There are a lot of myths and misconceptions surrounding eating disorders. In light of the fact that 3% of women will be affected by an eating disorder in their lifetime and they are now the third most common chronic illness among adolescent girls, the prevalence of the term and the disorders themselves beg for some understanding and awareness (NEDIC). After all, knowledge is power. And the more knowledge that we can gain about the eating disorders affecting ourselves, our family, friends and other loved ones, the better off we will be to get help and be a help to those affected.

So, let’s start from the beginning – what is an eating disorder?

According to the National Eating Disorder Information Centre (NEDIC), clinical eating disorders are defined as eating disorders that are recognized as medical conditions. There is a specific set of criteria used to determine whether an eating disorder is classifiable as a media condition. The American Psychological Association publishes the Diagnostic and Statistical Manual of Mental Disorders (presently in its fourth edition, shortened in further reference to DSM-IV), which outlines the characteristics of eating disorders. Under the title of eating disorders fall anorexia nervosa, bulimia nervosa, binge-eating disorder and eating disorders not otherwise specified (ED-NOS).

Before moving into an observation of the diagnostic criteria for each of these disorders, there are a few other distinctions to be made to further understanding in this topic. An eating disorder not otherwise specified is used to diagnose individuals who may have a mix of symptoms from the previous three clinical eating disorders and, as such, cannot be fit into one of the diagnostic criteria.

Also, the prominent measuring tool used to determine the healthy body weight for an individual is the body-mass index (also known as the BMI). Although slightly problematic because it fails to take into account variations in body types, the BMI is regarded as a good general measure. It is also important to note that eating disorders affect both men and women.

Of the four categories falling under the umbrella of clinical eating disorders, anorexia nervosa and bulimia nervosa are estimated to affect 8% of women, according to the American Psychiatric Association (NEDIC). There are four criteria set out by the DSM IV for diagnosing anorexia nervosa:

• A refusal to maintain body weight at or above a minimally normal weight for age and weight (or a failure to make the expected weight gain during a period of growth), leaving them with a body weight that is 85% less than what is expected

• An intense fear of gaining weight or becoming fat although the individual is visibly underweight

• A disturbance in the way one’s body shape or weight is experienced, an undue influence of body weight or shape on the individual’s self-evaluation or denial of the severity of the current body weight

• The presence of amenorrhea (absence of at least 3 menstrual periods)

At the diagnosis, there are two different types of anorexia that individual can have: restricting (the individual has not engaged in binge-eating or purging behavior) or binge-eating-purging type (the person has recently engaged in binge-eating or purging behavior during the recent episode of anorexia).

Bulimia nervosa also falls into two types: purging (involving regular engagement of self-induced vomiting or misuse of laxatives, enemas or diuretics) or non-purging (inappropriate, compensatory behaviors are present but they do not include the behaviours falling under the purging category). As well, there are five diagnostic criteria for bulimia:

• Recurrent episodes of binge eating characterized by both:

  • Eating (during a set time period) an amount of food that is sizably greater than what most people would eat during a similar time period and under similar circumstances

  • The individual feels a lack of self-control over eating during the episode (they cannot stop or control the amount being eaten)

• Recurrent inappropriate compensatory behavior to prevent weight gain (i.e. self-induced vomiting; misuse of diuretics, laxatives, enemas or other medications; fasting; excessive exercise)

• The binge-eating and compensatory behavior both occur, on average, at least twice a week for three months

• Self-evaluation is unduly influenced by body shape and weight

• This does not occur exclusively during episodes of anorexia nervosa

ED-NOS, an eating disorder not otherwise specified, is a title used to diagnose individuals who may have a mix of symptoms from the previous three clinical eating disorders and, as such, cannot be fit into one of the diagnostic criteria.

Binge-eating disorder is not yet recognized by the American Psychiatric Association and is, therefore, not included within the DSM-IV despite its acknowledgement by many organizations and associations within the field of eating disorders and its prevalence within society. Individuals with binge-eating disorder will consume excessive amounts of food as either a response to hunger experienced by restrictive dieting (or eating patterns) or because over-eating serves as a form of comfort, a way of avoiding uncomfortable situations or numbing feelings. Binging is an attempt to emotionally soothe oneself and, as well, it is associated with a great deal of shame and embarrassment in the individual (arguably similar to most, if not all, of these eating disorders). Unlike someone with bulimia, a binge-eater does not purge to relieve himself and, as such, may be ‘heavier’ than the average person.

Having had a few friends struggle with eating disorders over the years and, now, looking over these characteristics, it’s heart-breaking to see how people can end up here, with these disorders. What is it that drives them to this? How do they end up at this point, with one of these eating disorders? It’s a matter to be addressed in the second part of this article.

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