Written by Jessica Koroni, MS, RD, LDN, CEDS
This blog is a brief introduction into the eating disorder world. It is not meant to offer a diagnosis or be a replacement for a clinical evaluation. As an eating disorder dietitian, I have encountered numerous people who simply do not know what an eating disorder is. As a Certified Eating Disorder Specialist, it is my job (and honestly passion) to help educate people on eating disorders, dispel some common myths and hopefully encourage more open and honest conversation about them. If you are concerned someone you love may struggle with an eating disorder, or if you yourself are noticing a lot of challenges with food, do not hesitate to reach out to your provider and get a clinical assessment. Let’s begin.
According to the Diagnostic Statistical Manual of Mental Disorders-5th edition (DSM-5), feeding and eating disorders are “characterized by a persistent disturbance of eating or eating-related behavior that result in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning” (1). To put it simply, eating disorders impact a person’s mental and physical health through eating-related behaviors. There are different types of eating disorders, all with their own characteristics. The different types of eating disorders are listed below.
- Avoidant/Restrictive Food Intake Disorder (ARFID) – check out our blog on ARFID
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
- Binge Eating Disorder (BED)
- Other Specified Feeding or Eating Disorder (OSFED)
- Unspecified Feeding or Eating Disorder (UFED)
I’ve noticed when most people hear the term “eating disorder,” they immediately think of anorexia nervosa and imagine a very malnourished, white female. The truth is, eating disorders can affect anyone. Below are some common myths about eating disorders.
Common Eating Disorder Myths
“The most common type of eating disorder is Anorexia Nervosa”
False: The most common type of eating disorder to date is Binge Eating Disorder (BED) (2). Less than 6% of people with eating disorders are medically diagnosed as “underweight.” This means the majority of people with eating disorders do not live in noticeably malnourished bodies. (3)
“Eating disorders are a female problem”
False: Eating disorders are gender-neutral. Regardless of someone’s sex assigned at birth, or gender identity, any person can be impacted by an eating disorder. Among people who suffer from Anorexia Nervosa, 25% of those individuals are male. (4)
“Eating disorders are a choice”
False: Eating disorders are not a choice. They are a complex psychiatric condition that can create serious medical complications and adversely impact peoples’ lives (1). 28-74% of risk for eating disorders is through genetic heritability.(5)
“Eating disorders are about the food”
False: Despite how it may seem on the outside, eating disorders are not about food. Although food can be the source of control or lack of control, eating disorders are a complex psychiatric condition.
“Eating disorders typically affect white people”
False: Eating disorders affect people of all ethnicities and races (6). In fact, a study published in 2011 determined BN was more prevalent in Latinos and African American communities than it was in non-Latino White communities.
What Do I Do if I Think I/My Loved One Has an Eating Disorder?
This is a tough place to be. To start, I am proud of you for getting curious. Exploring an eating disorder can be tricky and intimidating, especially if you have never treaded these waters before. If you are concerned you, or someone you know, may have an eating disorder, seek understanding and support. Treating an eating disorder is not a one man job. It requires a team of professionals, family members, support people and lastly, the person actually struggling from one. As mentioned previously, eating disorders are a complex psychiatric condition and require a team to treat.
To start, there is a questionnaire developed to provide early screening for eating disorders. It is called the SCOFF questionnaire and it is 5 questions. This questionnaire is not intended to be a diagnostic tool, and there are areas in its design that are lacking. For example, the questionnaire was developed and tested on women suffering from AN and BN only. This leaves out other eating disorder diagnoses that present with different behaviors. For example ARFID typically does not have a body image component, and BED typically does not have compensatory behaviors. It is important to acknowledge these areas that are lacking when going through the questions.
Another limitation is question 3, “have you recently lost more than one stone in a 3 month period”? Individuals can suffer from an eating disorder, and not experience any weight loss. Although the questions can apply to everyone, they are created through a limited lens, and may not always flag someone who is struggling with an eating disorder. Keeping this in mind, the 5 SCOFF questions are listed below and can be a starting point for some. Each question answered yes = 1 point. A score with 2 or more points can indicate a likely diagnosis of AN or BN. (7)
The SCOFF questions*
• Do you make yourself Sick because you feel uncomfortably full?
• Do you worry that you have lost Control over how much you eat?
• Have you recently lost more than One stone (14 lb) in a 3-month period?
• Do you believe yourself to be Fat when others say you are too thin?
• Would you say that Food dominates your life?
Second, if you have completed the questionnaire and the results are leaning towards disordered eating/eating disorder behaviors, get a clinical evaluation. Eating disorder evaluations can be done by doctors or therapists. It is best to seek out an individual with an eating disorder background.
If you are diagnosed with an eating disorder, it is time to put together a team. Treating an eating disorder typically requires a doctor, psychiatrist, therapist and dietitian (in some cases a feeding therapist and/or speech language pathologist). If you don’t know where to even begin, start with your doctor or dietitian and ask for some referrals. Lastly, begin the process of exploring your eating disorder and working towards recovery. This process looks different for everyone, and may require different therapies, medications and/or nutrition plans.
What is a Dietitian’s Role in Treating an Eating Disorder?
Each team member has an important and necessary role in treating an eating disorder. The dietitian is there to provide individualized nutrition recommendations. Dietitians cannot diagnose an eating disorder, but they can diagnose a nutrition problem. Based on the nutrition problem, the dietitian will come up with a nutrition plan for the individual. They will also help the client explore their belief system around food. The dietitian does NOT solely create a caloric meal plan. Eating disorder dietitians have a strong background in eating disorders as well as expertise in food and nutrition, allowing them to provide nutrition recommendations in relation to the person’s eating disorder behaviors. Not every dietitian has a background in eating disorders, so it is best to try and work with someone with this knowledge. Looking for someone with the Certified Eating Disorder Specialist (CEDS) credentials or interviewing someone to ensure they have an eating disorder background is helpful. A CEDS certification is not a requirement for someone to work with the eating disorder community, but it does confirm they are educated in this area. There are a multitude of providers with years of experience in the eating disorder field, who choose not to posses the CEDS certification. It is important for you to not only find someone with and eating disorder background, but also someone who fits you and your needs.
Resources
- If you find yourself struggling with your relationship with food, book an assessment by a Peachy dietitian! See the link below:
- National Eating Disorder Association
- Project HEAL
References
1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
2. Marx, R. (2013). New in the DSM-5: Binge Eating Disorder. National Eating Disorders Association. Retrieved April 20th, 2023 from https://www.nationaleatingdisorders.org/blog/new-dsm-5-binge-eating-disorder
3. Flament, M., Henderson, K., Buchholz, A., Obeid, N., Nguyen, H., Birmingham, M., Goldfield, G. (2015). Weight Status and DSM-5 Diagnoses of Eating Disorders in Adolescents From the Community. Journal of the American Academy of Child & Adolescent Psychiatry, Vol. 54, Issue 5, 403-411
4. Hudson, J., Hiripi, E., Pope, H., & Kessler, R. (2007) “The prevalence and correlates of eating disorders in the national comorbidity survey replication.” Biological Psychiatry, 61, 348–358.
5. Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31.
6. Marques, L., Alegria, M., Becker, A. E., Chen, C. N., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders, 44(5), 412-420. https://doi.org/10.1002/eat.207877. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: a new screening tool for eating disorders. West J Med. 2000 Mar;172(3):164-5. doi: 10.1136/ewjm.172.3.164. PMID: 18751246; PMCID: PMC1070794.
