For real clarification, the DSM descriptions of the various criteria for Anorexia, Bulimia, and EDNOS can be found below:
Eating disorder not otherwise specified includes disorders of eating that do not meet the criteria for any specific eating disorder.
- For female patients, all of the criteria for anorexia nervosa are met except that the patient has regular menses.
- All of the criteria for anorexia nervosa are met except that, despite significant weight loss, the patient’s current weight is in the normal range.
- All of the criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur less than twice a week or for less than 3 months.
- The patient has normal body weight and regularly uses inappropriate compensatory behavior after eating small amounts of food (e.g., self-induced vomiting after consuming two cookies).
- Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
The criteria for Anorexia Nervosa is:
- Refusal to maintain body weight at or above a minimally normal weight for age and height: Weight loss leading to maintenance of body weight <85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected.
- Intense fear of gaining weight or becoming fat, even though under weight.
- Disturbance in the way one’s body weight or shape are experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
- Amenorrhea (at least three consecutive cycles) in postmenarchal girls and women. Amenorrhea is defined as periods occurring only following hormone (e.g., estrogen) administration.
And the criteria for Bulimia Nervosa:
- Recurrent episodes of binge eating characterized by both:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
- A sense of lack of control over eating during the episode, defined by a feeling that one cannot stop eating or control what or how much one is eating
- Self-induced vomiting
- Misuse of laxatives, diuretics, enemas, or other medications
- Excessive exercise
- Recurrent inappropriate compensatory behavior to prevent weight gain
- The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of anorexia nervosa
Recovering from any of these eating disorders is hard work. We have to learn to navigate the food playing field with healthy awareness. One of the interesting things I’ve learned about recovering from my own eating disorder is that food is merely a symptomatic component of the greater problem: low self-esteem, an out of control environment, poor body image, fear, control. Not eating was always a way to control the chaos around me. What I was clueless about was the fact that I was created chaos within. The more out of control the outside environment is, the more control someone struggling with an eating disorder requires to simply survive. Yes, there’s deep irony in the use of “survive” here, because the end result of some severe eating disorders is ultimately death.
Chelsea Roff, a recovering anorexic, yoga teacher, speaker, and author, has come out publically with her story of recovery. Chelsea suffered from a stroke when she was 15 and ended up in a hospital for 18 months under constant care. Her essay, bravely discussing her story first appeared in the book 21st Century Yoga: Culture, Politics, & Practice. From there, she was swept into the fray of instant publicity and exposure, ranging from the Huffington Post to Dr. Sanjay Gupta on CNN. While being in recovery isn’t about celebrity, there’s something to be said for a young girl who is taking this exposure and using it for good. There’s something deeply inspiring about someone who came from near death and is now thriving and being of service. In the end, being of service is what it’s about.
Eating disorders have their way of creeping back in when we least expect it. When we are of service and helping others, our own transparency is paramount to that process. In other words, being of service helps keep us honest. We have to eat. We have to learn to develop healthy relationships with our bodies and with food. Here, instead of vigilantly controlling our intake of calories, we can direct our vigilance to being of service. I look to Voice in Recovery and Chelsea Roff as young women who give back what was so freely given to them. I look to Melanie Klein (also a contributor in 21st Century Yoga) and Claire Mysko to provide the education and passion for body image advocacy in order to help young people gain a better understanding of the deeply rooted, media-infused sources of poor body image and eating disorders.
Kindness starts from within. We can and will recover.