As the years have gone by, the diagnosis of eating disorders has gotten more and more complicated because new ones keep popping up. There are still the three basics: anorexia nervosa, bulimia nervosa, and binge eating, but the most common diagnosis is EDNOS (Eating Disorder Not Otherwise Specified). This can be somebody who practices abnormal eating behaviors that are not in the diagnosis of any of the other three conditions, or somebody who has some but not all symptoms of anorexia, bulimia, or binge eating. Although some people who diet in unhealthy ways may overlap with eating disordered individuals in symptoms, such as restricting and then binging or false belief that one is overweight, they do not necessarily have eating disorders—this is often referred to as “disordered eating.” In the following list I will further explain each condition.

Anorexia Nervosa

In order to meet the diagnosis for this disease, one must exhibit: Refusal to maintain a weight over 85% of recommended body weight; intense fear of becoming fat or gaining weight; distorted view of body shape and size; loss of menstrual cycle for at least 3 consecutive months. There are two types: the restricting type, including those who lose weight simply by restricting food intake, and the binging/purging type, consisting of people who display the characteristics of anorexia and also either binge or engage in “purging” activities like vomiting, use of laxatives, or excessive exercising. Although it is very common for anorexics to induce vomiting in order to get rid of food they have consumed, this is different and separate from bulimia (for bulimia diagnosis, see below).

It should also be noted that while restriction of certain types of food, severe restriction of food, excessive exercise, drastic weight loss, excessive exercise, eating and dieting rituals, preoccupation with and distress over body weight and shape to the point of withdrawal from other activities are very common characteristics of anorexics, one does not have to display either of these to be diagnosed with the disease (the only characteristics required are those listed above).

I emphasized this because I was surprised to learn that fasting was not necessarily a characteristic of anorexia. I learned this when I told my psychiatrist I didn’t think I was ever anorexic because I rarely skipped meals. He informed me that the amount of food eaten is not part of the diagnostic criteria. One of his patients, in fact, had the same seemingly harmless ritual each day: a bagel for breakfast, a 6-inch sub for lunch, and pizza for dinner. Given her body type and physical activity, this was not enough to maintain her weight, and she met all the criteria for anorexia.

Anorexia has an extremely extensive history, although there is much debate about when the official disease anorexia nervosa originated. During the Middle Ages, there was a condition called anorexia mirabilis in which a girl or woman, such as Catherine of Sienna, claimed that their ability to go without eating was an indication of divine privilege and spiritual power. This phenomenon lasted through the 19th century, until people stopped believing in the religious implications of this behavior, and furthermore, scientists proved that although these women severely restricted their food intake, they did not survive entirely on God’s divine love as they had claimed. The term anorexia nervosa was coined in the early 20th century when doctors noticed anorexia (which means lack of appetite) linked to no other condition, such as digestive problems or mental illness. Those with this new disease severely restricted their food take solely because they experienced discomfort around food. Since then, there has been a growth in diagnosed anorexics, especially in the past few decades, almost one quarter of whom are male, which defies the stereotype that eating disorders are “girls’ diseases.”

Treatment includes giving parents total control over the child’s meals and insisting that they must eat or else be hospitalized (known as the Maudsley Method), taking in a high calorie diet, nutritional counseling, cognitive behavioral therapy (a fancy term for therapy), psychiatric counseling if needed, and in severe cases, hospitalization and/or tube feeding. Even so, about one tenth of anorexics die because of complications related to anorexia nervosa or suicide, which attests to how difficult it is to live with this disease.

Bulimia Nervosa

Bulimia is characterized by consumption of an abnormally large amount of food in a short period of time followed by some purging activity, such as self-induced vomiting, use of laxatives, diuretics, enemas, excessive exercise (often known as “exercise bulimia”), or fasting. These individuals evaluate themselves largely based on their body weight and size.

Bulimics are different from anorexics in that, although many anorexics exhibit binging and/or purging behavior, this behavior occurs more recurrently in bulimics. Bulimics often restrict food intake like anorexics do but then shortly follow these dieting periods with a binge-purge episode. Anorexia and bulimia each inflict 1-4% of the population.

Bulimic practices also date back many years. In ancient Rome, there was even a room called the vomitorium in feast halls. It was common practice for guests to eat huge amounts of food and then vomit it out before their next course (if you think I’m making this up, google it). It was also a regular ritual for members of this society to eat copious amounts of food one night and then fast for several days.

Although I am not a bulimic, I can attest that purging behaviors bulimics and some anorexics engage in are as ugly as they sound.

Treatment is similar to that of anorexia nervosa. In severe cases, the individual is taken to a hospital, where he/she is re-hydrated and given supervised meals. Some facilities monitor showers and bathroom visits; others simply force patients to wait a certain period of time after meals before using the bathroom. The Maudsley Method described earlier also applies to bulimic cases. Usually, parents’ normalizing their children’s eating and eliminating dieting rituals decreases the desire to binge and purge. Although bulimia is not as deadly or as noticeable as anorexia (bulimics are usually at normal weights), it brings about severe health complications that can lead to death.

Binge Eating Disorder

The most common of clinical eating disorders, binge eating disorder is characterized by consumption of excessive amounts of food in short periods of time and a feeling of being out of control of one’s eating. Again, many individuals with other disorders exhibit behaviors associated with Binge Eating Disorder, but not as frequently and usually combined with other behaviors. The binge eating is often overweight and often has low self-esteem and uses food to cope with emotional problems. Clearly, this disease has significant medical consequences because it can bring on obesity and the complications that arise because of it. I should emphasize, though, that any eating disorder has, in addition to medical consequences, severe psychological ones like obsession with food, inability to concentrate, body dysmorphia, intense self-loathing, and social withdrawal.

Binge eating disorder in children can also be treated with the Maudsley approach. Normalizing eating often decreases the desire to binge. Many binge eaters work through their problems on their own through therapy, seeing dieticians, and exercising and decreasing food intake in order to lose weight. Others don’t. Some go too far the other way and become anorexic or bulimic.

Parents should know that, although they may be concerned about their children’s weight, giving them restricted access to food and pushing “healthy” foods while prohibiting “junk” foods is actually harmful, not helpful. This approach does not decrease a child’s desire to eat “unhealthy” foods. Furthermore, it makes these foods something they turn to for emotional reasons because it is “special” or “prohibited” and because of this can lead to binge eating disorder (or any other disorder).

Eating Disorder Not Otherwise Specified (EDNOS)

Although not specified in the DSM (Diagnostic and Statistic Manual), EDNOS is the most common eating disorder and requires treatment just like the other ones. Some EDNOS patients have begun developing anorexia or bulimia, or have some symptoms, but do not fit all the criteria. Some fit certain criteria from each of the three main eating disorders but do not fit one exactly. Others display entirely different symptoms from a classical anorexic, bulimic, or binge eater. For example, some habitually chew food and then secretively spit it out. One girl I was in treatment with had significant trouble eating solid food because she was afraid of choking, although ingesting high-calorie liquids, soup, or other “less dangerous” foods like ice cream did not faze her. Often, an EDNOS patient is one who has partially recovered from an eating disorder but still meets some criteria. For example, I have restored most of my lost weight and regained my period, but still struggle with the desire to go back to my old behaviors and exhibit the other diagnostic criteria for anorexia (intense fear of becoming fat or gaining weight; distorted view of body shape and size).

Eating disorders are varied and complex, and it is important not to get too caught up in the specific diagnosis and instead focus on treatment. Whatever the physical consequences, all these disorders have severe mental and emotional ones. If one catches the eating disorder while it is first developing and still in the EDNOS stage, this is an advantage, but the person still must undergo one or several of the types of the treatment listed in order to halt the eating disorder before it entirely consumes his or her life (if it hasn’t already).

Despite the length of this article, there is much left unsaid, but this should provide you with a few basic ideas.