#137: For all of Mental Health Month we’ll be discussing the everyday use of words that correspond to mental health symptoms and disorders. This week we’re talking about words related to ADHD and eating disorders.
While editing this episode I realized that I was talking about anorexia and bulimia as if they were more common than binge eating disorder (BED) but that is not true. According to the statistics link in the show notes BED is “more than three times more common than anorexia and bulimia combined… also more common than breast cancer, HIV, and schizophrenia.”
To be honest, I wasn’t clear on those statistics until after we recorded.
To clarify on my question: (There’s a tl;dr at the end)
I really love studying the history and the production of psychiatric diagnoses and the reasons for why certain diagnoses exist and why they are useful (or not) in treatment.
Bulimia, Binge eating and Anorexia are amongst the most known eating disorders although there are a few misconceptions in what the main characteristics of these disorders are and why they are important. Establishing a diagnosis can be difficult if you aren’t careful.
Binge Eating Disorder is characterized by binges that consist in eating inordinate ammounts of food and feeling like you aren’t in control. Usually associated with feeling guilty afterwards, eating quickly or until uncomfortably full. It is a debated topic wether Binge eating disorder is associated with attention deficit as usually the issue resides in the patient not being conscious of their “fullness” or using food as a form of fidgeting.
Bulimia is very similar to Binge Eating disorder except that Binges are accompanied by unhealthy compensatory behaviors. It’s a common misconception that compensatory behaviors consist only on vomiting or the use of laxatives. Other compensatory behaviors could include prolonged periods of fasting or excessive exercise (Which people usually associate with Anorexia). But the important thing about Bulimia is that the severity of disease (therefore the weight on diagnosis) lies in the amount of compensatory behaviors. Fun fact: if the person’s body mass index is below normal, this person cannot be diagnosed with Bulimia. This is because bulimia is characterized by having a healthy or high weight but inappropriate compensatory behaviors because of the patient’s distorted (sometimes not so distorted) view of their own weight.
Anorexia is characterized by extremely low caloric intake to the point where BMI is below the healthy range. It is also accompanied by intense fear of gaining weight and negative self image. But the severity and weight of diagnosis depends on how low their BMI is. Anorexia has two subtypes:
Restrictive: which is the usual idea people have of people with anorexia. Someone who engages in severe weight loss through fasting, dieting and exercise. Without binging or the use of compensatory behaviors.
Binge-Eating / Purging: Which is more like the image people have of Bulimia, somebody who participates in binges and then engages in compensatory behaviors like vomiting, laxatives, fasting, ect.
tl;dr - Anorexia is defined by severely low BMI and Bulimia is defined by normal or high BMI with binge eating and compensatory behaviors. Both can present as a patients who is fasting excessively and doing excersize or as somebody who binge eats and then vomits or uses laxatives.
Hi! Yes, you are absolutely right. Because the DSM prioritizes clinical utility, anorexia nervosa is primarily defined by it’s low BMI because that is associated with higher mortality/worse treatment outcome than bulimia (even if all the behaviors are the same except for the BMI difference). It signifies the severity for the practitioner.