When your middle schooler starts requesting “healthier” snacks or your friend begins obsessing over the oil a restaurant uses to cook her meal, you might wonder: is this just health-consciousness, or should I be concerned? You might even ask this same question about yourself if you start, for example, becoming overly rigid with your workout routine or measuring all your food. No matter who you’re asking it about, the question can be hard to answer, in part because these habits and similar ones are often portrayed as normal or even desirable in our society. It’s also tricky because, for some people, these things may be genuinely healthy—but for others, they could be signs of disordered eating.

The risk of developing disordered eating habits is a real one: in a systematic review and meta-analysis including 63,000 children and adolescents around the world, 22 percent showed disordered eating. And while these habits on their own don’t signify a diagnosable condition, they can easily become a slippery slope to an eating disorder. Thankfully, learning to recognize disordered eating behaviors can go a long way toward preventing harmful habits and ensuring that you or your loved one get the support you need to prevent or address an eating disorder.

Read on to learn the difference between disordered eating and eating disorders, why both can be dangerous, and concrete next steps to take if you believe you or a loved one may be struggling with disordered eating.

What is a healthy relationship with food?

Before we can begin to understand disordered eating vs eating disorders, it’s helpful to have a baseline for comparison. As a caveat, every person’s eating behavior is unique to them, and there is no universal definition of “healthy” eating.

Still, if we look at the research, non-disordered eating tends to include:

• Consuming a balanced diet that provides the nutrients your body needs
• Having a positive attitude about food
• Being flexible with your eating. You eat in response to your hunger, schedule, proximity to food, and feelings, rather than rigid rules.

“Optimally, you're using interoceptive and internal cues to guide your hunger and fullness,” says Carol B. Peterson, PhD, Professor in the Department of Psychiatry and Behavioral Sciences at University of Minnesota Medical School. “Eating is also deeply culturally meaningful, from a social and interpersonal interconnectedness standpoint. Eating is a source of community and connection, and can and should be fun.”

What is disordered eating? A closer look at the behaviors

Disordered eating is a term used to describe a wide range of eating behaviors that may not warrant an eating disorder diagnosis but can cause physical and psychological harm. “Disordered eating is more of a descriptive term, and not an official psychiatric diagnosis described in the DSM-5,” explains Katherine Hill, MD, VP of Medical Affairs at Equip.

Some of the most common disordered eating examples include:

• A rigid approach to eating (tracking calories or macronutrients, inflexible meal times, reduced food variety)
• Assigning moral value to food (judging good foods vs bad foods)
• Skipping meals, fasting, or frequent dieting
• Binge eating
• Anxiety around trying new foods or eating in different environments
• Exercising to compensate for what has been eaten
• Using diuretics or laxatives
• Secretly eating
• Increased preoccupation with food and body and fear of weight gain

And while it's not an official eating disorder diagnosis, orthorexia—what is sometimes described as “clean eating disorder” or “eating too healthy disorder”—is another type of disordered eating. People with orthorexia become fixated on consuming only foods they believe are “clean” and “healthy,”often leading to very rigid rules about what can and can't be eaten. “Orthorexia often starts with good intentions but can lead to extreme restrictive behavior that can be problematic nutritionally,” Peterson says. “And for some, it can lead to a rebound of binge eating.”

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Causes of disordered eating

Many different factors might lead someone to develop disordered eating behaviors, but dieting is a major one. Fad diets that encourage extreme measures like intermittent fasting, cutting out entire food groups, or “cleansing” the body by only consuming certain liquids are all inherently forms of disordered eating in themselves. Although some people may be able to practice these things without any negative consequences, for a lot of people, they can be very problematic, Peterson says.

Another contributing factor is the reality that disordered eating behaviors have become increasingly normalized and even praised in our society, making them easy to dismiss. As the thin ideal still prevails and diet mentality permeates our culture, our conversations, and our conscience, habits like skipping meals or exercising for hours each day are often socially accepted. This not only means that harmful behaviors may go unnoticed, but may also encourage disordered eating behaviors in those susceptible to them.

Other causes of disordered eating may include societal or interpersonal pressure to lose weight, certain personality traits like perfectionism, and psychological factors such as depression, anxiety, or low self-esteem.

What qualifies as an eating disorder?

As opposed to disordered eating, which is a more general term that captures a number of different behaviors with varying levels of severity, eating disorders are serious mental illnesses with specific, narrow diagnostic criteria. Eating disorders can cause malnutrition, bone loss, damage to vital organs, and other severe physical health consequences. There are five official eating disorder diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, all with different symptoms and risks.

• Anorexia nervosa: Anorexia is characterized by extreme food restriction and an intense fear of gaining weight, leading to a significant low body weight in the context of age, sex developmental trajectory, and physical health.
• BED (binge eating disorder): BED is characterized by recurrent episodes of uncontrollably eating a large amount of food quickly (known as a binge), often followed by distressing feelings, like guilt and shame. The bingeing occurs at least once a week for three months, and is not associated with compensatory behaviors afterward. BED is the most common eating disorder in the U.S.
• Bulimia nervosa: Bulimia is an eating disorder characterized by recurrent episodes of binge eating (eating objectively large amounts of food quickly and with a lack of control) followed by compensatory purging behaviors to try to prevent weight gain. Purging may look like self-induced vomiting, misuse of laxatives or diuretics, or excessive exercise. This pattern occurs at least once a week for three months.
• ARFID (avoidant/restrictive food intake disorder): ARFID is characterized by eating a very small amount or variety of food (or both), leading to weight loss, failure to meet expected growth targets, nutritional deficiencies, the need for nutritional supplements, or a marked interference with psychosocial functioning. ARFID symptoms are not driven by body image concerns or a fear of weight gain, but rather come from sensory sensitivities, fears around eating, or a lack of interest in food.
• OSFED (other specified feeding and eating disorder): OSFED is a more general term to describe eating disorders that don't fit into other diagnoses. Some sub-categories of OSFED include atypical anorexia (when someone meets all of the criteria of anorexia nervosa except for significant low body weight), purging disorder, and night eating syndrome.

Eating disorders and disordered eating share many common behaviors, such as restricting food intake or “working off” meals. This makes differentiating one from the other that much more difficult.

The key differences: Severity, frequency, and life impact

The difference between eating disorders and disordered eating lies less in the behaviors themselves, and more in how often the behaviors happen, how intense the associated thoughts and feelings are, and how much these behaviors disrupt a person's life. “There's a fine line between disordered eating and an eating disorder,” Hill says. “Disordered eating is generally mild without a significant impact on someone’s mental or physical health or self-worth.”

Let's break down these three differences between an eating disorder vs disordered eating so you can better determine what you or your loved one may be dealing with.

Frequency of behaviors

To be diagnosed with most eating disorders, the behaviors have to occur at a specific frequency for a certain period of time. For example, binge eating disorder is diagnosed if the person binges at least weekly for at least three months.

“We'll also see people engage in bingeing less frequently, say monthly. That would potentially be disordered eating,” Peterson explains. Or consider specific occasions where people may overeat or undereat because of the circumstances, rather than an eating disorder. Take Thanksgiving, for example. Many people overeat on this holiday, but it's not problematic for them—it happens at that one meal, and then they're back to their typical eating the next day. That's not disordered eating or an eating disorder.

Severity of thoughts and feelings

What's happening inside someone's mind matters when comparing disordered eating vs an eating disorder. While those with disordered eating habits may think about food more than others, the level of obsession is far more intense with an eating disorder. Those struggling with an eating disorder are often so fixated on food—what they did eat, what they didn’t eat, what they will eat, how they'll avoid eating—that it impairs focus and makes it nearly impossible to stay present.

Thoughts and feelings about self-worth are another distraction. “In Western society, we see a high valuation in appearance and weight and shape, but in eating disorders, it's the number one thing,” Peterson says. “If they were to get an A on a test or lose a pound, the weight loss would have a bigger impact on their sense of self. Or if they got promoted and also gained weight, the weight gain would have a bigger impact.”

Life impact

While people with disordered eating habits may be preoccupied by thoughts around food and their body, their life generally isn't greatly impacted. With an eating disorder, however, those thoughts and behaviors occur so frequently, and are so intense, that the eating disorder reshapes life.

“You can't determine the severity of an eating disorder based on what someone does behaviorally,” Peterson says. “You want to understand what their life is like, and the extent to which these experiences and behaviors impact them. Often, their internal world is torturous."

For example, a child who skips her best friend's birthday party out of anxiety around the cake, or a teen who lies to his parents and goes out on a five-mile run despite having a bad cold are both situations where a person is likely struggling with an eating disorder. As an adult, you may be able to maintain a high level of functioning but struggle to pay attention in work meetings or truly engage with your kids.

One helpful way to think about it is to ask how often someone thinks about food or their body, and how often they want to think about food or their body. If the gulf between those two answers is significant, it shows that their brain is being monopolized by thoughts over which they don’t have control. This is a major red flag for an eating disorder.

“With an eating disorder, it is complete preoccupation,” Peterson says. “If you ask them, 'In a typical hour, how many minutes are you thinking about eating, your shape, or something related?' They'll say, 'Fifty-five minutes.'” This can make it difficult to concentrate at school, at work, and during conversations with friends.

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When disordered eating becomes dangerous: Physical and mental red flags

If disordered eating begins to have a negative impact on health, it's probably tipped over into eating disorder territory. “Disordered eating generally does not significantly impact someone's physical or mental health, whereas an eating disorder does,” Hill says.

Watch for the red flags listed below that indicate you or your loved one may have an eating disorder. If you notice a combination of them, it’s worth making an appointment with a medical provider for an evaluation. You can also schedule a free consultation with an Equip team member, or take our free eating disorder assessment.

Medical red flags

• Stalled growth in adolescents
• Menstrual irregularities
• GI symptoms
• Decreased bone density
• Low heart rate
• Loss of tooth enamel
• Hair loss
• Electrolyte imbalances

Psychological red flags

• Mood changes
• Depression
• Anxiety
• Increased social withdrawal and secrecy
• Body checking
• Suicidal thoughts
• Obsessive thoughts that interfere with daily tasks

Additionally, when someone has entered into eating disorder territory, you'll likely notice an observable shift in eating-related behaviors, Peterson says. This includes but isn't limited to:

• Greater tendency to skip meals
• Being more limited in what they're willing to eat
• Wanting to watch and see how food is prepared
• Saying “I ate already” at meals or food-related events
• Food going missing from the house, or evidence-of binge eating (i.e., excessive food wrappers or takeout containers)

The risks of "mild" disordered eating

It’s important to understand that even if someone's disordered eating habits don't meet the diagnostic criteria for an eating disorder, they can still cause significant harm.

Disordered eating is associated with physical and psychological problems such as:

• Anxiety and depression
• Struggles with self-esteem and body image
• Digestive problems (though it's unclear which comes first)
• Fatigue and difficulty concentrating
• Poor sleep
• Nutritional deficiencies and electrolyte imbalances
• Social isolation and withdrawal

And while disordered eating behaviors are harmful on their own (even if they never develop into a full-blown eating disorder diagnosis), someone “just” engaging in disordered eating behaviors for the time being could soon find themselves on the path toward an eating disorder. “People don't set out to have an eating disorder. They try to cut back carbs and increase protein, or skip dessert,” Peterson says. “But for people who are vulnerable—and it's unclear who those are—the diet becomes all-consuming, much more rigid, and pervasive in the longer term. This can lead to more and more restrictive eating that results in nutritional problems and unhealthy weight loss.”

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What to do if you or a loved one are struggling with disordered eating

If you're wondering, “Do I have disordered eating?” or you're worried that someone in your life is engaging in disordered eating behaviors, there's help and hope. First consider using an online eating disorder assessment to give you a better sense of what you may be dealing with.

If the results indicate a loved one may be struggling, talk to them during a private, low-stress time that doesn't involve food. Be mindful of how you approach the issue. Using threats or being the “food police” can make your loved one feel accused or scrutinized—which typically leads to more secrecy, Peterson says. Instead, “approach with a sense of curiosity of wanting to learn more,” she says. Express your concerns from a place of love, focus on how you're feeling and what you've noticed, and encourage professional guidance.

Here are some non-confrontational conversation starters that may help:

• "I’ve noticed that you’ve seemed a little down or stressed lately. Is there anything on your mind that you want to talk about?"
• "I've observed some changes in your routine lately. How are you feeling about everything?"
• "I know you’ve been going through a lot. Have you noticed any patterns in your eating habits that have been affecting you?"
• "I've noticed you seem anxious around food lately. Is there something I can do to help make things easier?"
• "You know, sometimes people struggle with food and their bodies without even realizing it. Have you ever felt like something might not be quite right with your eating habits?"
• "I notice you've been avoiding social situations that involve food. Is there something bothering you about those situations?"
• "You seem to be working really hard to control different aspects of your life. How does that feel for you?"

If they're open to it, offer to help them find a professional to talk to. If they're reluctant, emphasize that you love them and want to support them, and that you're there if they ever want to talk. You may have to have several conversations.

However, if someone is at medical risk, you need to step in, Peterson says. “You can say, 'This isn't a choice. We have to get you evaluated to make sure you are okay.” And if you’re the parent or caregiver for a minor who you think may have an eating disorder, it’s also important to intervene and help them get care, even if they resist.

To help a loved one or yourself get treatment, the first step is to make an appointment with a primary care provider or eating disorder specialist for a confidential consultation (you can also schedule a call with an Equip team member for a free, no obligation consultation). This advice holds true even if you believe the behavior isn't a full-blown eating disorder. “Early intervention is key to preventing further damage,” Tanimura says.

During a professional assessment, a healthcare provider may:

• Ask about any history of dieting, changes in eating and exercise habits, and use of appetite suppressants, diuretics, and other medications that can affect weight
• Perform a physical exam to look for physical symptoms like bloating, lanugo (fine hair all over the body), and knuckle calluses (evidence of purging)
• Order bloodwork to check electrolytes and other markers
• Use mental health screenings designed to help diagnose eating disorders

Whether the provider concludes you're dealing with disordered eating or an eating disorder, they can help you determine the next steps, including referring you to an eating disorders specialist. “Often people are extremely hesitant to seek treatment, afraid of forced treatment, and feel deep shame or fear of being misunderstood,” Peterson says. “Once they start treatment, they're enormously relieved. They feel understood for the first time.”

Frequently Asked Questions

What is the main difference between disordered eating and an eating disorder?

There are three main differences between disordered eating and an eating disorder: 1. With an eating disorder, the behaviors occur at a specific frequency for a certain period of time. With disordered eating, the behaviors are less regular and less frequent. 2. The thoughts and feelings of someone with an eating disorder are more intense, to the point where they're constantly preoccupied. 3. An eating disorder negatively impacts someone's life, where they begin to skip out on fun social events and can't perform as well at school and work because they're so distracted.

Can disordered eating harm my health even if it's not a full eating disorder?

Yes, disordered eating can be harmful to physical and mental health. It's associated with anxiety, depression, fatigue, difficulty concentrating, poor sleep, nutritional deficiencies, electrolyte imbalances, social isolation, and poor self-esteem.

When does dieting cross the line into an eating disorder?

Distinguishing a diet vs eating disorder can be challenging, especially since many disordered eating habits have been normalized in our society. However, red flags that dieting may have crossed the line into an eating disorder include stalled growth (in adolescents), menstrual irregularities, GI symptoms, low heart rate, mood changes, increased social withdrawal and secrecy, and obsessive thoughts that interfere with daily tasks.

Is skipping meals considered an eating disorder?

Skipping a meal here and there isn't an eating disorder. However, skipping meals can become an eating disorder if the person regularly skips meals and/or skips more than one meal a day, and this is affecting their day-to-day functioning.

What is a "mild eating disorder?"

There isn't such a thing as a “mild eating disorder.” By definition, eating disorders are serious health conditions that can lead to major health problems. Even disordered eating, which may not meet the diagnostic criteria of an eating disorder, can cause potential health complications. If you suspect that you or a loved one may have disordered eating or an eating disorder, see a medical provider for an evaluation as soon as possible.