Eating disorders 101

About nine percent of the U.S. population (28.8 million people) will have an eating disorder (ED) at some point in their life. With eating disorders affecting such a large portion of the country, it’s vital that registered dietitians have a foundational understanding of the different eating disorders and how to identify characteristics in the patients they treat. 

Despite their prevalence, eating disorders are often misunderstood, with a common misconception being that they primarily affect white, thin women. In actuality, eating disorders can affect people of any weight, gender, socioeconomic status, age, religion, or ethnicity. Keep this in mind as you read below.  

Breaking down each eating disorder

Anorexia nervosa (AN) is characterized by restrictive caloric intake (which is relative to each person’s individual needs), fear of weight gain, and poor body image. Within the anorexia nervosa umbrella are two subtypes:  

• AN Restricting Type: Attempting weight loss via restricting intake and/or exercising  
• AN Binge/Purge Type: Restriction paired with bingeing and purging via laxatives, vomiting, and/or diuretics  

Binge eating disorder (BED) is described as feeling a lack of control around food and eating more than a “normal” amount of food within a certain amount of time, such as a 2-hour period. Those with diagnosable binge eating disorder identify with at least 3 of the following:  

• Eating at a rapid pace  
• Eating even when not hungry  
• Eating alone due to embarrassment  
• Eating past fullness  
• Feeling guilty   

Bulimia nervosa (BN) Involves engaging in bingeing (as described above) followed by compensatory behaviors, such as vomiting, excessive exercise, laxative or diuretic misuse, and/or fasting.   

Avoidant/restrictive food intake disorder (ARFID) is a relatively new diagnosis, only being recognized in the DSM in 2013. Below are the 3 main subtypes of ARFID:  

• Avoidant: Patients have sensory (smell, taste, texture, appearance, etc.) sensitivities with food. Those with this subtype find seemingly “normal” foods unappealing and/or grotesque.  
• Aversive: This involves a fear of an aversive consequence from eating (gagging, choking, stomach pain, vomiting, etc.). This fear often originates from witnessing/experiencing a traumatic event involving food.   
• Restrictive: These patients don’t necessarily feel anxiety around food as much as a general disinterest in eating and lack of interoceptive awareness.   

Other specified feeding and eating disorders (OSFED), previously known as “eating disorders not otherwise specified (EDNOS)”, is a catch-all diagnosis for those who don’t fit into any category above yet still engage in eating disorder behaviors. Some subtypes of this eating disorder include:  

• Atypical anorexia nervosa: This is a controversial diagnosis whose only difference from AN is someone’s BMI. Because EDs come in all shapes/sizes, identifying someone as atypical AN may be considered an outdated practice.   
• Orthorexia: This involves obsessing/fixating on diet and exercise in the name of health. Striving for health isn’t inherently harmful, but there comes a tipping point where the stress of pursuing it outweighs the benefits.  
• Night eating syndrome (NES): As the name suggests, patients eat in the middle of the night, which can positively or negatively impact their ability to sleep.  
• Rumination disorder: This is characterized by intentional or unintentional regurgitation of food.   

Nearly every dietitian has worked with a patient who has an eating disorder or, at the very least, disordered eating, and recognizing the signs and symptoms is vital in ensuring patients receive the proper guidance and treatment.   

Tips to keep in mind when working with patients to avoid causing harm:  

• It’s critical never to assume someone’s eating habits based on appearance. Eating disorders come in all shapes and sizes.  
• Gather thorough information on a patient’s eating habits before offering nutrition recommendations.   
• If your patient has an eating disorder, and you are not trained to work with that population, refer to a registered dietitian specializing in eating disorder support.   

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References

Statistics. Available at: https://www.nationaleatingdisorders.org/statistics/#general-eating-disorder-statistics. Accessed on 11/30/24.  

Eating Disorders. Available at: https://www.nimh.nih.gov/health/statistics/eating-disorders. Accessed on 11/30/24