‘Eating disorder’ and ‘disordered eating’ are not the same

During the holidays, many families will gather for festive meals. If you pay attention to how and what a tween, teen or young adult is eating, you may detect a pattern that could indicate something is “off” about their approach to food.

So that makes this an appropriate time to discuss what constitutes an eating disorder, how it differs from “disordered eating,” and what are the appropriate actions to take if you suspect one or the other.

An eating disorder is characterized by obsessive thoughts about food, extreme concern about calories, significant changes in weight, and body dysmorphia — the belief that “I’m fat” even though that’s clearly not reality. There may also be a risk of impaired physical health because of binging, purging and extreme exercising.

The three major eating disorder diagnoses are anorexia nervosa (intense fear of gaining weight), bulimia (excessive food intake, followed by feelings of guilt and shame), and bulimia nervosa (binging combined with purging, through vomiting or excessive use of laxatives).

It’s heartbreaking to watch a young person struggle with an eating disorder, which may be accompanied by a mental illness such as depression, anxiety or obsessive-compulsive disorder (OCD). Singer Karen Carpenter died in 1983 from heart failure brought on by anorexia nervosa. She was only 32. Overcoming an eating disorder requires intensive therapy, often in a residential setting.

A more recently identified diagnosis is ARFID, or avoidant/restrictive food intake disorder, a condition that causes someone to limit the amount and types of food they eat. It isn’t the result of a distorted self-image or an attempt to lose weight, but comes from a fear of consequences (such as choking) or a loss of interest in eating.

“Disordered eating,” on the other hand, doesn’t meet the diagnostic criteria for an eating disorder. Some of the behaviors may be similar, but they are less frequent and less intense.

A person experiencing disordered eating may use food as a response to stress or emotional upheaval. They may restrict calories, label foods as “good” or “bad,” or engage in elaborate rituals, such as making sure their foods don’t touch, using different plates for different foods, or not eating foods with certain colors. Or they may overindulge, leading to physical discomfort and feelings of shame or guilt.

Some therapists believe that abnormal eating patterns can play a role in the eventual development of an eating disorder, but not everyone with disordered eating ends up with an eating disorder.

And not every picky eater is a disordered eater. A lot of us just don’t like the taste or texture of some foods. Children go through periods where they’ll only eat mac and cheese or chicken nuggets, but they still get enough nutrients and usually outgrow those habits.

Both eating disorders and disordered eating have physical consequences because the body isn’t being nourished. Muscle weakness, malnutrition, electrolyte imbalance, confusion, weight loss or gain, anemia, and low blood pressure are some of the signs that eating habits need to be addressed by a doctor.

Coping with and preventing disordered eating and eating disorders isn’t easy in our culture, which prizes beauty and thinness. Social media and peer pressure can make teens, especially girls, feel they have to live up to some physical ideal. Even people of healthy weight can be made to feel “fat.” GLP-1 injections (Ozempic, Wegovy, Mounjaro and the like) are putting the focus on weight loss.

Some of the strategies:

• Avoid fad diets that limit types of food.

• Avoid labeling foods as “good” or “bad.”

• Taste everything. If you don’t like it after three bites, it’s OK to pass

• Don’t be a member of the “clean plate club.” It’s an outdated concept.

• Practice body neutrality. Accept your body for what it is and instead focus on taking care of it with nutrition and exercise. (You only get the one body, you know.)

• Stop negative self-talk and focus on what you like about yourself — your eyes, your creativity, your personality.

• Practice mindful eating: Focus on the meal, eat at a table off a plate.

Disordered eating is related to anxiety about food and the perception of what the outside world thinks of us — it’s a self-esteem issue. OCD and eating disorders often go hand-in-hand. Don’t be afraid to address underlying mental health concerns with a therapist.

• Bonnie Lane, M.S., is principal consultant with Family Support Services in Northbrook, specializing in supporting families whose loved ones suffer from severe mental illness or substance addiction. Daily Herald readers can contact her at (847) 651-1554 or bonnielane@thefamilysupportservices.com.