The term “subclinical” is often associated with sentiments like less important and in need of less treatment.
Subclinical eating disorders tend to include 'subclinical', 'subthreshold' or 'low frequency' bulimia or binge eating disorder, and "atypical" anorexia. Let’s be clear: these words have taken on a negative connotation, and can lead to feelings of invalidity surrounding the severity of the behaviors, and decreased access to appropriate care.
Disordered behaviors and eating disorders are both worthy of treatment, care, and validation that one is “sick enough.” Any deviation from normal, intuitive eating is worthy of exploring and healing, and the majority of us are affected by messages about how we view food and bodies.
There's No Such Thing As "Sick Enough"
Why do we have delineations in research?: to make sure that we provide appropriate interventions and care based on the level of severity. There are two terms I learned about called sensitivity and specificity: sensitivity is a tool used to make sure that enough people who are sick are captured in diagnostic criteria, while specificity aims to ensure that not everyone is diagnosed when they do not truly exhibit clinical behaviors. The difficulty with eating disorders and disordered eating lies in the cultural normativeness and prevalence of disordered thoughts about food and body. It’s not just individuals who are sick, it is our society’s mindset.
So many of us are taught from an early age, whether implicitly or explicitly, that our bodies are bad, restriction and weight loss ought to be praised always, and that we should shrink and be smaller.
All of us long to be validated in our struggles. The naming of our pain and trauma is the beginning of healing because we understand, and we know that others understand where we have been. Then, we are able to move through our emotions and grapple with the places we find ourselves.
We need to recognize the importance of weight restoration for individuals in larger bodies
(whether due to weight suppression or because of malnutrition that did not support their
set point) and nutritional rehabilitation for people in all bodies. Restriction and
malnourishment are harmful for individuals of all different shapes and sizes, and we need
to stop prescribing harmful behaviors to individuals based on their body size.
The idea of “subclinical” eating disorders perpetuates the idea that one needs to “work
harder” to be “sick enough” to have a “real” eating disorder. We need to validate and
recognize that OSFED (otherwise specified feeding and eating disorders) is a real and valid
diagnosis, just as clinically significant as “typical” bulimia, anorexia, and binge eating
disorder, and validate the struggles of individuals who suffer from disordered eating, but
don’t meet criteria for an eating disorder as well. We need to stop recommending weight
loss or telling people they “missed” the diagnostic criteria for an eating disorder, and therefore cannot get the level of care they need.
Adequate care doesn’t look at weight as the determining factor of pathology, but looks at thoughts and behaviors, and emotional needs in navigating the appropriate level of care.
There is so much pain in disordered eating and eating disorders, and recovery, full and whole recovery, is absolutely possible. Rooting for you,
Mimi is a graduate student in Clinical Rehabilitation and Mental Health Counselling in North Carolina. She loves to read, write, and build relationships with other people, and is excited to dive deeper into therapeutic work. You can find her on Instagram @the.lovelybecoming or on on her website.
Mimi Cole on the importance of validating "subclinical" disorders