Reading Time: 5 minutes
Being able to tell the difference between an eating disorder and disordered eating can sometimes be difficult. After all, there are no standardized definitions of disordered eating used in the scientific literature, and many are often confused about what does (and doesn’t) constitute a disordered pattern of behaviour.
Eating disorders and disordered eating are indeed highly correlated, but they’re far from the same thing and they shouldn’t be used interchangeably.
Eating disorders, like bulimia nervosa, binge-eating disorder, and anorexia nervosa, are mental illnesses that are based on a very specific set of diagnostic criteria met by only a minority of people. Disordered eating, on the other hand, represents an array of disturbed behavioral and attitudinal patterns of eating that can be experienced by many people in the general population.
Think of it as a continuum, with normal eating anchored on the far left of the continuum, disordered eating towards the middle, and eating disorders anchored towards the far right.
We can also distinguish an eating disorder from disordered eating based on the following 4 features.
1. Breadth of symptoms
The amount and type of symptoms can give insight into whether the person might have an eating disorder or disordered eating.
As mentioned earlier, there are very specific criteria one needs to meet to receive a diagnosis of an eating disorder. These criteria are based on a limited set of symptoms.
The 5 key symptoms that underpin the main eating disorders include:
Undue influence of weight and shape on self-evaluationsRecurrent binge eating (loss of control overeating)Self-induced vomiting, laxative use, driven exercise, or fastingIntense fear of weight gainRestriction of energy intake resulting in a significantly low body weight
Certain combinations of these specific symptoms will define whether someone has anorexia nervosa, binge-eating disorder, bulimia nervosa, and other specified feeding or eating disorder.
You’ll notice that these symptoms are limited and that there are many other abnormal patterns of eating that people experience.
This is where disordered eating comes in. In addition to the symptoms listed above, disordered eating encompasses a broader range of pathological behaviours and attitudes associated with eating, shape, and weight.
Some key examples of disordered eating symptoms include:
Skipping meals Excluding food types or groupsObsession with calorie countingSmoking to suppress appetite Preoccupation with weight and shapeRecurring episodes of emotional eatingGrazing behaviourUnusual food rituals (e.g., eating with specific utensils)Hoarding foodsSpending long periods of time in the supermarket Weighing yourself repeatedly Completely avoiding your body image
This list is by no means exhaustive, but the point is that eating disorders are based on a limited number of symptoms whereas disordered eating is based on many different abnormal patterns.
This is not to say that people with eating disorders do not also experience these disordered eating features too. In fact, there’s a high chance that a person with an eating disorder experiences all of these disordered eating patterns.
But if the person only experiences those disordered eating features (and not the symptoms listed under eating disorders), then, by definition, they won’t be considered to have an eating disorder.
It’s the unique combination of symptoms, their duration, and the degree of impact on one’s quality of life that determines whether it is an eating disorder or disordered eating.
2. The length of time
How long someone experiences certain symptoms may also determine whether a person has an eating disorder or disordered eating.
According to the latest DSM-V, for example, to receive a diagnosis of binge-eating disorder, the person must have engaged in binge eating at least once per week, on average, over the past 3 months.
Similarly, to receive a diagnosis of bulimia nervosa, the person must have binged or purged at least once per week, on average, over the past 3 months.
Now, someone who has binged below this frequency and duration (say, once a month over the past 2 months) would not receive a classification of binge-eating disorder, but would be considered to have experienced irregular disordered eating patterns.
Ultimately, engaging in certain symptoms below the diagnostic frequency is better classed as disordered eating in the absence of an eating disorder.
3. Impact on life functioning
Both disordered eating and eating disorders can take a mental, physical and social toll on the individual.
For example, smoking to suppress appetite – a form of disordered eating – can do damage to the lungs while self-induced vomiting can erode the person’s teeth.
Research suggests that eating disorders are much more impairing than disordered eating1Crow, S. J., Stewart Agras, W., Halmi, K., Mitchell, J. E., & Kraemer, H. C. (2002). Full syndromal versus subthreshold anorexia nervosa, bulimia nervosa, and binge eating disorder: A multicenter study. International Journal of Eating Disorders, 32(3), 309-318..
This is usually explained by the fact that people with eating disorders experience these symptoms almost daily, whereas people with disordered eating exhibit these symptoms less frequently and severely. Of course, there are exceptions to this, and both tend to have a profound impact on a person’s ability to function.
4. Prevalence rate
Another key difference between eating disorders and disordered eating lies in their frequency of occurrence.
Eating disorders are experienced by a very small minority of people, whereas a much greater proportion of people engage in disordered eating in the absence of an eating disorder.
Here are some statistics on the prevalence of eating disorders.
Between 0.3% and 1.5% of individuals will suffer from anorexia nervosa in their lifetime 2 van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current opinion in psychiatry, 34(6), 515. Between 2.5 and 4.5% of individuals will suffer from binge-eating disorder in their lifetime 3 Erskine HE, Whiteford HA. Epidemiology of binge eating disorder. Current opinion in psychiatry. 2018 Between1-3% of individuals will suffer from bulimia nervosa in their lifetime 4 van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current opinion in psychiatry, 34(6), 515.
Now let’s take a look at some statistics on disordered eating
4.1% of men and 5.7% of women reported engaging in binge eating5Mitchison D, Hay PJ, Slewa-Younan S, et al. The changing demographic profile of eating disorder behaviors in the community. BMC Public Health. 2014;14:942.4% of men and 4.3% of women reported engaging in extreme dieting 6 Mitchison D, Hay PJ, Slewa-Younan S, et al. The changing demographic profile of eating disorder behaviors in the community. BMC Public Health. 2014;14:94 13% of women over 50 engage in eating disorder behaviors 7 https://anad.org/eating-disorders-statistics/ More than 40% of women and 20% of men report a fear of weight gain 8 Slof-Op‘t Landt, M. C., van Furth, E. F., van Beijsterveldt, C. E., Bartels, M., Willemsen, G., de Geus, E. J., … & Boomsma, D. I. (2017). Prevalence of dieting and fear of weight gain across ages: a community sample from adolescents to the elderly. International journal of public health, 62(8), 911-919. 1 in 3 adult women report going on a restrictive weight loss diet 9 Slof-Op‘t Landt, M. C., van Furth, E. F., van Beijsterveldt, C. E., Bartels, M., Willemsen, G., de Geus, E. J., … & Boomsma, D. I. (2017). Prevalence of dieting and fear of weight gain across ages: a community sample from adolescents to the elderly. International journal of public health, 62(8), 911-919.
So, what is the difference between disordered eating and eating disorders?
In summary, eating disorders and disordered eating can be distinguished by multiple features, including the type of symptoms experienced, their severity and frequency, impact on quality of life, and their prevalence.
Disordered eating often morphs into an eating disorder over time if it is not addressed. This is why it’s critical to address any abnormal patterns of eating disorders as early as possible – before they can get out of control.
