How A Mental Health Professional May Approach The Diagnosis Of Eating Disorders

Eating disorders are serious mental disorders in which a person typically has persistent distressing thoughts around food and disturbances to eating behaviors, often with the goal of losing weight or otherwise altering their body’s physical shape. Eating disorders can lead to number of mental and physical health complications. Understanding what constitutes an eating disorder can be the first step toward finding support and getting treatment.

Diagnostic criteria for binge eating disorder, anorexia nervosa, bulimia nervosa, and other eating disorders

While eating disorders can sometimes have symptoms in common, each disorder has separate criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A person typically has to meet certain criteria related to severity and frequency of episodes to be diagnosed with an eating disorder. 

Binge eating disorder

Binge eating disorder (BED) is an eating disorder associated with regular episodes of binge eating, in which large amounts of food are consumed in a short period of time. Diagnostic criteria for BED include: 

• A person must have engaged in a binge eating episode at least once a week for three months.
• Binge eating must result in three or more of the following symptoms: eating quickly (not because of any time constraints), eating until one is uncomfortable, eating when not hungry, eating alone out of a sense of shame or embarrassment, or feeling disgust, sadness, or guilt after eating. 
• The person does not participate in any compensatory measures to eliminate the food after a binge eating episode. 

Anorexia nervosa

Bulimia nervosa

Bulimia nervosa involves the same binge eating patterns as binge eating disorder but also incorporates purging behavior. To receive a bulimia diagnosis, patients must:

• Engage in regular binge eating episodes.
• Participate in compensatory behaviors designed to avoid gaining weight from binges, including forcing themselves to vomit, using laxatives in an unhealthy way, exercising excessively, or fasting for long periods of time after a binge.
• Engage in a binge eating and purging cycle at least once a week for three months.
• Believe that their value and self-worth are inherently tied to their weight. 

Other eating disorders

Binge eating disorder, anorexia nervosa, and bulimia nervosa are some of the most common eating disorders, but other eating disorders exist. These disorders can include:

• Pica: One of the eating disorders not associated with distorted body image or pursuit of weight loss, pica involves the regular consumption of non-food items. In some cases, pica can result in intestinal blockages, which may require a doctor to perform emergency surgery.
• Purging disorder: Purging disorder is similar to bulimia, but individuals with this disorder do not typically engage in binges before participating in purges.
• Night eating syndrome: Night eating syndrome involves episodes of eating an additional meal after waking up in the middle of the night (not because of a work schedule that requires nighttime meal consumption). 

The role of weight loss in eating disorder diagnoses

Many people may assume that people with eating disorders are visibly or dangerously underweight or that they experience high levels of weight loss in a short period of time. However, this situation is not always the case. 

Does a person need to have experienced significant weight loss in order to be diagnosed with an eating disorder?

The only eating disorder that requires a certain amount of weight loss for diagnosis is anorexia. Many people may exhibit an obsession with losing weight, distorted body image, and unhealthy habits and attitudes toward food that are associated with anorexia, but unless they have lost a specific percentage of body weight, they are likely to be diagnosed with unspecified feeding or eating disorder. Weight loss is not required for a bulimia or binge eating disorder diagnosis, and people with those conditions may maintain a weight that is considered “normal” or even overweight for their body type. 

Can eating disorders be self-diagnosed?

Like all mental disorders, eating disorders can only be formally diagnosed by a doctor or a mental health professional. However, it is possible to recognize disordered eating patterns and unhealthy eating habits in one’s own behaviors or those of family members, friends, or other loved ones. If you are concerned that you or someone close to you may be developing an eating disorder, it may help to connect with a mental health provider as soon as possible to engage in therapy and develop a treatment plan. 

Treatment and mental health support for people with eating disorders

The process of shifting toward healthy eating habits and breaking the negative thought patterns associated with eating disorders typically requires the intervention of professional mental health care. Some patients with severe eating disorders, particularly people with anorexia, may require hospitalization and intensive nutritional care. However, many eating disorder patients can address their symptoms through outpatient treatment with a counselor or therapist. 

Online therapy for eating disorder treatment

Eating disorders be linked to feelings of shame, guilt, and remorse. If a person is embarrassed about their eating behavior, they may be less willing to engage with a mental health professional. In these cases, online therapy can provide a sense of distance and may help eating disorder patients to receive the help they need. 

Psychology researchers have found evidence suggesting that online therapy may be just as effective as traditional in-person therapy at treating a number of mental health conditions, including eating disorders. One study found that patients with bulimia who completed an online therapeutic intervention had comparable levels of symptom reduction compared to those who attended treatment in person.