Posts Tagged ‘OSFED’

Is it possible to have two eating disorders at once? What if you restrict and binge and purge? Is that anorexia or bulimia? Both? Neither?

It’s a common question, one that makes sense to ask. Many people do experience a continuum of disordered behaviors within or over the course of their illness, at times restricting, bingeing, and purging. One behavior leads to another in what is often called the eating disorder “cycle.” Trapped in this cycle, people experience symptoms that overlap multiple eating disorder diagnoses. They may be left to wonder: Exactly what, then, is the appropriate diagnosis?

One common symptom of an eating disorder is the perceived need to eliminate or restrict certain foods. Extreme restriction of certain foods may indicate the presence of a disorder such as Anorexia Nervosa or Orthorexia. Restricted food groups often include processed foods, fast foods, or foods that are higher in sugar and fats (snack items, sweets, and desserts).

Alternatively, someone struggling with Compulsive Overeating or Binge Eating Disorder might alternate between periods of severe overconsumption and total restriction. It is important that intensive work is done in treatment to normalize both one’s attitudes toward and intake of such foods when working to reintroduce that person to the variety, novelty, and pleasure of eating.

The term “all foods fit” is often used to emphasize that there are no “good” foods or “bad” foods. The idea that no food has a moral value is an important concept in removing judgments and distortions that often form in disordered eating beliefs and practices. 

Unfortunately, it is also common for foods like fruits, vegetables, and whole grains to become associated with eating disorder patterns. For example, a client once said “Focusing on eating vegetables was something I did when I was restricting or I started focusing on clean eating. If I was having salads, it meant I was dieting, denying, or punishing myself.”  In a situation where food is restricted, working on accepting and practicing the idea that all food has a place in a healthy diet is essential. By re-incorporating all of the vital components of a balanced diet, individuals can develop an eating pattern free of eating disorder behaviors.

With the prevalence of diet culture and restriction-based diets like paleo, keto, and whole 30, it can be challenging to identify when restrictive eating becomes disordered. While certain restrictive diets can be healthy and not imply further eating disorder concerns, other restrictive eating patterns can be a warning sign of an eating disorder. To understand when eating becomes disordered, it’s important to be aware of the five ways to identify problematic restrictive eating.

1. Refusing to eat certain foods

An obvious way to identify restrictive eating is if an individual is refusing to eat certain foods. While not eating certain foods is restrictive, it is not always a red flag, which is why it is important to understand why the food is being restricted. For example, if a person abides by a vegan diet and refuses to eat meat or dairy, that could be healthy for them or it could be a sign of disordered eating. To understand which it is, it is important to ask why an individual is eliminating certain foods. For example, if someone refuses to eat dairy because they are lactose intolerant, that is restrictive and it is a healthy choice for them because if they ate dairy, they would feel ill. If someone avoids dairy, but when asked why responds by saying that it has too many calories or causes fat, that may be a sign of disordered eating.

As a field, we are beginning to understand that males are at a high-risk for eating disorders and that it is crucial to understand how males present with eating disorders and how we can treat them. Realizing that men have eating disorders is extraordinarily important. Eating disorders are serious and potentially life-threatening and unfortunately, they are often overlooked and trivialized.

The reality of the eating disorder world is that the diagnoses of eating disorders have historically been based on women. Studies to define what eating disorders are have been done primarily with women. The criteria used to describe eating disorders has been normed to women. The professional field is primarily women and treatment is often designed with a gender bias.  However, we are very aware that men can get eating disorders and that more men are presenting with symptoms and entering treatment. As a result, we have a lot of work to do to truly understand how males present with eating disorders.

To give an example of how eating disorder treatment is normed to women, we can look at current eating disorder screening tests. Typically, there are statements such as these where a client can answer yes or no.

Many individuals with eating disorders also struggle with alcohol and drugs. In fact, about half of all individuals diagnosed with an eating disorder also have a substance use disorder. Let’s take a look at the nature of both eating disorders and substance use disorders so we can examine their relationship and how to best treat these disorders when they co-occur.

Eating Disorders

Eating disorders are real, complex illnesses that are affected by biological, psychological, social, and environmental factors in an individual’s life. Eating disorders are characterized by a disturbance in eating or food behaviors and are often accompanied by negative body image. Eating disorders often co-occur with other mental health disorders such as substance use, anxiety, or depression. Eating disorders are categorized in the DSM-5 as follows:

Anorexia Nervosa. Anorexia revolves around the restriction of food intake and an obsession with body weight, size, or shape. It is the most fatal of all mental illnesses. Warning signs in preteens and teens may include a refusal to maintain an age-appropriate weight, body dysmorphia, over-exercising, and restrictive behavior around food.

Eating disorders are real, complex illnesses that can cause serious harm. Eating disorders are characterized by a disturbance in an individual’s eating and food behaviors or self-perception. Common warning signs of eating disorders are extreme weight changes, altered eating behaviors, or an intense fixation on food and body talk. Eating disorders are biologically-based brain illnesses that are affected by environmental, social, and psychological factors. This means that illness is not caused by one specific factor, but rather by a series of factors in an individual’s unique life experience.

Types of Eating Disorders

Due to the complexity of eating disorders, the DSM-5 divides eating disorders into the following five categories:

Anorexia Nervosa. Anorexia is noted by extreme food restriction that causes dramatic and prolonged weight loss. It often presents with body dysmorphia and a genuine fear of food.

Avoidant/Restrictive Food Intake Disorder (ARFID). ARFID includes feeding or eating disorders that involve a lack of interest in or an avoidance of certain foods that result in a failure to meet nutritional needs. ARFID, unlike anorexia, does not include a drive for thinness.