What Is Disordered Eating?

Turn on your TV, scroll through your social media feed, or simply have a conversation with friends, and you’re sure to hear about the latest fad diet or “secret” to weight loss.

With all the pressures around us to reach a certain number on the scale or be as fit as our favorite celebrities, it’s no surprise that more than half of Americans say they are usually on a quest to lose weight. That can make it tempting to try the latest dieting trend — but that could lead you down a path of disordered eating.

Disordered eating is not a medical diagnosis. It’s a way to describe certain eating behaviors that veer off the track of healthy eating and can sometimes lead to or signal a clinical eating disorder. “Disordered eating is often accompanied by dissatisfaction with the body, or a real preoccupation with needing to look a certain way or follow a certain regimen,” says Dr. Evelyn Attia, director of the Center for Eating Disorders at NewYork-Presbyterian.

Health Matters spoke with Dr. Attia to learn how to recognize the signs of disordered eating and how to determine if your eating patterns are turning into a more serious health concern.

To understand the signs of disordered eating, it’s helpful to first understand what constitutes healthy eating behaviors, Dr. Attia says. Healthy eating typically looks like:

• Eating three meals a day separated by several hours, along with a snack or two
• Eating from all food groups
• Eating a variety of foods
• Eating to support a healthy, stable weight
• Eating comfortably in social situations

“If efforts to optimize health, well-being, or maintaining weight in a healthy range push an individual to veer from this general structure, it probably means that something not very healthy is going on,” says Dr. Attia, who is also a professor of clinical psychiatry at Weill Cornell Medicine and professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons.

On the flip side, examples of disordered eating can include:

• Skipping meals
• Excluding entire categories of food from your diet
• Sticking to rigid rules or restrictions regarding food
• A fixation on healthy or clean eating and/or the quality of food ingredients (also known as orthorexia)
• Anxiety about eating in social situations

“There could be changes to the way somebody eats in order to maintain their health that doesn’t go off the rails and lead to meal-skipping and avoidance,” Dr. Attia says. For instance, deciding to limit your desserts to a few times a week to avoid overindulgence, or trying to reduce the amount of processed food you eat overall, may be healthy choices. “But foods shouldn’t be considered all bad or all good. And you shouldn’t think of yourself as ‘good’ or ‘bad’ based on your eating patterns,” she says. “Thinking this way might be a sign of disordered eating or a formally recognized eating disorder.”

If a fad diet offers fast results, that’s also a sign it likely won’t promote healthy eating habits. “In healthy eating, we wouldn’t expect what we eat in a given day or week to lead to weight going significantly up or down,” Dr. Attia says. “There’s variation to everyone’s weight, but we all live within some kind of weight range. Healthy eating should support maintenance of that range.”

Disordered eating doesn’t always develop into a formally recognized eating disorder. Psychological, biological, and social and cultural determinants can all factor into the diagnosis of an eating disorder, so the only way to know for sure if you have one is to see a medical and mental health professional.

Research shows that 9% of Americans, or more than 28 million people, will experience an eating disorder during their lifetime, and a study published in JAMA Pediatrics showed that rates of hospitalization for eating disorders skyrocketed during the pandemic among adolescents and young adults.

If you’re not sure whether disordered eating behaviors are symptomatic of an eating disorder, consider asking these questions:

• Are you unable to enjoy eating with friends or family because of your diet?

“We are social organisms, and healthy eating includes being able to eat in social groups,” Dr. Attia says. For example, not being able to enjoy a meal with friends because all you can think about is what you can’t order, or having to eat a different meal from the rest of your family because of food restrictions, could be signs of trouble.

“In the diagnostic criteria for some of the eating disorders, psychosocial changes or eating that interferes with social experiences is listed, and they serve as a real clue that something’s not right in the area of eating,” Dr. Attia says. “When eating behavioral changes get severe enough that somebody does meet the criteria for an eating disorder, we’ll commonly hear, ‘I take care of what it is that I need. I just don’t need to do it with anybody else.’ That’s not normal eating.”

• Have you noticed physical symptoms resulting from your eating patterns?

Feeling weak, dizzy, faint, or dehydrated, among many other physical signs, could mean you aren’t getting the nutrients you need. “If one is not eating appropriately or sufficiently, there can absolutely be changes to one’s vital signs,” says Dr. Attia. “Once we get into eating patterns that are associated with medical risk, we may be in the more formally recognized eating disorder categories.”

This can especially be the case when entire categories of food are left out of a diet. “For example, people don’t realize that excluding dietary fats means that every cell in the body that builds a membrane is missing a necessary building block,” she adds.

• Does a preoccupation with weight or body image negatively impact your life?

Some people are more susceptible to societal pressures around the pursuit of thinness or an unsustainable level of fitness, so it’s important to keep tabs on whether dissatisfaction with your body is leading to unhealthy behaviors and thoughts.

“We receive regular social messages that suggest we not eat in a healthful and balanced way or with joy and social connections,” Dr. Attia says. “Individuals who go on to develop formal eating disorders may feel that they are achieving higher health standards, when it’s the opposite of that. If there’s a real restriction to nutritional intake, it could get some vulnerable folks into a lot of trouble.”

Treatment for a recognized eating disorder — or help to course-correct disordered eating that is becoming problematic — is centered on working with a mental health professional to get to the root cause of the behaviors that lead to troubling eating patterns. This often includes cognitive behavioral therapy or other psychological approaches “that help people take apart the thoughts that lead to the behaviors, and the behaviors that then drive more thoughts,” Dr. Attia says. “We want to really break down that cycle of connections and make changes that aim for a pattern of healthier eating.”

If patients are not in a healthy weight range or are showing other medical symptoms, they can expect a multidisciplinary approach to treatment. “There may be a therapist, a medical doctor, a dietitian, or a psychiatrist involved, depending on what the person needs,” Dr. Attia says. “Not uncommonly, there’s a team of professionals who work together to help the individual move forward.”

It’s also important to recognize that anyone can be impacted by eating disorders — it isn’t just a “women’s disease.” While women tend to be treated for eating disorders more often than men, “there’s no one group that is immune to developing an eating disorder,” Dr. Attia says. For example, binge-eating disorder is about as common in men as it is women. “Eating disorders don’t discriminate.”

If a friend or loved one is exhibiting disordered eating habits, Dr. Attia encourages gently saying something. “If you want to try to help, consider expressing concern — not criticism — over a change you have noticed,” she says. For instance, you can gently bring up that you’ve noticed a physical change in someone that seems worrisome. Or if a friend you used to enjoy eating out with seems to be avoiding meals because of concerns over their weight, “it’s appropriate to say, ‘I’m a little worried. Every time I bring up a great place for us to have lunch or spend time together, I get the feeling you’re avoiding me,’” Dr. Attia suggests. “It’s important to know that help is out there. Eating problems are treatable, and letting people know that there are resources available can be very useful.”

 

Evelyn Attia, M.D., is an attending psychiatrist at NewYork-Presbyterian, professor of clinical psychiatry at Weill Cornell Medicine, and professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons. She is also the director of the Center for Eating Disorders at NewYork-Presbyterian and the New York State Psychiatric Institute. She is a member of the Eating Disorders Research Society and a fellow of the Academy for Eating Disorders.