by Tasha Castor, MSEd., LPC
When a client comes to see me for an eating disorder assessment, she often comments, “But it’s not that bad. It’s not like I need to be in the hospital.”
Thanks to the media’s portrayal of eating disorders, many people think an eating disorder is a diagnosis only for someone who is emaciated and eats nothing. While I’m not hung up on diagnoses, an accurate one is important so that a person can get help.
So what do I tell my clients? An eating disorder is an eating disorder, no matter how “not that bad” it may seem. Sure, there are certain symptoms that define an eating disorder. For anorexia nervosa: weighing 85% or less of one’s ideal body weight, being afraid of gaining weight, and having body image issues. For bulimia nervosa: binge eating, purging or somehow compensating for binge eating, and also, having body image issues.
However, even The American Psychiatric Association (APA) has recognized that an eating disorder is an eating disorder. In the last year, the APA has changed the definitions of eating disorders because the old ones were too exclusive, something that often prevented people from getting treatment.
Now, a woman can be diagnosed with anorexia nervosa, even if she is still having regular menstrual cycles. We don’t have to wait until a severely underweight woman’s reproductive system shuts down before we can call it an eating disorder and allow her to get help. Bulimia nervosa no longer requires twice weekly binges to be called an eating disorder. Isn’t it just as distressing to binge once a week?
What does this mean? The APA is saying that a person does not have to be near death to have a serious eating disorder. Eating disorders are eating disorders, and eating disorders are serious.
Part of the “not that bad” label that my clients give their eating disorders is the disease itself. From the post “What Does Ed Sound Like?” you may know that an eating disorder operates in extremes. Call it black and white, all or nothing, but it’s the same concept. If a person doesn’t need to be in the hospital, the eating disorder voice tells her she doesn’t have an eating disorder and she’s “just fine.”
So when one of my clients claims she doesn’t have an eating disorder because it’s “not that bad,” I know that challenging that all-or-nothing thinking is likely to be the next step in treatment.