A question that is often posed in recovery is whether all types of eating disorders are the same, or at least similar. There has been some debate in the field as to whether eating disorders are best conceptualized through a categorical modelor a dimensionalmodel.
The categorical model contends that each eating disorder is a distinct syndrome and is best viewed as being independent from other eating disorders. According to the categorical view, it is important to consider each eating disorder as distinct in order to optimize treatments for each one. For example, someone with Anorexia Nervosa may need to prioritize reducing restrictive eating, but for someone with Bulimia Nervosa this may not be a concern at all. Therefore, it would be inefficient to work with someone with Bulimia Nervosa to reduce restrictive eating, when that is not currently an issue for them. One of the notable challenges, however, with this model is that there is high degree of diagnostic comorbidity amongst eating disorders, meaning multiple diagnoses occurr at the same time. For example, someone with an eating disorder may have features of multiple types of eating disorders, or their eating disorder may morph from one form to another over time. An individual may start with behaviors that develop into Anorexia Nervosa via restrictive eating, for instance. Over time, these behaviors may move into Bulimia Nervosa, whereby the means through which the individual tries to control weight are no longer through restriction, and the diagnostic criteria for Bulimia Nervosa become more applicable. This begs that question that if eating disorders were so different from one another why is there such a high degree of comorbidity between diagnoses.
The dimensional view looks at eating disorders as occurring on a spectrum, rather than being dissected into specific categories. A dimensional view would support the idea that there is more similarity between the various eating disorders than there are differences, and that the diagnostic features (the symptoms) associated with eating disorders are more important to focus on than the diagnostic label itself. Binge eating, for example is a behavior which can be a feature of Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. Restrictive eating is perhaps more emblematic of Anorexia Nervosa, but it often occurs in Bulimia Nervosa and Binge Eating Disorder, and so treatment targeting that specific behavior would be relevant to individuals struggling with various kinds of eating disorders regardless of the diagnosis they hold.
Abrief analysis of the pathological behaviors associated with the various Eating Disorders demonstratesthere is a substantial degree of overlap within many of the diagnoses. Additionally, the mindset held by many individuals with eating disorders is strikingly similar if not identical. As a result, there has been a movement within the field towards the dimensional view, which has led to what is now known as the transdiagnostic approach. The transdiagnostic approach supports the notion that all eating disorders share similar characteristics and that underlying psychopathology behind eating disorders is manifested by similar behaviors and cognitions. In essence, eating disorders have the same underlying causes, and any changes in the symptoms do not necessarily mean a change in the underlying causes. This approach makes a good deal of sense intuitively, and on a practical level it enables treatment providers and researchers to limit chasing various symptoms and instead develop treatments with greater applicability to all forms of disordered eating. The transdiagnostic approach has shown strong support from the research and treatment community for this reason.
Most importantly, patients in treatment foreating disorders find this approach beneficial, because it helps them feel less alone, and see more common ground with other individuals who have similar struggles. Each person’s eating disorder is different, and treatment has to be somewhat customized for the individual regardless. At Cielo House we are pioneers in the individualized approach to eating disorder treatment. However, it is helpful to look at eating disorders as being similar phenomena so that we can create a sense of consistency in treatment, and a sense of community amongst those individuals who are overcoming an eating disorder.At Cielo House we provide customized treatment that takes into account the individuality and preferences of the person, while still offering treatments that have been shown to be effective for eating disorders in general. We recognize that while all eating disorders are largely similar, all people are vastly different.
Dr. Matt Keck, MFT is CEO and Co-founder of Cielo House. He works with clients to used the latest evidence-based approaches to eating disorder treatment in a way that is personalized and customized to each individual’s needs.