food into their mouths and make ridiculous excuses for it?”

    Why is it that society is supposed to feel sorry for and offer all this support to people like YOU who used to starve and barf up anything you did manage to eat…oh but I’m betting you never made any excuses for that behavior though right??

    People who are anorexic or bulimic are looked at with sympathy and treated. If you are obese or worse, morbidly obese, you are treated worse than garbage. You are NOT treated like you too have a issue with eating that needs to be treated. You think it’s not PC to tell someone they are fat? I can assure you that most doctors will go out of their way to not only inform you of it but to berate you and make you feel even more worthless than before.

    When you were diagnosed as anorexic I’m willing to bet you weren’t talked down to like you were stupid and worthless. In fact I bet you were giving tons of support and well wishes from doctors and everyone else. Because after all it’s not PC to say “Hey you skinny anorexic b!tch why don’t you get a grip and eat a sandwich before you drop dead of a heart attack.” OK, that was pretty harsh…as you would say.

    My point is that disordered eating affects so many people…men, women, and worst of all children are being suckered into it. Because god forbid a child be looked at as fat, really in our society there’s nothing worse. If that same child were looked at as anorexic, well then she’d be nourished back to health. If she stays even a tad bit on the chubby side she will be treated like crap over and over again till she has the idea ingrained in her head that she’s not worthy because of her weight.

    Whatever there’s really probably no point here in what I’m saying because some people are so ignorant. A person whether they are anorexic or an obese binge eater, they both deserve help just the same. And they both deserve to be treated with respect. Why is it that one is seen as it’s the person’s own fault they can’t just undo it but the other is seen as this terrible disorder that one can hardly control?

  5. jamil says:

    MelissaG, once again believe me fat people are almost constantly reminded of how fat and gross and unhealthy and unattractive and unloveable and everything else they are ALL THE TIME! It’s actually tough to find a doctor who will help you with your obesity without judging you for it.

    And Joy in Seattle, wow you sound like such an understanding friend. With friends like you who needs enemies? Your friend obviously has a problem. Sometimes when you gain so much weight it’s so depressing trying to get yourself out of it that you end up eating to cover that pain. Does that make sense, no. Does it make sense when a perfectly normal weight girl barfs her guts up in the bathroom after every meal? No, but it’s tolerable because she’s not fat. God forbid anyone be fat.

    You say yourself that your friend “can’t stop herself” and “can’t regulate herself.” HELLO, that sounds like a problem then doesn’t it? Do you think she just decided one day it would be really fun to always eat too much and to have a weight problem? Yeah I know that’s what most women want to live like.

    All I’m saying is that not every fat person in the world just sits around all day eating and doing nothing else because they are a fat lazy pig. People just really have no compassion for people who are overweight because they “do it to themselves”. Well so do anorexics and bulimics. If everyone would let up and realize not everyone is made to be a size 0 then maybe there wouldn’t be so much of this crap in the world.

  6. Heather K says:

    Who says nobody tells fat people they are fat?? They get told everyday by the media, friends (and people who are not friends) and by health professionals too! Where are you getting your information? Just as an anorexic or bulimic they have a choice to listen to what their doctors say to get better or not.

    As someone who battled with eating disorders yourself (Melissa G – as you stated above) tell me…did you quit the first, second or even third time someone, doctor or otherwise, told you to? Somehow I doubt it.

    Back to the article, I appreciate the new category. As a bulimic that is not a stick figure I often feel that no one believes me or wants to work with me b/c I don’t represent their idea of what it means to be bulimic.

  7. CBT says:

    It all comes down to people generating more emotion than is necessary or helpful, more than they know what to do with, and in particular shame and anxiety, in response to their life events and situations. It’s perfectly understandable to do so, especially since we do so little when we have a chance in schools to teach young people to better manage how they respond cognitively and emotionally to what happens around them, or to them, at the same time young girls especially are bombarded by challenges from young guys, and so many messages from advertising and media that can negatively impact the cognitive choices they make about what they see in the mirror, usually without them being consciously aware of it. Be it overeating or the behavior associated with eating disorders, it serves a purpose. And what gives it purpose is that young people generate more emotion than they know what to do with. We could and should be doing much more to help them with this. Teach them to have unconditional self-acceptance, and an internal locus of control so that they are not making how they feel depend so much on things outside themselves, including other people opinions and actions, and some unrealistic standards set by advertising and media. Everyone has cognitive choice to make that they alone can make, but we can help young people make them better. Schools are only slowly beginning to recognize a need to do so. Not fast enough for many.

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