Do I Need An Eating Disorder Diagnosis To Get Support With My Relationship To Food and Body?
By Katherine Metzelaar, MSN, RDN, CD
In my many years of work, I have witnessed the difficulty of people navigating getting support with their relationship to food and body.
Questions like, “Am I sick enough to deserve help?” or, “Am I wasting your time?” and “Should I even be here if I don’t have an eating disorder?” are common questions. I understand where some of these fears are coming from and they make a lot of sense. And, they are also the same kind of questions that can prevent you from getting the support that you need.
If there is chaos in the brain, you deserve support.
There is no such thing as “sick enough.” You suffering matters even if comparatively it’s different than someone else’s. This thought can be related to and rooted in not feeling like you deserve care. It can also stem from your experiences as an emotional caretaker for others growing up, questioning your own symptoms because you have never received an official diagnosis, and fear of getting support. So please know that feeling like you don’t deserve support, that you should wait until things get worse or telling yourself that things “aren't that bad,” is really common. And, I want to encourage you to start questioning that voice. I fundamentally believe that if there is chaos in the brain with food and body that you deserve support. You deserve to not have food and your body take up so much headspace.
Eating disorders are significantly under-diagnosed and diagnosing is tricky.
Without getting into the challenges of the DSM (Diagnostic and Statistical Manual of Mental Disorders) which is what is used to officially diagnose an eating disorder, I will say that it’s not always particularly comprehensive and it’s got a long ways to go. While I know that receiving a diagnosis can feel good for many, there are many that don’t fit the exact criteria in the DSM and because of this they slip under the radar. There are also what we call “sub clinical” eating disorders, which describes someone who doesn’t fit the criteria for an eating disorder, but does experience eating disorder behaviors. Even with all of that in mind, finding a mental health clinician to properly diagnose is challenging as they would need to specialize in eating disorders and understand their own implicit biases. So, even if you don’t fit eating disorder criteria, it doesn’t negate from your suffering. Your pain matters, diagnosis or not.
And also, eating disorders are shape-shifters and your past may be impacting the present.
Many people reach out because their therapist recommended it or because things with food and body are feeling hard only to find out in our work together that they had an un-diagnosed eating disorder in the past or are currently engaging in disordered eating behaviors. It’s important to keep in mind that eating disorders and disordered eating will ebb and flow over time, especially when we haven’t gotten support. It’s also not uncommon to have one eating disorder and then have a different one later on and all the while be engaging in disordered eating behaviors. Eating disorders are shape-shifters. And considering the diet culture that we exist in, it can seem like you are “recovered” when in fact you have decreased certain disordered behaviors and are now engaging in “socially acceptable” disordered behaviors.
Prevention is key. If food is taking up a ton of headspace and you feel unhappy about your relationship with your body, you don’t need a eating disorder diagnosis to get help.
Don’t wait until things get worse. Don’t wait until so much of your life is impacted that you have to do something about it ASAP. Don’t continue to suffer alone because you think that you don’t deserve support or wonder if you are “sick enough.”
If you are questioning if getting support with your relationship to food and body might be helpful, odds are you need support and would benefit from it. The sooner you can get help and support, the better.
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