In 2010, I lost 15 pounds in a span of a month and a half as a result of compulsive over-exercising and calorie counting. I was always athletic and never had a problem with my weight, so this drastic weight loss worried my mother, who decided it would be beneficial for me to see a therapist. I recognized that my obsession with dieting and exercising was a problem, but eating disorders were a foreign topic that I had perhaps skimmed over in a Seventeen magazine article but knew very little about. I knew that anorexics starved themselves and bulimics made themselves throw up, but I was doing neither of those things, so I took to the Internet to gain some more insight into the world of eating disorders. Through my research and my experiences with therapy, I learned that eating disorders are classified using a rigid system that did not provide me – and countless others – with a sufficient diagnosis.

The first thing I learned was that there are not just two major eating disorders but three: binge eating disorder, bulimia nervosa, and anorexia nervosa. I ruled out binge eating disorder right away. According to the National Eating Disorder Association’s (NEDA) website, binge eating disorder is characterized by “recurrent binge eating without the regular use of compensatory measures to counter the binge eating.” In other words, someone with binge eating disorder, or BED, consumes a larger amount of food than a “normal” person would over the same time period, and he or she does not use weight control methods to counteract the food intake. Someone with BED also feels as if he or she is “out of control” and experiences strong feelings of guilt following or during the period of binge eating. Just because someone eats a lot does not mean that he or she has BED; a serious problem is indicated by behaviors such as eating past satiety, eating when not hungry, or bingeing alone so as to avoid the feelings of shame. Though I did experience strong feelings of guilt following food consumption, I certainly was not eating excessive amounts of food, so I moved on.

Bulimia nervosa, on the other hand, correlated a bit more with my own symptoms. NEDA writes that bulimia is characterized by “a cycle of bingeing and compensatory behaviors,” or a “binge and purge” mindset. Someone with bulimia has the same pattern of bingeing as someone with binge eating disorder, as well as the same feelings of being out of control, but unlike the BED patient, a bulimic takes serious measures to “make up for” the bingeing episode. The most well known compensatory method is self-induced vomiting, but bulimics can also rely on laxatives as well as – and this is what caught my attention – compulsive exercise. The NEDA website describes an “excessive, rigid exercise regimen; despite weather, fatigue, illness, or injury, the compulsive need to ‘burn off’ calories taken in.” This was one of my most problematic symptoms, as I would force myself to run four to six miles at least six times a week despite exhaustion or injury in order to make up for the calories I had consumed or was to consume. However, I was missing one of the key pieces of a bulimia diagnosis, which was the bingeing. I was compulsively monitoring every calorie that went into my body as well as the calories I burned off. I was purging, but I wasn’t bingeing, so I ruled out bulimia as well.

That left me with anorexia nervosa, and as I scanned the page, I recognized nearly every symptom. Writes NEDA, “Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.” The symptoms – inadequate food intake, intense fear of weight gain, measures to prevent weight gain, and self-esteem related to body image – were all familiar. The warning signs were familiar too; “Preoccupation with weight, food, calories, fat grams, and dieting” was my most obvious symptom other than weight loss, but I also recognized anxiety over weight gain, a compulsion to make excuses to avoid situations involving food, and refusal to eat foods that I had once enjoyed. The last warning sign listed was, “In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns,” and this statement resonated with me. My life revolved around food and exercise, and everything else was secondary.

I entered my first therapy appointment nearly certain that I would be diagnosed with anorexia nervosa, but I was unaware of one crucial component of the diagnosis: the weight requirements. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a diagnosis of anorexia is not appropriate unless the patient has a Body Mass Index (BMI), a standard measurement of body fat based on height and weight, of 17 or less. Seventeen is the number that separates the underweight from the people of normal weight, the people who are eligible for a serious diagnosis of anorexia nervosa from the people for whom another diagnosis must be selected. My BMI was 17.8. I was nearly underweight by BMI standards, but I was not underweight. All of my symptoms and warning signs were irrelevant because I was not “thin enough” to warrant the diagnosis of anorexia nervosa. I was diagnosed instead with Eating Disorder Not Otherwise Specified (EDNOS). What is EDNOS?

Any eating disorder that does not meet the diagnostic requirements of binge eating disorder, bulimia, or anorexia is swept into a catch-all category of which many people are unaware. EDNOS, or OSFED (Other Specified Feeding or Eating Disorder) as it’s known under the latest edition of the DSM, includes anything from night eating syndrome, or “excessive nighttime food consumption,” to atypical anorexia nervosa, which is anorexia without a BMI below 17, and my most appropriate diagnosis. Disorders classified under EDNOS/OSFED are united by one common factor, which is “the serious emotional and psychological suffering and/or serious problems in areas of work, school, or relationships.” This is a strong statement that urges anyone struggling with body image issues to seek help from a therapist, but it also makes EDNOS/OSFED a vague category, and this causes difficulty for people seeking eating disorder treatment. As it turns out, EDNOS/OSFED can be just as severe and life-threatening as any of the three major eating disorders, but many EDNOS/OSFED patients are denied treatment because they do not meet any specific criteria.

There is a better chance that an eating disorder patient will make a full mental and physical recovery if the disorder is diagnosed and treated early, but in my case, the diagnosis impeded my treatment. To me, EDNOS sounded much less severe than anorexia, and while I would have benefited from outpatient eating disorder treatment, at the very least I was never made aware that EDNOS was an equally severe diagnosis. Even if I had sought more intense treatment, it is unlikely that insurance would have covered it because I did not meet the diagnosis for anorexia. A number and a pile of misconceptions stood between me and the treatment I needed.

I am lucky that I have been able to stave off my eating disorder without anorexia-specific treatment, but many others who suffer from similar symptoms end up much sicker because they are denied treatment when they first recognize that they need it. I know that I am not the only person who has had treatment impeded by this system of classification. Eating disorders do not just come in three different forms; they exist on a continuum, and just because someone does not meet an arbitrary set of criteria does not mean that his or her eating disorder is benign. Eating disorders are best treated when they are caught and treated early, and because of the faults in the eating disorder classification system, I have a long and difficult road ahead if I am ever to truly recover. A rigid classification system does not suffice when treating eating disorders, and this system needs to be adjusted in order to better serve eating disorder patients.