In this post we will outline eating disorder symptoms from individuals with Anorexia Nervosa and Bulimia Nervosa, and then compare them to eating disorder symptoms from Binge Eating Disorders.
All types of eating disorders are characterized by a persistent disturbance of eating or eating-related behavior. They cause individuals to alter their consumption of food (e.g., eating more or restricting what they eat), which significantly impairs their physical health and/ or functioning. Let’s take a look at the most common eating disorder symptoms:
Individuals with Anorexia Nervosa (AN)
- Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health).
- Either an intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain (even though significantly low weight).
- Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Individuals with Bulimia Nervosa (BN)
- Engage in recurrent episodes of binge eating (eating a larger amount of food than normal in a discrete period of time and feeling out of control when binge eating) at least once a week for 3 months
- Perform compensatory behaviors (e.g., self-induced vomiting) at least once a week for 3 months to prevent weight gain
- Self-evaluation that is unduly influenced by body shape and weight
- Have not experienced disturbances in eating exclusively during episodes of anorexia
Individuals with Binge Eating Disorder (BED)
- Engage in recurrent episodes of binge eating (eating a larger amount of food than normal in a discrete period of time and feeling out of control when binge eating) at least once a week for three months
- May experience eating more rapidly than normal, eating until uncomfortably full, eating when not hungry, eating alone because of embarrassment, or feeling disgusted or guilty after eating
- Experience marked distress regarding their binge eating
- Do not regularly perform compensatory behaviors like individuals with BN
- Have not experienced disturbances in eating exclusively during episodes of AN or BN
Note that both BED and BN involve recurrent episodes of binge eating. However, there are key differences between the two. You must rule out BN, as well as other potential conditions, before making a diagnosis of BED. Therefore, being able to differentiate between BED and BN is essential. (See Table 1 below)
It is also essential to understand what binge eating actually means. According to the DSM-5, an episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
This type of eating may sound familiar. Most people have, for example, attended a party where the food was so good they found it difficult not to overeat. However, the context in which the eating occurs is critical— a quantity of food and frequency of eating that might be considered excessive for a typical meal may be considered normal during a celebration or holiday. BED is not just occasional overeating at social events. While overeating is a challenge for many Americans, recurrent binge eating is much less common, far more severe, and is associated with significant physical and psychological problems. 9 Those with BED feel that their eating is out of control during a binge and find their binges very upsetting.
Binge-eating episodes must be associated with three (or more) of the following: eating very quickly, eating beyond feeling full, eating a lot when not hungry, eating in secret to hide how much is being eaten, and feeling guilty after a binge. Ultimately, to make a diagnosis of BED, all of the DSM-5 criteria (which will be covered in answer to the next question) must be met.
The most striking distinguishing feature of BED compared to other eating disorders is the absence of regularly compensatory behavior. Those with BED do not purge, use laxatives, or over-exercise to compensate for binge eating. They can, however, be very restrictive during times when they are not bingeing (and the course of BED can include periods of frequent bingeing alternating with periods of having control over eating, either of which can last days, months, or years). BED can occur in normal weight, overweight, and obese adults.
BED is the most common eating disorder in the United States, affecting about 2.8 million adults— two to three times the number of people with anorexia and bulimia combined. It is seen across racial and ethnic groups. While other eating disorders are twice as common for women, 40% of those with BED are men, with BED occurring in about 3.5% of women and 2% of men. The age of onset of BED is generally in adulthood, with a median age of 21. BED has a broader age range of onset than other eating disorders, spanning from childhood to late in life. BED is not part of another disorder. That being said, while we used to think of the various eating disorders as completely separate and distinct, we now know that over the course of a lifetime, a person may go in and out of different forms of eating disorder. For example, an individual can go from having BED to later developing AN and then having a period of BN.
There is an underlying dynamic common to BED and the other eating disorders. Any person with an eating disorder, whether it is AN, BN, or BED, is struggling on some level with the issue of self-care. The ability to feed and nourish oneself appropriately is, perhaps, the most basic, foundational requirement of human existence. Therefore, while the symptoms may vary, a basic issue these individuals need to resolve is a capacity for self-validation. Generally, healing from any eating disorder includes coming to the realization that:
- I have needs
- My needs are valid
- My needs are worth attending to in a conscious and conscientious way
- I deserve self-care
It is because of this shared internal experience that patients with differing eating disorders often gain healing insights from each other as members of a therapeutic group in a clinical setting or treatment center. There is a basic cycle of unmet needs, shame, and unhealthy behaviors around food; only the behaviors are unique to each disorder. This cycle is illustrated in Figure 1 below:
Dr. Wendy Oliver-Pyatt is a world-leading expert on treating eating disorders. With more than 20 years of clinical experience, Wendy has developed a unique treatment approach that delves into the underlying issues that place a person at risk for mental health conditions and eating disorders and lead to healing, health and inner peace. Wendy, Mental Health Speaker, Eating Disorder Educator, and Mental Health Advocate, currently delivers keynote speeches for leading organizations on topics such as eating disorders, treating serious mental health issues, and healthful approaches to weight concerns. Contact Wendy for your next keynote!