Posted on June 6, 2024 by Meagan McDowell

While at first, it might sound as though they could be interchangeable terms, “eating disorders” and “disordered eating" are entirely different from one another.

Eating disorders are “behavioral conditions characterized by severe and persistent disturbance in eating behaviors.” They are medically diagnosed mental health issues. Disordered eating, on the other hand, refers to many behaviors we’ve come to normalize as a society, including fasting, cleanses, and supplement misuse, to name a few. They are not formally diagnosed.

This blog post will explore the differences between eating disorders and disordered eating and how they overlap. We will also discuss why both are common among military service members and what change needs to occur to minimize this issue.

What Defines Eating Disorders

To be diagnosed with an eating disorder, a patient must be seen by their general health care provider or mental health specialist. There, they will undergo a physical examination, a psychological evaluation, and laboratory tests. It’s essential to be thorough and get a baseline on the patient’s overall health to formulate the appropriate treatment plan.

Medical professionals will use the DSM-5-TR, the latest publication of The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. It contains criteria for a patient to be formally diagnosed with an eating disorder, as well as other mental health issues.

Categories of Eating Disorders and Warning Signs

The DSM-5-TR classifies eating disorders as anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder (ARFID), other specified feeding or eating disorder (OSFED), and unspecified feeding and eating disorder (UFED). Please note that many people struggle with multiple types of eating disorders, and while medically, these terms are cut and dry, eating disorders and how they are experienced individually are incredibly nuanced.

All of the following definitions come from the DSM-5 diagnostic criteria for Eating Disorders.

1. Anorexia Nervosa

Anorexia Nervosa individuals severely restrict their caloric intake, leading to low body weight, potential organ failure, osteoporosis, fatigue, and dehydration. Some warning signs of anorexia include body dysmorphia, fixation on food prep, excessive exercise, fear of becoming fat, and sudden unusual eating behaviors.

Anorexia has the highest rate of mortality of any mental health issue. According to a study from Deloitte Access Economics, “Around 20 percent of those that experience AN (anorexia) die by suicide, and others die as a result of natural causes related to anorexia.”

2. Bulimia Nervosa

Bulimia Nervosa is defined as recurring binge eating where a person eats a large amount of food within a 2-hour window, feels a lack of self-control, and compensates for overeating by misuse of laxatives, diuretics, and self-induced vomiting.  These behaviors must occur once a week for three months to be formally diagnosed. The severity ranges from mild to extreme, meaning the patient experiences one to three or as many as 14 episodes a week.

3. Binge Eating Disorder

Binge eating disorder (BED) is diagnosed when a patient has recurrent episodes of bingeing in a 2-hour window, where they’re uncomfortably full and feel there is a lack of control over their eating and cannot stop themselves.

As with bulimia, the levels of severity range from mild to extreme, with one to three or 14 or more binge-eating episodes a week, respectively.

4. Avoidant/Restrictive Food Intake Disorder (ARFID)

According to DSM-5-TR, ARFID is “an eating or feeding disturbance so pervasive that the person is unable to meet appropriate nutritional needs, resulting in one (or more) of the following: significant weight loss, nutritional deficiency, dependency on nutritional supplements, or interference in social functioning.”

Unlike anorexia and bulimia, patients who suffer from ARFID are not concerned with their size or weight. Children with ARFID are selective in their food choices and sometimes have little interest in food, leading to poor nutrition and growth.

5. Other Specified Feeding or Eating Disorder (OSFED)

Other Specified Feeding or Eating Disorder (OSFED) applies to people whose symptoms cause significant stress in their daily lives but do not meet the full criteria for an anorexia, bulimia, or a binge eating disorder diagnosis. Treatment is still available, and talking with a medical professional about the next steps is crucial.

6. Unspecified Feeding or Eating Disorder (UFED)

While UFED fits under the umbrella term of OSFED, they vary greatly. UFED is diagnosed when a person is experiencing severe distress due to an eating disorder but does not meet the full criteria for one or more listed above. Clinicians may use this diagnosis if they cannot, or decide not to, formally diagnose a patient, as it takes a great deal of time to gather information, or it may not be the correct setting, such as the ER.

Examples of UFED include:

• Pica: This occurs when a patient eats non-food items like chalk, paper products, or even soap.
• Rumination: This is when a person who ruminates regurgitates their food, often rechewing, swallowing, or spitting it out.
• Orthorexia: This is an obsession with clean eating and living the healthiest lifestyle possible.
• Chewing and spitting

A person who chews and spits will do so with food that’s considered unhealthy, something that’s high in fat or sugar. They can enjoy the taste of these foods without having to consume them.

What Defines Disordered Eating

Disordered eating is “the presence of one or more irregular eating habits.” It’s not an eating disorder, so it’s not formally diagnosed. However, it’s just as dangerous and debilitating. Many behaviors society deems as “normal” and trendy, like fasting and cleanses, are classified as disordered eating.

More examples include:

• Skipping meals regularly.
• Counting calories obsessively.
• Avoiding certain food groups without medical necessity (e.g., carbs, fats).
• Engaging in excessive exercise to "earn" or "burn off" food.
• Eating only at specific times of day, regardless of hunger cues.
• Feeling guilty or ashamed after eating certain foods.
• Using laxatives or diuretics to control weight.
• Restricting food intake in anticipation of social events or special occasions.
• Eating in secret or hiding food consumption from others.
• Fixating on food-related rituals or routines, such as cutting food into tiny pieces or eating meals in a specific order.
• Measuring one’s self-worth by weight or body image.
• Supplement misuse, such as diet pills or creatine, and self-induced vomiting.

Information concerning these over-the-counter methods is rampant in online forums, especially if someone tries to “make weight” quickly.

Disordered Eating vs. Eating Disorders: How They Overlap

While it is possible to develop disordered eating habits and not an eating disorder, for many people, the former develops into the latter. When comparing disordered eating vs eating disorders, there are also many ways they overlap. Here are some of those similarities.

Psychological Impact

Both disordered eating and eating disorders have significant psychological effects on individuals. They may experience feelings of guilt, shame, or anxiety surrounding food, body image, and weight.

Distorted Body Image

Individuals with both disordered eating and eating disorders may have distorted perceptions of their bodies. They may perceive themselves as overweight or flawed, even when they are underweight or within a healthy weight range.

Preoccupation with Food

Both conditions involve an excessive focus on food, eating habits, and body weight. This preoccupation consumes significant mental energy and interferes with daily activities and relationships.

Impact on Physical Health

While the severity differs, both disordered eating and eating disorders have negative consequences for physical health. These may include nutritional deficiencies, electrolyte imbalances, gastrointestinal problems, and disruptions in metabolic function.

Sociocultural Influences

Sociocultural factors, such as media portrayals of ideal body types and societal pressures to conform to specific beauty standards, can contribute to both disordered eating and eating disorders.

Potential Progression

Disordered eating behaviors can sometimes escalate over time and develop into full-blown eating disorders if left untreated. Early intervention and support are crucial in preventing the progression.

Impact on Relationships

Both disordered eating and eating disorders may strain relationships with family, friends, and peers. Withdrawal from social activities, mood swings, and secrecy surrounding food behaviors can create tension and isolation.

Coping Mechanisms

Individuals may use disordered eating behaviors or eating disorder symptoms as coping mechanisms to deal with stress, emotional distress, or underlying psychological issues.

Perfectionism

Perfectionistic tendencies are common in both disordered eating and eating disorders. Individuals may set unrealistic standards for themselves regarding food intake, body weight, and appearance.

Treatment Needs

While the treatment approach may vary, both disordered eating and eating disorders may benefit from professional intervention, including therapy, nutritional counseling, and medical management. Treatment addresses underlying psychological factors, improves coping skills, and promotes healthier relationships with food and body image.

Why Both of These Are Common in the Military

For one, it’s a stressful work environment that values sacrifice. There’s also a strong emphasis on physical fitness and appearance. Service members undergo physical fitness assessments once or twice yearly, depending on the branch. They are scored for each physical event based on age and gender. They are also weighed before their co-workers, and BMI is calculated.

A remedial physical training program is implemented if a service member fails their PFA, which has the potential to affect their career negatively, even being forced out of service if failed a second time.

This is a breeding ground for members to develop disordered eating habits in an attempt to fit the standard. Studies have shown that:

• About 3% of active-duty females and up to 5.2% of female cadets engaged in self-induced vomiting.
• Between 4% and 9.7% of female military personnel used laxatives.
• Up to 18% of female cadets and active-duty women used diet pills.
• Nearly 4% of active-duty men engaged in self-induced vomiting and diet pill use, while 3.4% used laxatives.
• Over 19% of female military personnel engaged in binge eating episodes.
• About 25% of male military members engaged in binge eating.

While the percentage of disordered eating increases, a study from the Military Health System study shows in a “5-year surveillance period, from 2017 through 2021, annual incidence rates of eating disorders increased from 2.8 cases per 10,000 person-years (p-yrs) to 5.0 cases per 10,000 p-yrs. Periodic Health Assessment (PHA) forms completed in the 1-year period before and 1-year period after eating disorder diagnosis indicated an increased prevalence of major life stressors, depression, and post-traumatic stress disorder (PTSD) following diagnosis.”

The same study cited “5-8% of active-duty women, 0.1% of active-duty men, 4.6% of Veteran women and 1-4% of Veteran men have a diagnosed eating disorder.”

While it’s alarming to see an increase in the number of service members being diagnosed, there is a disparity among the available information. Cases go unreported due to a variety of reasons: the stigma associated with eating disorders, as men, in particular, are more reluctant to seek treatment; the fear of negative impact on one’s career; or they have not recognized the need for help.

Thankfully, last year, the DoD awarded researchers at the University of Kansas a $4.2 million grant to study the prevalence of eating disorders in the military. Their goal is to create a thorough method of identifying eating disorders and the “factors that predict the development of eating disorders in military service members in their first three years of service.”

We Need to Make a Change

Even with studies, facts, and figures, adequate care is lacking. TRICARE covers treatment for eating disorders, but not much information is available online; other than stating it’s covered and facilities must meet the standards, exclusions apply.

The SERVE Act was passed in 2021, allowing residential treatment for service members and dependents over the age of 20. Unfortunately, as of today, the DOD and TRICARE have yet to implement the federal law, and only dependents under 20 are covered.

How SEA WAVES is MAKING WAVES

The stress of active-duty experience can drive service members toward perfectionism. With a high emphasis on appearance in uniform and potential exposure to traumatic events, it’s not surprising that eating disorders and disordered eating are common in the United States military as an unhealthy coping mechanism.

Our founder, Leah Stiles, personally experienced eating disorders for many years as a high-ranking active-duty service member. She also experienced how difficult it was to get help through the military. In the end, it was her family’s commitment to her recovery and her own determination to recover that saved her life. Learn about her story in the video below.