A teenage girl refusing to put a morsel of food in her mouth, although she is severely emaciated and at death’s door, is the picture we get when we hear the term “eating disorder,” right?
Well, that picture represents an Anorexic-type presentation. Anorexia Nervosa in only one of 8 identified feeding and eating disorders in the 2013 update of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). Furthermore, Anorexia Nervosa has two subdivisions- restricting type, and binge-eating/purging type. Patients with Anorexia might present with being mildly, moderately, severely, or extremely underweight, and males can also present with eating disorders. Essentially, an emaciated teenage girl is a representation of a small fraction of eating disorders presentations.
When we speak about the core eating disorders that often present in clinical settings, we refer to Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED). I will add to that another critical category; other specified feeding and eating disorders (OSFED). Patients in the OSFED category fall in the “grey area” because they represent clinically severe cases but do not meet the diagnostic criteria of the other feeding and eating disorders.
The clinical diagnosis given to a patient is a snapshot of their presentation around the time of presenting for professional help. I have known quite a few patients who presented as one disorder at a period. Over time, the picture looked more like a different eating disorder. We determine the diagnosis by considering several factors, including the patients’ weight, the occurrence/frequency of binging eating and purging behavior, the severity of both of these elements.
Many eating disorder sufferers fly under the radar for a long time, sometimes years. They may go unnoticed because they do not appear underweight, and their ED has not caused very notable secondary effects. Except for AN, patients presenting with the other eating disorders can be within a relatively average body shape and size or even above that. The overlap in the presentation is that there is an over-evaluation of weight and shape and control of one’s weight and shape in all cases. To a large degree, there is a marginalization of other areas of functioning primarily due to preoccupation with eating habits and body shape and weight. Patients will also experience physical and psychological consequences of the eating disorder on the person. All eating disorders are significant. People need to get treatment as soon as they realize that they are suffering from an ED. The longer one stays with an untreated ED, the harder it is to achieve full recovery.
Clinical Psychologist, LinkedCare Consortium
Anele Honono
BSc cum laude (UP-MEDUNSA), BSc Psychology Hons cum laude (UP-MEDUNSA), MSc Clinical Psychology (UP-MEDUNSA), CBT-E certificate