Subclinical eating disorders: Milder illness, more suffering

Posted by Frank Gillespie MA

We hear a lot about classic types of clinical eating disorders such as anorexia nervosa and bulimia nervosa in different forums. These sources undoubtedly carry important information and raise awareness, even if they do nothing more than raising questions, re-listing symptoms and deterrent mortality and suicide data. In the last few years the number of individuals diagnosed with subclinical eating disorders grew significantly. Subclinical refers to the condition when a person does not fulfill the diagnostic criteria for an eating disorder, may show overlapping signs of different disorders and may have shorter or longer symptom free periods. But what is this like exactly?

According to statistics, approximately 24 million people in the U.S. struggle with an eating disorder. Among U.S. females in their teens and 20s, the prevalence of clinical and subclinical anorexia may be as high as 15%. More severe data is that a mere 10% of people with eating disorders receive treatment, and of those only 35% seek treatment from a facility that specializes in eating disorders. Untreated eating disorders increase the risk of becoming chronic and associating with other psychological disorders and the appearance of other complications.

Sometimes clinical psychology and psychiatry can only deal with developed eating disorders and do not have adequate methods for treating milder forms. The latter may have less severe behavioral symptoms, for example, a person with such disorder might overeat and vomit `only` once in a week instead of three, but it is still not normal. On one hand, the development of biological complications is less likely in their case, while on the other hand they have to face the psychological and social complications the same way, such as: feeling of helplessness, worthlessness, isolation, commitment problems in relationships, sexual dysfunctions etc.

Subclinical eating disorders deserve close attention too, because less severe symptoms can often be chronic, persisting for even 15-20 years. This leads to a personality pervaded by distorted eating habits similar to eating disorders, cognitive characteristics and inhibited expression of feelings. The person only realizes indirectly (through failures in relationships, work or parenting) that something is wrong inside and around. Some are able to connect these failures to their eating disorder, some can see only parts of the interactions and there are some people who are not able to see any connection at all.

Indeed, a high proportion of constant dieters show some symptoms of eating disorders over time. Unfortunately, there are some weight loss tips that can cause the development of eating disorders, especially among those who carry individual or family predispositions. Such a harmful idea is for example, to be on a strict diet for six days a week but on the 7th you are allowed to eat everything you denied from yourself during the week. Most cases of bulimia start like this. Also, fasting may start an anorexic process. It is important to know that all anorexia starts with a `successful` diet. Banning and denouncing some food as `guilty` can increase the likelihood of overeating.

Many people have less severe eating problems, but they may suffer more than people with severe clinical symptoms. Mild disorders can dramatically destroy the quality of life too, especially when they remain unrevealed and untreated for years or decades.

The treatment of certain areas of obesity problems and milder forms of eating disorders fall within the scope of psychology. Such areas are like the improvement of self-control functions, teaching of stress-relief and stress-management techniques, improvement of self-expression and self-assertion- just to mention a few. An overweighed or obese person will gain back weight if he or she has dysfunction in the above areas or he or she only follows methods that concentrate solely on weight loss. And a person with eating disorder might be symptom free for a while but will fall back again.

An essential feature of eating disorders is that there are always interconnected causes in their background instead of one underlying cause. These causes are rooted deeply in the childhood and affect all the important parts of the personality. Causes that may indicate predisposition to eating disorder include: low self-esteem, lack of self-awareness, failure avoidance or failure seeking attitude, inflexible personality, tendency to increased anxiety, the importance of physical appearance in the family, low level of coping skills.

Subclinical eating disorders supposedly have fewer of these underlying causes or they are less powerful. However, they can get deeper and more severe and develop into clinical eating disorders due to the effects of weight-loss failures.


omplete recovery or long-term weight-loss is only possible with the correction of the affected areas. Consequences associated with disordered eating (e.g., frequent vomiting, excessive exercise, anxiety) can have long-term effects and require intervention. Early intervention may also prevent progression to a full-blown clinical eating disorder.

Frank Gillespie MA

Frank Gillespie has a Master's Degree in Counseling from LaSalle University in Philadelphia. He is a nationally Certified Counselor (NCC). He has provided therapy for over 23 years. During his career, he has helped more than 10,000 people move past their obstacles towards reaching their potential and fulfillment in their lives. He practices Cognitive Behavioral Therapy with a warm and nurturing approach. In addition to being a therapist, Frank has been an adjunct college professor teaching social work, a clinical consultant, a clinical director, and a seminar speaker. Frank has recently retired from his full time practice to focus on a part time online practice. He is married. He enjoys listening to music, watching sports, power walking, swimming, reading and writing.


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