Subclinical Eating Disorders

You might have heard about clinical eating disorders such as anorexia nervosa and bulimia nervosa. But what issues with eating that don’t fit into those categories?

If you’re concerned about your relationship with food, eating, and/or body image, it’s worth considering whether you might have a subclinical eating disorder.

What is a subclinical eating disorder?

Technically speaking, “subclinical” refers to a disease that isn’t severe enough to receive a formal diagnosis.

But make no mistake: people who struggle with subclinical eating disorders still suffer, and they can still benefit from working with a therapist.

To understand subclinical eating disorders, it’s helpful to think of disordered eating on a continuum. At one extreme, we see formal diagnoses of anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding or eating disorder. At the other extreme, we see what’s considered “normal,” which can include occasional dieting or body-dissatisfaction.

In the middle of the continuum, we see everyone in between. These are folks who don’t quite meet the criteria for a diagnosis, but who show one or more of the following warning signs:

Subclinical eating disorders vs. clinical eating disorders

Ultimately, what distinguishes subclinical eating disorders from clinical eating disorders are two words: frequency and severity.

For example, two people may struggle with a similar preoccupation with food, body, and/or exercise. Both may report extreme body dissatisfaction. Both may engage in concerning behaviors such as restrictive dieting, binging and purging, and/or compulsive exercise. Both may even lose weight, but the person who drops into a weight range we deem “dangerous” is more likely to get a diagnosis and treatment than the other person, who may be struggling internally just as much.  

It’s also worth noting that research shows that subclinical eating disorders are quite common. According to one study from the National Eating Disorders Association, nearly 50% of the population experiences “problematic or disordered relationships with food, body, and exercise.” The same study notes that clinical eating disorders are much less common – just 1%-3% of the population. [1]

Symptoms of a subclinical eating disorder

Symptoms can be different for everyone, and not everyone will experience every symptom.

That said, some especially common symptoms of subclinical eating disorders include:

*List is adapted from NEDA [2].

What happens in a therapy session for a subclinical eating disorder

There’s no one treatment for subclinical eating disorders, but treatment will often following steps like the following:

1. Treatment typically starts with a thorough assessment of your history, present-day behaviors and concerns, relationship with your food and body.

2. Then, you and your therapist will have a discussion about what your treatment objectives for therapy are and how your treatment will help you work toward those goals.

3. In this early phase, you will likely be asked for a 24-hour record of what you’ve eaten recently, just so the therapist can get a sense of your eating behavior. A good therapist will offer you lots of compassion; we know how hard it can be to get into the nitty-gritty about this stuff. Try to remember, though, that the more forthcoming you can be about your symptoms, the more effective your treatment will be.

4. As sessions continue, you’ll likely work toward some of the following goals:

5. In between sessions, you may be asked to keep records of your behavior or complete homework exercises. These assignments will help you increase your self-awareness and give you the opportunity to try out strategies outside sessions.

What to look for in a therapist who treats subclinical eating disorders

People seeking help need to ensure that their therapist is trained and experienced in the treatment of the full continuum of disordered eating.

Keep these points in mind to find someone who’s a good fit:

  1. When researching an eating disorder therapist’s website, check out what kind of clinical experience and training they have had. True specialists have spent time working in eating disorder treatment centers.
  2. Eating disorder therapists should also be familiar with evidence-based treatments such as Cognitive Behavioral Therapy-Enhanced (CBT-E).
  3. You should also ask if your therapist is informed about the principles of Health at Every Size (HAES) and Intuitive Eating (IE), and ensure that they have a weight-inclusive practice.
  4. It’s also very important to avoid any therapist who claims to help you lose weight. Intentional weight loss is never recommended as a part of treatment for any eating disorder. Unfortunately, many well-meaning therapists, even within the eating disorders community, have internalized weight stigma and may make unhelpful assumptions about folks in larger bodies.

What else should I know about subclinical eating disorders?

Remember that no problem is too small and no body is too big to deserve treatment for disordered eating.

All individuals deserve to have a peaceful relationship with food, exercise, and their bodies.

Resources:
1:  https://www.nationaleatingdisorders.org/statistics-research-eating-disorders
2: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/osfed