Diagnosing Eating Disorders
Katie* is in her third semester of college and she's beginning to get frustrated with her life. "I am taking 15 credit hours, working two jobs, hold an internship, belong to a service organization, play on a women's soccer team and take improv acting classes," she says. "I expect a lot out of myself. Food and eating is a release for me. I let myself lose control and eat anything and everything. Afterwards, I need to regain control and purge. Now I feel guilty after I eat anything. I usually vomit three times a day."
She's hidden her eating disorder from her family because she doesn't want anyone to think she is vulnerable, but she understands that she needs help. "It's not a weight issue," she says. "But it is scary how much of my thoughts and actions are devoted to thinking about eating and getting rid of food."
Sarah's* eating disorder stems from her need to control everything around her. She was a competitive runner and as a high school freshman, she had the natural curves of a girl going from child to womanhood. She felt the curves were slowing her down, so she began to focus on losing weight. "I became obsessive about exercise," she says. "If I ate something, I went running." When she was 16, her parents stepped in and forced her into therapy. It likely saved her life.
There are specific criteria to be diagnosed as anorexic or bulimic, says Dr. Jennifer Nardozzi, assistant clinical director of the Renfrew Center of Florida. To be diagnosed with anorexia, the patient needs to be at 85 percent or less of expected body weight, a fear of gaining weight, unhealthy view of their weight (thinking they are fat when they are severely underweight), and for women, three months of a missed menstrual cycle. There are two types of anorexia: restricting (decreasing calories to lose weight) and engaging in purging behaviors.
To be diagnosed with bulimia, the patient eats a large amount of food in a two-hour period or is out of control while eating and then purges the food. Purging can be done in a variety of ways: vomiting, laxatives, enemas and over-exercising. This behavior happens at least twice a week for at least three months.
Most people know the terms anorexia and bulimia, but many would be surprised to know that there are actually three types of eating disorders: anorexia, bulimia and eating disorders not otherwise specified.
Eating disorder not specified is a catch-all phrase for all other eating disorders, says Amy Mueller, clinical director at Walden Behavioral Center. The other eating disorders may have the qualities of bulimia or anorexia, but they doesn't meet all the criteria to be officially diagnosed as one of those two disorders. For example, a young woman might binge and purge only once a week for a period of four or five months. While it doesn't fit the exact criteria of bulimia, it is an eating disorder.
"Eating disorders vary," Mueller says. "That's why there are specific and different diagnoses. The important thing to remember is if eating issues start interfering with daily functions like school or work or relationships, there might be a problem."
Some more specific eating disorders that currently fall under eating disorders not specified include binge eating disorder, orthorexia and disordered eating.
Binge Eating Disorder
Binge eating disorder (BED) has only recently been recognized as an eating disorder. According to Dr. Michael Kaplan of The Center for Medical Weight Loss, BED consists of the following symptoms:
- continue to eat after being full
- cannot stop eating
- lack of control of eating
- eating large quantities of food when not hungry
"It's an addiction – and no different from most addictions," Dr. Kaplan says. "The person gets an increased pleasure when participating in the activity, and they can't stop themselves."
To treat the disorder is also to treat the addiction. "We put patients on a low-calorie diet, and then get them counseling to help them to understand and break the addiction," he says.
According to Jane White, associate dean for research and graduate programs at Adelphia University School of Nursing, orthorexia happens to people who think they are eating healthy but aren't.
"They are using supplements, vitamins, minerals – supposedly healthy approaches, but they end up doing damage to their bodies," she says. People who insist on eating organic foods only are at risk for orthorexia, she says. "They won't or can't eat out normally. Eating organic becomes an obsession."
An obsession is one of the hallmarks of an eating disorder. Experts are quick to remind you that eating disorders aren't about the food or eating itself; it's the psychological problems that lead to dysfunctional views.
Disordered eating occurs in those who are obsessive about weight. Obviously, this can cover various eating disorders, but it also covers the person who eats disproportionately to compensate for too many calories at one meal or the person who skips a meal thinking this is the best way to lose weight.
How You Can Help
"You never know who will be predisposed to develop a disorder," Dr. Nardozzi says. "A lot of people diet, but for some, it gets worse."
If parents notice their child taking a disinterest in food or too much interest in losing weight, Dr. Nardozzi suggests watching for other behaviors and physical changes like the following:
- change in moods
- secretive behaviors
- going to the bathroom more frequently
- "chipmunk" cheeks (comes from frequent purging)
- pale or yellowish skin tone
"Eating disorders are often a way to cope with emotional problems," Dr. Nardozzi says. Losing weight or severely restricting food intake can create the illusion of being in control. But it's not just losing weight that attracts those with emotional difficulties; binge eating does as well. "It may be soothing to overeat," Dr. Nardozi says. "For some, that large size is like a protection."
If you think your child is dealing with an eating disorder, Mueller says to contact your family physician and ask if he understands the treatment of eating disorders. If not, ask for a recommendation to a doctor who does. Don't be afraid to put your child into a clinic or a hospital for treatment. There the child will get both the psychological and nutritional treatments necessary to begin living a healthy life.
*Last name withheld to protect privacy.