Why Eating Disorder Diagnoses Are More Complicated Than You Think
Eating disorders are complex, often evolving over time.
While diagnoses can provide useful frameworks for understanding a person’s experience, they often don’t capture the full picture. Research highlights just how mush these diagnoses can shift. One study found that over a 30-month period, eating disorder diagnoses frequently changed between assessments. This research reflects what I often see in my practice as an eating disorder therapist: eating disorder behaviors are dynamic and rarely fit neatly into predefined categories.
How eating disorder behaviors can shift over time
Behaviors and patterns associated with eating disorders often shift and evolve, sometimes significantly, over time. For example:
Someone who once restricted their food intake might begin bingeing or purging.
A client who previously engaged in bingeing and purging might shift to only restricting their food.
An individual who once restricted all foods (a behavior often associated with anorexia) might shift to restricting specific foods, focusing on “clean” or “healthy” eating patterns (which can align with orthorexia).
These changes don’t mean that one diagnosis was wrong, or another is right—it’s simply a reflection of how eating disorders can manifest differently at different times in a person’s life.
Why accurate diagnosis matters (but isn’t everything)
When I assess a client, my goal is always to provide the most accurate diagnosis possible in that moment. Diagnoses can help guide treatment plans and offer insight into someone’s struggles. That being said, I emphasize to my clients that diagnoses are not definitive answers—they’re tools that help us better understand behaviors, and identify areas for support.
Focusing too much on a diagnosis can sometimes obscure the bigger picture. Two people with the same diagnosis may have very different experiences, behaviors, and needs. A diagnosis is a snapshot in time, but healing requires ongoing, individualized support that adapts as behaviors and circumstances change.
As an eating disorder therapist, I aim to create a supportive space where clients feel seen, understood, and empowered to make meaningful progress.
Eating disorders exist on a spectrum
One of the biggest misconceptions about eating disorders is that they’re rigid categories. In reality, eating disorders exist on a spectrum, with overlapping behaviors, thoughts, and emotional patterns.
For instance, someone might meet the diagnostic criteria for anorexia but also display patterns of binge eating. Another person might not meet the full criteria for any single diagnosis but still be deeply impacted by disordered eating behaviors.
The spectrum model offers a more flexible way to understand eating disorders—one that recognizes how personal each person’s experience can be.
How I support clients through this complexity
Eating disorders are fluid, and diagnoses are tools—not definitive answers. While they can provide helpful insights, diagnoses don’t tell the whole story. In my work, I focus on meeting clients where they are, even when their symptoms don’t align neatly with a specific diagnosis. We work together to understand the deeper emotions, fears, and patterns driving their relationship with food.
Through eating disorder treatment, clients can begin to address not only their symptoms but also the root causes of their struggles.
The goal isn’t just to reduce specific behaviors but to build a sustainable, healthy relationship with food and self.
If you or someone you know is struggling with disordered eating, know that support is available. If you’re in MA, RI, VT, or VA, I may be able to help. Contact me today for a free consultation to learn more about eating disorder treatment, and let’s work together toward healing.
