Eating Disorders or Not?

It is my opinion that Eating Disorders are far more prevalent an issue than DSM diagnostic criteria can categorize. People having distorted relationships with both their bodies and's in Hollywood, on magazine covers, on TV...but I think most importantly it exists amongst everyday "normal" people like you and me.

I'm not saying that more people should be drafted as members of the "Team Eating Disorder" diagnosis, but there are MANY more people around with body and food issues that clearly are existing problematically in these areas and, to me, that's concerning!. There is no arguing hat eating disorders are real psychiatric diagnoses...if of course they meet certain criteria outlined in the DSM. Eating Disorders are serious, potentially dangerous, life-threatening, pervasive illnesses that, according to NEDA,“ impact millions of people every year in the United States (NEDA, 2013).” The eating issues, such as overeating and using exercise excessively. Maybe these will be addressed in the DSM 6. Maybe. But despite these criteria-met diagnoses, I don't know of one person in my life who doesn't have some odd relationship with food and consequently or reciprocally, their body. And truthfully, who's to say it's odd? Or even diagnostic? I guess because I'm a psychologist, it's within my purview to wonder of either possibility, but I'm thinking about the lines between "diagnostic" and a peccadillo or streamlined, disturbing thinking. And we should not diminish the concerning elements of these non-diagnostic, but glaringly noticeable and interfering relationships with food and body-experiences…because they are everywhere.

Who doesn't know someone (or who is that someone) who, for example will "enjoy" a nice meal with lovely people and then be overcome with anxiety about the calories consumed and what it might do to change his/her body? As a result they might then compensate by either exercising more than usual or making sure to pull out every last bit of bagel flesh tomorrow morning so that all that’s left to consume is the bagel “skin” that remains. Eating only this part feels safe. Come on! That's a little nutty...but we all know people who do something like that (or exactly that) regularly and they don't fit the criteria of having a "restrictive" type sub-categorical diagnosis of Bulimia or Anorexia Nervosa. And what about the person who is an avid marathoner who increases her regime to training for an Ironman®, and also starts doing multiple relay races that involve running huge numbers of miles over the course of a 24 hour period of time...and simultaneously does a juice cleanse (inadvisable to exercise vigorously or at all when doing one [Juice Press Guide to Nutrition and Juice Cleansing], 2012) because it's supposed to be good for you? These chosen behaviors are likely ego-syntonic  (i.e., feel comfortable, don’t cause conflict) as in the case of most eating disorders, but these extreme “gestures” do not necessarily (again) meet psychiatric diagnostic criteria, even though they seemingly (obviously?) are on the hairy edge of being dangerous, at least.

Then there’s my concern about actual disease-“healing” diets that are being used to lose weight, suchas both the Paleo Diet (Cordain, L. Miller, J., Eaton SB., Mann, N., Holt, SHA., Speth, JD., 2000) and the Gluten-free movement, the latter of which is primarily meant to help those with Celiac disease, the former “is based upon extensive scientific research examining the types and quantities of foods our hunter-gatherer ancestors ate.”  The Paleo way of eating is being marketed to help those with autoimmune diseases such as Crohns Disease, IBS, Multiple Sclerosis and others. Whether it works is a very serious matter of debate amongst experts in the medical field. 

Recently there was an article in The New York Times (Chang, K. 2013), about the wave of proponents abiding by a Gluten free diet, originally determined primarily as a consumption
solution for those diagnosed with Celiac disease, as referred to above. The article speaks about the issues of gluten-insensitivity and how the diet can truly make a difference for those with Celiac disease. It goes further to indicate how there have been discoveries of a sub-category of “gluten or wheat intolerance,” with some credence given to the benefits of partaking in ancestral eating habits, proffered by this eating plan. Also noted was the awareness of  a particular protein found in gluten that some people have an “allergic reaction” to, but a whole lot of skepticism about the true benefits of not eating wheat and, thusly the possible missed-out on nutrients as a result of eating such a restricted diet. And while the article cites Miley Cyrus’s claim that “my skin, physical and mental health [are] amazing” as a result of going gluten free, it doesn't say and most definitely can be heard via word of mouth (as I heard it recently) that certain celebrities are "going gluten free" as a way to fight bloating.

Ergo, we have yet another way to facilitate problematic tendencies to achieve distorted body images that many of us (all of us?) at times ascribe as ideals to achieve. Bottom line…even though some eating and body-related behaviors do not (yet?) meet DSM diagnostic criteria (which is also a bit arbitrary if you think about it), this is not to say that these behaviors are not of concern and signs of struggle and some kind of body dysmorphia. Should that be paid attention to or fed into, so to speak…can’t fight it with the arm of a diagnosis, so just let it be? Letting it be without an argument or show of concern seems ridiculous, but what can be done?

American Psychiatric Association,2012. DSM-5 Development. 2013. FromURLChang, K.(2013, February 5).

Gluten-free, whether you need it or not. The New York Times, pp. D1, D7.

Cordain L, Brand Miller J, Eaton SB, Mann N, Holt SHA, Speth JD. Plant to animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets.

American Journal of Clinical Nutrition, 2000, 71:682-92.

Juice Press, 2012. Guide to nutrition and juice cleansing. Can I exercise during a cleanse? 2013 From URL. NEDA (2013). Statistics. 2013. From URL.