Stages of an Eating Disorder
Lemberg (1992) also proposes a model of development whereby a person moves from voluntary dieting through a number of stages to reach a fully entrenched eating disorder.
Stage 1: Normal, voluntary dieting behaviour. Unfortunately dieting behaviours have become the “norm”, with 47% of people in Australia having tried to lose weight in the past twelve months. 68% of fifteen year old girls are dieting at any one time, 8% of these are on a severe diet (Lemberg, 1992). While these diets are severe enough to be considered an eating disorder, they are unhealthy and result in rapid weight changes, disrupted metabolism, dehydration, low energy and lack of essential vitamins, minerals and nutrients.
Stage 1B: (in Bulimia Nervosa only). The hunger associated with dieting and restriction leads to severe and constant cravings, which result in loss of control and overcompensation by bingeing on large amounts of food.
Stage 2: A Diagnosable Disorder. At this stage the dieting behaviour has become a diagnosable mental illness according to the Diagnostic & Statistical Manual IV-TR (APA, 2000). At this stage there are serious consequences and a morbid fear of fatness, and the dieting is no longer under the person’s control. However the person is unable to see the negative consequences and is in denial of the eating disorder. In bulimia nervosa the bingeing behaviours, rather than being due to dietary restriction, occur more generally as a result of stress or negative emotional states.
Stage 3A: Autonomous Behaviour. At this stage the person is generally able to see there is a problem, but as the behaviours are no longer under the person’s control, the disorder does not resolve even if precipitating conditions have been resolved.
Stage 3B: Illness becomes the identity. At this stage, rather than the eating disorder behaviours being a solution to a problem, the person now identifies him or herself only with the eating disorder and has difficulty separating themselves from the illness. The eating disorder behaviours are now constant rather than used as coping strategies, and the person feels they are nothing without their illness. They identify with being the illness, i.e. I am anorexic, rather than I have anorexia. The prospect of giving up the disorder can lead to existential fears of nothingness. Recovery requires not only finding alternative coping strategies, but helping the person identify themselves without the eating disorder.