You Don’t Need a Diagnosis to Deserve Help: Understanding Eating Disorders

Chances are, if you are reading this post, you have asked yourself this exact question:

“Am I sick enough to get help for this?”

And... chances are, if you are reading this post, that the answer is a resounding YES!

Disordered eating is everywhere we look. You don’t need to be in a hospital bed to need to talk about your relationship with food with a professional. In fact, according to the JAMA Pediatric research journal, “22% of children and adolescents worldwide show disordered eating.” (Lopez-Gil et al., 2023).

I can say with fair certainty that the number is grossly underestimated, considering all the eating disorder dietitians I know in Charlotte alone who have waitlists! After reading this blog post, you will understand:

• The eating disorder diagnoses in the Diagnostic & Statistical Manual (5th edition) of Psychiatric Disorders

• Common manifestations of these diagnoses

• Why all people who suffer may not meet criteria

Even though I am writing this post detailing the diagnoses, I cannot provide anyone with an eating disorder diagnosis. An eating disorder diagnosis must come from a doctor, psychiatrist, therapist, or other medical professional. Ironically, as eating disorder dietitians, we cannot diagnose anything other than malnutrition. This also means that getting a diagnosis requires access and resources. It means seeing a medical or mental health provider, which isn’t always possible or affordable.

Diagnoses can be extremely beneficial for insurance purposes, and as your dietitians we work with other members of the care team to obtain any on file for this purpose. However, diagnoses are often exclusionary. For example, an “overweight” BMI code may get you full coverage, but you could be deep in the depths of restrictive Anorexia Nervosa. But per diagnosis terms, you wouldn’t be considered to have Anorexia Nervosa unless your BMI is underweight.

Many clients review their patient charts at medical offices and feel unsettled when the diagnosis is not what they expected. For this and many other reasons, diagnoses are just tools. Just labels that help make care more accessible! They are NOT a measure of worthiness or need for care.

As a disclaimer, even the gold standard Diagnostic & Statistical Manual (5th edition) of Psychiatric Disorders does not fit someone perfectly every time. Healthcare professionals learn based on standard policies and practices, often guided by books written by seasoned professionals. More often than not, an eating disorder case will not fit the mold laid out in the DSM-5. It makes sense- eating disorders present in so many ways, and impact so many people, that we can't expect these experiences to be reduced to just a few categories with checkboxes.

In addition, marginalized folks like BIPOC & disabled persons, are not well-represented in the DSM-5. The weight and appearance-related criteria can fail many low-income patients who cannot pay out-of-pocket. There’s no need to worry about meeting all of the criteria exactly to receive insurance coverage, but unfortunately, it is a factor. Trained eating disorder professionals can meet you where you are, at any stage. 

If your symptoms are below the threshold of a clinical diagnosis, we want you to know that you are seen and your struggle is valid!

Here's a quick high-level breakdown of eating disorder diagnoses (per the DSM-5):

1. Anorexia Nervosa (AN)

   • Restriction, fear of weight gain, often (but not always) low weight

     1. Two subtypes: restrictive AN & binge-purge AN

2. Bulimia Nervosa (BN)

   • Cycles of binge eating and compensatory behaviors (purging, over-exercising, use of laxatives/diuretics, etc)

3. Binge Eating Disorder (BED)

   • Episodes of feeling out of control with food, without compensation

4. Avoidant/Restrictive Food Intake Disorder (ARFID)

   • Restriction based on sensory issues, fear of choking/illness, or lack of interest in food

     1. By definition, not tied to body image

     2. Common in neurodiverse populations

5. Other Specified Feeding or Eating Disorder (OSFED)

   • Mixed or subthreshold symptoms. Still very real and very serious. Formerly “EDNOS”

     1. Atypical Anorexia

     2. Night eating syndrome

     3. Orthorexia

     4. Low-frequency BED and BN

Information about diagnoses can be helpful. For some clients, receiving a diagnosis can be extremely valididating of the signs and symptoms they are experiencing. For others, it's a way to access treatment by using the code for insurance billing.

But at the end of the day, you do not have to be diagnosed with an eating disorder to deserve care. If you are struggling in our relationship with food and body, that is enough reason to have support.

If thoughts about food, movement, or your body are interfering with your life, that’s reason enough to reach out. Healing isn’t about meeting criteria. It’s about reclaiming your life back from self-hatred and diet culture.

Shame and stigma should never be barriers to care, although they often are. You’re not alone, and you’re not overreacting. There are trained professionals and free resources ready to help, from therapists and dietitians to support groups and hotlines. Even starting with one honest conversation with a trusted person can be a powerful first step.

If you or anyone you know is struggling with disordered eating, a registered dietitian and/or a mental health professional who specializes in EDs can be a great place to start. Even if we aren't local to you or you don't have insurance, you can reach out to us and we will do the best we can to connect you to helpful resources. Some we often recommend include Project HEAL and the National Alliance for Eating Disorders.

If you think working with us might be a possibility, we'd love to meet you. We meet with clients at our office in Charlotte and our second location in Cornelius opens next month! We are also able to meet with folks in NC, SC and a handful of other states via telehealth. You can schedule a discovery call here if you want to chat before scheduling. If you're ready to schedule with one of our dietitians, you can contact us here.

Citations:

López-Gil, J. F., García-Hermoso, A., Smith, L., Firth, J., Trott, M., Mesas, A. E., Jiménez-López, E., Gutiérrez-Espinoza, H., Tárraga-López, P. J., & Victoria-Montesinos, D. (2023). Global Proportion of Disordered Eating in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA pediatrics, 177(4), 363–372. https://doi.org/10.1001/jamapediatrics.2022.5848