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Food is not the Problem: Deal with what is!

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Definitions of Eating Disorders

At the CEDRIC Centre we absolutely believe that the way you interact with food and the way you feel about your body are coping strategies. They are ways that you have found to be in the world, to be in your life, without being conscious of the distress that you are feeling. You have had to tune out to that distress because for one reason or another you felt that it was too overwhelming or that you couldn't do anything to resolve the situation; to make it safe or better.

As such, your use of food to cope makes perfect sense. It is the best way that you could find to make it through the stress or trauma of those past situations. The problem of course, is that it is a very harmful coping strategy and it doesn't go anywhere near solving the underlying trigger. Not only that, but it becomes it's own problem and now you have something of a mess.

Don't despair, we have all been there and we know that your use of food to cope and your underlying trigger(s) can be healed and completely overcome and left behind you for good.

We know that your approach to food serves a great purpose for you and that until you find something else, more honoring and life-enhancing, to replace your food coping strategy with, you will hang on to it for dear life, as it truly has been a life-line.

Our goal in all of our work with our clients is to support you to see the needs that are met in your use of food to cope and to identify other ways to meet those needs that do not harm you or rob you of a high quality of life.

We have listed the formal, medical diagnostic criteria for eating disorders here because sometimes it is helpful for that critical voice in our heads (We call it "the Drill Sgt.") to see that the behaviours and thoughts you have are not unique to you and that they can be healed. There is nothing wrong with you. You are responding the best way you could find to the events and circumstances in your life. The problem is that your solution is a harmful one and will never lead you to a life of peace, ease, fun, and passion.

So remember that: you have a perfectly good reason for being where you are and you do not have to be there any more. You must be ready to acknowledge that your use of food to cope can't get you to where you want to be. And you must be willing to allow for the possibility that you can learn to let it go and to be in the world safely, independently, confidently, without food and body image as a coping strategy. That's what we're here for! We can support you to go from the old harmful coping strategy to a new, secure, grounded state of being.

Now let's explore the diagnostic criteria so your Drill Sgt. can begin to cut you some slack and acknowledge that maybe you could use some support to heal this coping strategy once and for all.

The DSM-IV Criteria for Eating Disorder Diagnosis

To define each eating disorder we used the guidelines directly from the DSM IV. The criterion for each eating disorder is strict, i.e. for a diagnosis of anorexia nervosa the DSM IV requires an absence of three consecutive menstrual cycles. At The CEDRIC Centre, and in most eating disorder treatment practices, the criteria used by the DSM IV does not always apply to real life situations. We encounter many clients who fit some criterion, but not others, or who display a combination of all three major eating disorders. For the sake of simplicity we often follow a client's cues about the label for their eating disorder, and work to resolve the root causes, which are similar for all eating disorders.

Diagnostic criteria: Anorexia Nervosa

  1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 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).
  2. Intense fear of gaining weight or becoming fat, even though underweight.
  3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
  4. In post menarcheal females the absence of at least three consecutive menstrual cycles.

Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Binge-Eating Type or Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating OR purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Characteristics are:

  • An intense drive for thinness
  • An intense fear of gaining weight or becoming fat
  • A disturbance in body image
  • In women - a cessation of the menstrual cycle for at least three months
  • In men - a decreased sexual drive

Source:
Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC : American Psychological Association, 1994.

Diagnostic Criteria: Bulimia Nervosa

  1. Recurrent episodes of binge eating.
    • An episode of binge eating is characterized by both of the following:
    • 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.
  2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other me dications; fasting; or excessive exercise.
  3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
  4. Self-evaluation is unduly influenced by body shape and weight.
  5. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Sources:
American Psychiatric Association (1998), Eating Disorders.
Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC : American Psychological Association, 1994.

Diagnostic Criteria: Binge Eating Disorder

Recurrent episodes of binge eating. An episode is characterized by:

  • Eating a larger amount of food than normal during a short period of time (within any two hour period)
  • Lack of control over eating during the binge episode (i.e. the feeling that one cannot stop eating).

Binge eating episodes are associated with three or more of the following:

  • Eating until feeling uncomfortably full 
  • Eating large amounts of food when not physically hungry
  • Eating much more rapidly than normal
  • Eating alone because you are embarrassed by how much you're eating
  • Feeling disgusted, depressed, or guilty after overeating
  • Marked distress regarding binge eating is present
  • Binge eating occurs, on average, at least 2 days a week for six months
  • Binge eating is not associated with the regular use of inappropriate compensatory behavior (i.e. purging, excessive exercise, etc.) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Source: From the DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Washington D.C.: American Psychiatric Association, 1994.

Diagnostic Criteria: Eating Disorders Not Otherwise Specified

  1. All of the criteria for Anorexia Nervosa are met except the individual has regular me nses.
  2. All of the criteria for Anorexia Nervosa are met except that, despite substantial weight loss, the individual's current weight is in the normal range.
  3. All of the criteria for Bulimia Nervosa are met except binges occur at a frequency of less than twice a week or for duration of less than 3 months.
  4. An individual of normal body weight who regularly engages in inappropriate compensatory behavior after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies).
  5. An individual, who repeatedly chews and spits out, but does not swallow, large amounts of food.
  6. Recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.

Sources:
American Psychiatric Association (1998), Eating Disorders.
Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC: American Psychological Association, 1994.

If any of these diagnoses felt like a fit for you recall what we said earlier about the need for food to cope stemming from stress and overwhelming circumstances that felt beyond our control or too confusing and distressing to be fully conscious of. You have a reason for turning to food to cope and it's not that you are weak, lack willpower, or don't care about yourself.

Let us support you to understand where your need for food to cope came from and what you can do to begin to live a life that is free from food and body focus.

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Michelle Morand
Michelle Morand

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