Eating Disorders are complex diseases that are impacted by genetics, environment, culture, and many other factors. An important concept to understand regarding eating disorders is that no one body type that gets an eating disorder. Unfortunately, people in any body can experience an eating disorder. Someone can be restricting in a larger body, and someone can be bingeing in a smaller body. You cannot tell someone’s health or behaviors by the size of their body. Let’s talk about different kinds of eating disorders:
Anorexia is characterized by restricting food intake, with rapid weight loss to the point of becoming underweight. Restriction can be done by restricting calories, restricting certain types of food, or certain food groups. Individuals who are struggling with anorexia are afraid of gaining weight and often do not perceive their body shape the same way others do (most often they feel like they are much bigger than they are). People with anorexia can also engage in binge/purge behaviors.
People with bulimia engage in episodes of bingeing and purging. Bingeing is eating a lot of food in a short amount of time; people often say they feel out of control, shame, and guilt when they binge. Sometimes people will plan to binge and go out and buy certain foods ahead of time, or go to several different restaurants to buy food. Other times, people will find that they started eating something and then felt like they couldn’t stop and have cleaned out the pantry or fridge.
Purging is any compensatory behavior that involves getting rid of the food (whether or not you get rid of the food). The most common forms of purging are through vomiting, laxative abuse, and diuretic abuse. However, people can also purge through exercise and other activities that are attempting to get rid of the food in some way. Purging is very dangerous and puts people medically at-risk fairly quickly. People struggling with bulimia can also restrict, which often is the trigger for a binge/purge episode. And despite, what some people think, people in any size body can have bulimia.
Binge Eating Disorder:
Binge eating disorder, which is the most common eating disorder, is the process of engaging in bingeing behavior but not purging behaviors. That doesn’t mean that people who struggle with binge eating never purge or never restrict; in fact, restriction can often be a trigger for a binge; what it means is that this is the predominant behavior in which they engage. People who struggle with binge eating come in all different types of bodies. There is a lot of stigmas and weight bias that people with binge eating experience, mainly that all people with binge eating must be in larger bodies. Many people who are dealing with binge eating are in larger bodies and many people in smaller bodies. You cannot tell if someone has an eating disorder, or if they do, what kind of eating disorder they have by the size of their body.
Avoidant/Restrictive Food Intake Disorder:
Avoidant/Restrictive Food Intake Disorder, otherwise known as ARFID, is a newer classification for eating disorders. Individuals with ARFID are not concerned about their weight and body size, nor are they trying to lose weight, though they very often drop weight quickly because their food intake is so restricted. Folks with ARFID often struggle with different textures and tastes that make eating incredibly difficult for them. Very often, there are sensory issues or trauma around food (such as a choking experience) which makes eating very difficult.
Other Specified Feeding and Eating Disorder:
There is a myth that OSFED, or Other Specified Feeding and Eating Disorders, are not eating disorders; this is most certainly, not true! Labels are important for all sorts of reasons when it comes to mental health, but as we know from working with people, not everyone falls neatly into a box or a label. Many people engage in some symptoms from a diagnostic category, but not all, they are struggling and in pain, but they don’t fall neatly into the box. Some people are restricting and doing dangerous things to their bodies, who have not met the underweight criteria for anorexia; this is called atypical anorexia. Some people just purge, or do not engage in bingeing and purging often enough to meet criteria for bulimia, but their behaviors have caused major difficulties in their lives. OSFED allows mental health professionals to access treatment (through insurance companies) for people who are experiencing debilitating and difficult symptoms of eating disorders who do not meet other eating disorder criteria.