Spoon has done a great deal to raise awareness about eating disorders. We’ve served as a platform for people to share their personal struggles with eating disorders, provide information on what to do if you have an eating disorder, and discuss their controversial opinions about eating disorders.
But what does this label really mean? An eating disorder is a complex, psychological term, and most of us don’t have the education to fully understand the intricacies of that label. So we sat down with psychologist Dr. Maureen Keown to discuss what the term eating disorder means, how they are diagnosed, and the issue of self-diagnosis.
Nickens: Many men and women now openly struggle with poor body image and their relationship with food. However, these issues don’t necessarily constitute an eating disorder. When does a poor relationship with food or one’s body become more?
Dr. Keown: Those types of issues are so pervasive now, but eating disorders go beyond the typical thoughts of, “I wish I had a little bit of help in this area or that area” or “Hey, maybe I should hold off on the dessert.”
Those types of things obviously do not fall in the realm of eating disorders. While they’re certainly negative thoughts about body image, it’s not until it truly starts impacting a person’s behavior and functioning that it could be considered an eating disorder.
If you’re looking at yourself, examples of questions to ask yourself might be: Am I constantly thinking about this? Does this preoccupation exist in my mind more than school or friends or work? Am I avoiding going to dinner with friends? Am I changing outfits 20 times and making myself late for work? Are these issues actually having a real impact on my daily life and my functioning?
That’s still just a rule of thumb. That wouldn’t be the criteria that a psychologist would use to diagnose, but it’s sort of a good indication that those problems probably crossed into the realm of something more problematic.
Nickens: So is that also a good indicator of when someone should seek treatment?
Dr. Keown: That is absolutely what I would say. You need to seek treatment when it starts impacting your life or when you’re bothered by it. Even if you don’t feel like you’ve crossed in to some realm, you may feel like “I don’t like the way that I’m thinking” or “I don’t like the way I’m feeling.”
You certainly don’t even have to have a diagnosable disorder to seek help. The truth is, a lot of people start just feeling, “I just want to lose a little bit of weight” or “I’m just not super happy with the way I look right now.” And very, very quickly this can morph, for some people, into a full blown eating disorder.
Nickens: How do you, as a psychologist, diagnose an eating disorder?
Dr. Keown: We use DSM-5, which is for all mental health disorders. It changes with every new addition, and thankfully, they made some much needed changes to eating disorders in the 5th edition. It breaks eating disorders down into a few different categories, and it has very specific criteria for each category.
Most people are familiar with anorexia nervosa, which includes restrictive eating and extremely low body weight. Most people are also familiar with bulimia nervosa, and I guess that would loosely be considered binging and purging. That one also has fairly specific criteria, but not so much about body weight because a lot of people would have relatively normal body weights with bulimia. Its criteria would be more like you must binge/purge once a week for 3 months.
The other one that I think is very pervasive now is binge eating disorder. It’s the binge part of bulimia nervosa but without the purging behavior. The DSM-5 also has the definition of a binge: eating more than would be typical within a short time frame.
It gets kind of specific sometimes about these things. You have the different categories, and the criteria for meeting them can be kind of specific, but really, that’s more for the diagnostician to worry about.
Nickens: Why does it get so specific?
Dr. Keown: The thing that you’ve got to remember about diagnoses is that so much of them are really for the professional community more so than the people who are receiving the diagnosis. It’s a way that we can communicate with each other. I can communicate with the medical team or other professionals in this field. It’s a way of looking at a set of symptoms that a person is experiencing and giving a shorthand version of what they’re dealing with.
The other thing about diagnosing is that so many people want or need to use their insurance to cover treatment, and the insurance companies require meeting criteria of an actual diagnosis.
Still, professionals and people who suffer from the disorders also need to be aware that, just because you meet criteria for a certain disorder, your disorder could look completely different from someone else’s disorder who meet the same criteria. Everyone is an individual. Your triggers might be different. The things you struggle with might be different. You don’t want to lump everyone together.
Nickens: Now that these criteria are pretty widely available online, lots of people will self-diagnose themselves without seeing a doctor. What do you think about self-diagnosing?
Dr. Keown: I know that a lot of people identify with an eating disorder even if they haven’t officially been diagnosed, but I really think the diagnosis is more for the professional community in terms of studies, research, and treatment. It’s great for the person experiencing it to have an understanding of what’s going on with them, but I don’t how much the diagnosis actually helps them move through therapy or their treatment. It’s more informational.
People also can get very, very wrapped up in a label. People either see themselves or are seen as this eating disorder. There’s a pretty big distinction between “I’m anorexic” as opposed to “I am a person with anorexia.” Don’t stamp that on your forehead because you’re a whole person.
But their struggle, while it might not be diagnosable or might not meet the criteria, is still their struggle. You don’t want to take that away from them or make them feel like they don’t get it.