As an eating disorder professional, I use the DSM to determine the appropriate diagnostic category for my patients. We have a lot of data to support differences in the clinical presentation of individuals that have binge eating disorder (BED), bulimia nervosa (BN) and anorexia nervosa (AN), and we determine treatment plans according to those differences. We also know that among the eating disorder diagnoses, there is a common occurrence of diagnostic migration (diagnostic crossover during a person’s life). Some of this crossover can be explained by the number of similarities that exist between these diagnoses. The shared features between these diagnoses are important to recognize when working with individuals with eating disorders.
Decreased Quality of Life: Perhaps the most important similarity is the effect that these eating disorder diagnoses have on an individual’s day-to-day function and quality of life. All of these diagnoses are serious illnesses with multiple negative physical and psychological consequences that must be taken seriously by the individual living with the condition and their providers.
Evaluation of Self-Worth: The cognitive behavioral theory of eating disorders proposes that the most shared component of these three diagnoses is cognitive in nature. Individuals who have AN, BN or BED evaluate and judge their self-worth largely based on their weight and shape. Placing such importance on external appearance often leads to behaviors aimed at controlling weight and shape – many of which also overlap between diagnostic categories.
Body Image Distress: In all these diagnoses, there is a common dissatisfaction with body image that contributes to the cycle of disordered eating and thinking. This distress is more severe and influential than the ‘normative discontent’ experienced by many people in the general population. For many individuals with AN, BN or BED, this leads to an avoidance of situations or settings where appearance or revealing one’s body is highlighted (weddings, family gatherings, wearing a bathing suit, etc.). Body image distress contributes to the common eating disordered belief that life will improve only when weight and shape changes in the intended direction.
Dietary Restraint: Eating habits are affected in all three of these diagnoses and the behavior that is common to them all is dietary restraint. For people with AN, BN or BED, this form of dieting is more intense than the dieting practices that are common in US culture. This population sets rigid and demanding rules that aim to limit the overall amount eaten. These rules take multiple forms but often encompass limiting the total number of calories consumed each day, cutting out certain foods from one’s diet altogether or delaying eating as long as possible.
Binge eating: Binge eating is another feature of eating disordered behavior that presents in all the diagnostic categories. In many individuals, consuming an objectively large quantity of food with a loss of control over eating takes place in the context of some form of dietary restraint.
Other similarities include:
• Individuals in all these diagnostic categories may also engage in excessive exercising, in an attempt to influence shape and weight.
• Purging behavior is common, except in BED (by definition).
• With the exception of AN, most individuals with BN and BED have an unremarkable body weight, highlighting the fact that eating disorders are not necessarily visible to an outside observer.
There are a number of different treatment approaches that can be taken to address the similarities and differences between these disorders. If you are working with a person living with an eating disorder, clinicians at Walden Behavioral Care are happy to collaborate with you to provide the best care for this complex population.
Dr. Kate Craigen is the clinical director of binge eating and bariatric support services. She is responsible for the clinical development and consistent implementation of binge eating disorder programming across Walden’s inpatient, residential, partial hospitalization, intensive outpatient and outpatient levels. Additionally, Dr. Craigen collaborates with various bariatric providers and partners throughout New England, ensuring both pre- and post-bariatric surgery patients gain the proper behavioral skills to enhance long-term outcomes. Previously, she was a clinician in Walden’s partial hospitalization and intensive outpatient programs in Waltham. She also served as a postdoctoral fellow and clinical instructor at the Eating and Weight Disorders Program in the Department of Psychiatry at the Mount Sinai School of Medicine. Dr. Craigen received her doctorate in clinical psychology from Fairleigh Dickinson University. Her professional interests include the role of supervision and training in the field of eating disorders and the role of gender in the diagnosis and treatment of eating disorders.