The most common eating disorder you've never heard of

    What goes through your mind when you indulge in a slice of pizza? Photo by Barbara L. Hanson on Flickr, licensed under the Creative Commons.

    Sara always blots her pizza with a tissue to save calories. Carrie never eats the crust. Margaret professes to love deep dish pizza, but peels off all of the cheese. Mark rarely eats pizza because he doesn’t deserve it unless he runs ten miles first.

    Which of these behaviors is normal? Which might be signs of an eating disorder? Sometimes it’s hard to make a distinction.

    While perhaps none of these fictional characters would be diagnosed with anorexia, bulimia or a binge eating disorder –- the most commonly referenced eating disorders -– they may each have their own varying levels of undefinable psychological food struggles.

    According to the National Eating Disorders Association, signs of an eating disorder include a preoccupation with body image and weight, fluctuation in weight unrelated to a medical condition and secretive or strange behavior during mealtimes.

    EDNOS, or Eating Disorders Not Otherwise Specified, is the most common diagnosis for those with eating disorders. A study published in the International Journal of Eating Disorders found that over 77 percent of eating disorders were classified as EDNOS. Yet despite its prevalence, EDNOS is often neglected in the study of eating disorders, with most research focusing on anorexia and bulimia.

    Anorexia nervosa and bulimia nervosa have very specific criteria listed in the Diagnostic and Statistical Manual of Mental Disorders. If you do not meet all the criteria, you are not diagnosed with the disease. For example, if you severely restrict caloric intake to the point of malnutrition, but do not experience amenorrhea (several missed periods), technically you do not qualify as anorexic.

    The current eating disorder classification system places the majority of eating disorders in a miscellaneous category, underscoring the severity of these undefined disorders. A meta-analysis of EDNOS conducted in 2008 by the Eating Disorders Clinical and Research Program found that EDNOS pathology mirrors that of anorexia nervosa and binge eating disorder. Because EDNOS is just as destructive as clinically classified disorders, it is necessary to treat it with equal gravity. But how do you decide what constitutes an eating disorder?

    While all eating disorders fall under the umbrella classification of psychological disorders, the underlying social, psychological, interpersonal and biological causes vary on a case by case basis. Traumatic events, social or family problems, failure at school or work, and major life transitions can all be triggers. Many develop eating disorders as coping mechanisms when life spirals out of control.

    Dr. Eileen Burke, coordinator of the Eating Concerns Assessment and Treatment Team at CAPS, defines healthy eating as “being able to eat from all food groups in moderation; to eat when hungry and to stop eating when full; and to regularly consume enough nutrition to support physical health.”

    Burke encourages students to seek help if “eating habits, body image concerns, and/or preoccupation with food” begin to have a negative impact on your “mood, physical health, relationships with family and friends, or school work.”

    If you feel your eating habits are disordered, CAPS is an excellent resource. CAPS counselors are also available if you are worried about a friend’s eating habits. CAPS works in conjunction with student health to address both the psychological and physical aspects of an eating disorder. To schedule a triage appointment, call 847-491-2151.

    Another resource available to students is Northwestern’s registered dietician, Megan Campbell. Campbell offers free individual nutrition consultations to all students, including those with eating disorders. To schedule a private appointment, students can call 847-491-DIET(3438) or email

    Sometimes a simple diet can transform into a constant preoccupation with calories and food. College campuses with the combined stresses of university life and independent living arrangements, are often cited as a fertile breeding ground for eating disorders. Eating disorders, whether EDNOS or anorexia, are not to be taken lightly. Fighting an eating disorder can last a lifetime, but you can recover. Instead of obsessively counting calories, your mind will be free to focus on the activities, classes and people that really matter.


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