Eating Disorder Classification Does Not Work

The diagnostic classification of eating disorders is problematic. Anorexia, Bulimia and Binge Eating Disorder are the only accepted diagnoses, yet many people with eating disorders, especially those struggling for many years, only fit into the box of Eating Disorder, Unspecified.

It may seem like these diagnoses shouldn’t be very important, but insurance companies insist on a diagnosis for reimbursement and treatment. Since insurance has so much power to dictate medical care, the diagnosis does matter.

Moreover, the diagnosis helps define the problem and lay out a clear path for recovery. Even if the clinical team insists that the diagnosis does not reflect the severity of the disease or importance of recovery, an unspecified diagnosis feels demeaning and dismissive and often decreases the motivation for a patient trying to take their illness seriously.

The diagnostic criteria need to take into account the shift in symptoms through the course of an illness in order to help describe the various disorders more clearly. For now, the classification only describes the earliest symptoms of illness.

For instance, people with anorexia in the first couple of years meet the criteria for weight and eating behaviors, but many fewer continue to do so for five years or more. The body biologically tries to survive the illness by finding ways to compensate for long-standing food restriction or by slowing metabolism to conserve energy. Thus, people with chronic anorexia usually don’t meet the weight criteria after a number of years, a very demoralizing and misleading change. However, even through these adaptations, it’s clear to any clinician the person still has anorexia, just in later stages.

The same can be said about all eating disorders in many different ways. The diagnoses don’t distinguish the myriad ways eating disorder present and persist.

Formally clarifying the distinction between stages of illness would not only be illuminating but also help patients better understand their diagnosis and how to conceive of treatment.

The best next steps in diagnosis would be to create stages of illness that allow people to recognize their diagnosis and also where they are both in the course of the disorder and in recovery.