Eating disorders are estimated to affect up to ten million women and one million men in the United States alone. Multi-faceted diseases, eating disorders are present in men and women of all shapes and sizes. Symptoms vary from heavy restriction of calories, bingeing on large quantities of food, to purging calories through excessive exercise, self induced vomiting, misuse of laxatives and diuretics and fasting are all forms in which an eating disorder can take. In a society that emphasizes an unrealistic portrait of what people’s bodies “should” look like, all too often we see people struggling with their size and body shape; women and men of all sizes suffer from a broad spectrum of disordered eating. Although society has come a long way in recognizing eating disorders, the prevailing belief is that eating disorders fall into one of two categories, anorexia nervosa or bulimia nervosa, leaving many who suffer from life consuming thoughts and behaviors of disordered eating to remain undiagnosed and therefore untreated. Eating disorders are progressive diseases; frequently, people who suffer from one form of disordered eating engage many behaviors.
It is not unusual for people who suffer from eating disorders to switch from one maladaptive behavior to another. Commonly, those who suffer from eating disorders have other mental health illnesses, such as major depression, bi-polar disorder, obsessive compulsive disorder and anxiety disorders. “We (2) found that 71% of 271 current subjects with eating disorders had lifetime comorbidity with at least one anxiety disorder (64% for Dr. Kaye et al.)” (Godart, Berthoz,Perdereau, Jeammet 1) Along with other mental disorders, it is also known that people who suffer from disordered eating can suffer from other addictive behaviors such as drug or alcohol use. “Many studies have documented the high rate of cooccurrence of eating and substance-related disorders in clinical (1-6) and community (7,8) patients” (Varner 224)
Eating disorders as a diagnosable psychiatric disorder are relatively new, first appearing in the DSM in the 1980‘s. “The recognition of the diagnosis was due in large part to a dramatic increase in cases in the 1970s and '80s. Experts often attribute the increase to the intense focus in the popular media on thinness as an ideal for young women and to a greater recognition of the condition by health care professionals.” (Encyclopædia Britannica online) The initial recognition of eating disorders in the DSM was limited to two diagnosable illnesses, anorexia nervosa and bulimia nervosa. Though currently many who suffer from disordered eating are unable to obtain a diagnosis, as their patterns of disordered eating and thought do not fit within the DSM IV’s narrow criteria for either anorexia or bulimia nervosa, newly acknowledged disordered eating patterns are on their way to recognition.
Other disruptions in eating patterns include orthorexia, which is “Similar to anorexia nervosa, the well-known eating disorder in which someone stops eating or eats very little to become thinner, orthorexia significantly restricts what a person eats in order to be supposedly healthy and to feel 'pure."” (Choquette 16), night eating syndrome, where “The core criterion is an abnormally increased food intake in the evening and nighttime, manifested by (1) consumption of at least 25% of intake after the evening meal, and/or (2) nocturnal awakenings with ingestions at least twice per week.”, and compulsive overeating and binge eating disorder, where individuals are drawn to continue eating, trying to feed an insatiable hunger, leading to bingeing much like someone who suffers from bulimia nervosa does. While these eating disorders vary greatly in symptoms, often the underlying causes of the disorder are very similar.
Eating Disorder Not Otherwise Specified is a category that encompasses individuals who do not meet or fit in the diagnostic criteria for anorexia nervosa or bulimia nervosa. “At least half of all people diagnosed with an eating disorder do not meet the full criteria for either of the two main categories described above. The diagnosis of eating disorder, not otherwise specified, or EDNOS, is given to those with clinically significant eating disturbances that meet some, but not all, of the diagnostic criteria for either anorexia nervosa or bulimia nervosa.” (Encyclopedia Britannica Online) For example, an individual can severely restrict their calories and may be underweight, but continues to have their period, therefore would not fit in the diagnostic criteria for Anorexia Nervosa. “Many clinicians report that some girls and women with symptoms of anorexia do not lose their periods, yet the current DSM requires amenorrhea as a condition of diagnosis, he explains. This criterion is also irrelevant to men and difficult to apply to women on birth control pills, Walsh notes.” (DeAngelles 44) Some individuals suffer from binge eating disorder or compulsive overeating. In these disorders individuals experience bingeing much like a someone who suffers from bulimia nervosa, but do not do anything to compensate for the calories consumed. There are plans, however, to address the holes in the diagnostic criteria for eating disorders in the DSM V. “Psychologists are playing a major role in work to revise the eating-disorders criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, due out in 2012.” (DeAngelles 44)) With hopes to include disorders such as binge eating disorder, psychologists are searching to find the best ways to redefine the symptoms and criteria for diagnosis. There are such an array of symptoms that individuals can suffer from that do not meet or fit into the diagnostic criteria for either Anorexia Nervosa or Bulimia Nervosa, and therefore the category EDNOS developed.
Bulimia Nervosa is characterized by episodes of bingeing, which is defined as eating a much larger portion of food in a short amount of time than a normal individual would, followed by purging, which can take many forms, such as self induced vomiting, misuse of laxatives and diuretics, fasting, and excessive exercise. While it is known that individuals suffering from Anorexia Nervosa are unable to maintain a healthy weight, Bulimics are often in the healthy weight range to overweight. Within bulimia nervosa, there are two sub-categories: bulimia purge type and bulimia non-purge type. Though both of these forms include a way of compensating for the calories consumed, non-purge type bulimics use excessive exercise and/or fasting opposed to purge type bulimics who induce vomiting, and/or misuse laxatives and diuretics. The DSM IV’s diagnostic criteria for Bulimia Nervosa states than an individual must binge and purge at a minimum of two times per week for three consecutive months. (Encyclopedia Britannica Online)
Anorexia nervosa is an eating disorder in which an individual severely restricts their calorie intake, leading to dramatic weight loss. As noted in the DSM IV, anorexics fail to maintain at least 85% of their body weight. In post-monarchal women, the lack of body fat due to self starvation causes cessation of menstruation. It is also noted that anorexics suffer from severe distorted body image; unable to see how thin they are, they believe themselves to be too heavy or “fat”, and have an intense fear of gaining weight. Much like bulimia nervosa, there are two sub-categories of anorexia nervosa: binge/purge type and restrictive type. “The binge-eating/purging type is characterized by regular engagement in binge eating (eating of a significantly large amount of food during a given period of time) or purging (self-induced vomiting or misuse of laxatives, diuretics, or enemas) during the current episode of anorexia nervosa. The restricting type is characterized as unhealthy weight loss due to food restriction.” (Encyclopedia Britannica Online)
Having experienced a variety of disordered eating behaviors, I’ve experienced first hand the many forms which an eating disorder can take. As my behaviors changed, my body morphed; going from emaciated to normal weight, the fluctuations of emotion and frequency of my behaviors did not subside the thinner, or heavier for that matter, I became. These feelings support my belief that eating disorders are not about weight, and are, in fact, buried deep with in an individual’s emotions.
My experience with eating disorders was similar to the research in that it was not the only mental disorder I faced. Depression is found on both sides of my family and has affected me greatly. In addition to my eating disorder, I faced a long battle with self-injury and addictive tendencies towards drugs and alcohol. “Krahn suggested (2) that eating disorders and substance-related disorders may represent different expressions of the same underlying problem, that is, a predisposition to addictive behavior patterns.”
With the pending publication of the DSM V, estimated to be published in 2012 with anticipated inclusions of diagnosable criteria for eating disorders will hopefully enable these suffering from an eating disorder to seek the treatment they need. Though hopeful for the new DSM’s standards for diagnosis's, much more than editing the diagnostic criteria for eating disorders will have to change before people can receive the treatment they need. Insurance companies rarely, if ever, have adequate coverage for even those who fit into the diagnosable criteria for anorexia nervosa or bulimia nervosa. Often, treatment companies deny patients the care they need to make a full recovery. Being one of the lucky individuals able to attend all forms of treatment, from hospitalizations, residential treatment centers, partial hospitalization programs, intensive out patient programs to out patient programs, it was not because my insurance recognized the severity of my illness, but that I had a treatment team and parents willing to do whatever it took for me to get the treatment I needed, resulting in over 80% of treatment being paid for out of pocket.
What can be noted is this-- the advances in diagnosis and treatment of eating disorders since their debut in the DSM in 1980 are monumental. We have discovered that eating disorders are often coupled with other psychological disorders as well as addictions. That the prevalence in eating disorders is on the rise, with eleven million suffering in the United States alone. We also know that weight is completely irrelevant to the degree in which someone is suffering, and that there are many more than just two eating disorders that people suffer from. From anorexia nervosa, to binge eating disorder, and everything in between, eating disorders are life threatening illnesses that are incredibly prevalent in today’s society.
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