Our expert Clinicians specialize in treating adolescents, athletes and young adults. Our Therapists are highly skilled and trained in utilizing evidenced based treatments; Family Based Treatment (FBT) and Cognitive Behavioral Therapy enhanced for Eating Disorders (CBT-E). Our Dietitians are trained in Certified Eating Disorder Nutrition and Sports Nutrition. And our Mentors have lived experiences either with their own children who are in successful recovery or their own path through recovery. They are also professionally trained in Mentorship in eating disorder recovery.

We offer a highly effective 3-4 person care team to each family and individual. This team includes; Therapist (s), Dietitian, and Mentor who stay with the family for the duration of treatment and is committed to their success.   

We offer an all inclusive program of therapist, mentor and RD services. Our clients will be set up with all 3 providers after their assessments. We do not offer separate services for only one provider, such as a therapist or Dietitian. 

Our practice accepts insurance for Therapy services. Our Family and Mentor services are Fee based. Please contact our practice for more specific costs for services. 

Yes we take the following insurance plans for therapy services:

Anthem BCBS

Aetna

Optum (United Healthcare, Oscar, Oxford)

Our Dietitians are not in-network with insurance plans, they are considered out-of-network (OON). We can help you contact your insurance company to understand your OON reimbursement. We can also facilitate reimbursement for you. This is at no cost to you.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes  related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call RCED @ (804) 767-0111

We offer therapy and nutrition counseling via a secure and compliant telehealth software.

We require 48 hours notice for all appointments and charge full session fee for each missed appointment.

The Fan District

1312 B W Main St. Richmond, Va 23220

Get Directions

There is on street parking in front of our building.

According to the National Eating Disorder Association (NEDA), AN has the following symptoms and impact:

Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.

Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years.

Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.

DIAGNOSTIC CRITERIA

To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:

Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

Intense fear of gaining weight or becoming fat, even though underweight.

Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.

WARNING SIGNS & SYMPTOMS OF ANOREXIA NERVOSA

Emotional and behavioral

Dramatic weight loss

Dresses in layers to hide weight loss or stay warm

Is preoccupied with weight, food, calories, fat grams, and dieting

Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)

Makes frequent comments about feeling “fat” or overweight despite weight loss

Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy

Denies feeling hungry

Develops food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)

Cooks meals for others without eating

Consistently makes excuses to avoid mealtimes or situations involving food

Expresses a need to “burn off” calories taken in

Maintains an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury

Withdraws from usual friends and activities and becomes more isolated, withdrawn, and secretive

Seems concerned about eating in public

Has limited social spontaneity

Resists or is unable to maintain a body weight appropriate for their age, height, and build

Has intense fear of weight gain or being “fat,” even though underweight

Has disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight

Postpuberty female loses menstrual period

Feels ineffective

Has strong need for control

Shows inflexible thinking

Has overly restrained initiative and emotional expression

Physical

Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

Difficulties concentrating

Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

Dizziness

Fainting/syncope

Feeling cold all the time

Sleep problems

Menstrual irregularities—amenorrhea, irregular periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

Cuts and calluses across the top of finger joints (a result of inducing vomiting)

Dental problems, such as enamel erosion, cavities, and tooth sensitivity

Dry skin

Dry and brittle nails

Swelling around area of salivary glands

Fine hair on body (lanugo)

Thinning of hair on head, dry and brittle hair

Cavities, or discoloration of teeth, from vomiting

Muscle weakness

Yellow skin (in context of eating large amounts of carrots)

Cold, mottled hands and feet or swelling of feet

Poor wound healing

Impaired immune functioning

HEALTH CONSEQUENCES OF ANOREXIA NERVOSA

In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences.

The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.

According to the National Eating Disorder Association ARFID has the following signs and impact:

Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis in the DSM-5, and was previously referred to as “Selective Eating Disorder.” ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness.

Although many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly and, in adults, to maintain basic body function. In children, this results in stalled weight gain and vertical growth; in adults, this results in weight loss. ARFID can also result in problems at school or work, due to difficulties eating with others and extended times needed to eat.

DIAGNOSTIC CRITERIA

According to the DSM-5, ARFID is diagnosed when:

An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).

Significant nutritional deficiency.

Dependence on enteral feeding or oral nutritional supplements.

Marked interference with psychosocial functioning.

The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.

The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

RISK FACTORS

As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, which means two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms. Researchers know much less about what puts someone at risk of developing ARFID, but here’s what they do know:

People with autism spectrum conditions are much more likely to develop ARFID, as are those with ADHD and intellectual disabilities.

Children who don’t outgrow normal picky eating, or in whom picky eating is severe, appear to be more likely to develop ARFID.

Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders.

WARNING SIGNS & SYMPTOMS OF ARFID

Behavioral and psychological

Dramatic weight loss

Dresses in layers to hide weight loss or stay warm

Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy

Reports consistent, vague gastrointestinal issues (“upset stomach”, feels full, etc.) around mealtimes that have no known cause

Dramatic restriction in types or amount of food eaten

Will only eat certain textures of food

Fears of choking or vomiting

Lack of appetite or interest in food

Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens).

No body image disturbance or fear of weight gain

Physical

Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.

Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

Menstrual irregularities—missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

Difficulties concentrating

Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

Postpuberty female loses menstrual period

Dizziness

Fainting/syncope

Feeling cold all the time

Sleep problems

Dry skin

Dry and brittle nails

Fine hair on body (lanugo)

Thinning of hair on head, dry and brittle hair

Muscle weakness

Cold, mottled hands and feet or swelling of feet

Poor wound healing

Impaired immune functioning

HEALTH CONSEQUENCES OF ARFID

In ARFID, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences. The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.

Signs of Bigorexia

• Overexerting themselves at the gym
• Working out compulsively
• Use of steroids
• Excessively looking at their body in the mirror
• Abuse of supplements and constantly drinking protein shakes
• Irritability and angry outbursts
• Depression and mania
• Panicking if a gym session is missed

Causes of Bigorexia

Unfortunately, experts don’t have a clear understanding of what causes bigorexia or muscle dysmorphia just yet but like other compulsive disorders, research suggests that there are a number of factors which could contribute to it:

• Genetics – those who have a relative suffering from the condition may be more likely to develop it
• Brain differences – it’s thought that people with muscle dysmorphia may have insufficient levels of serotonin which is an important transmitter in the brain that affects mood and well-being
• Environment – childhood environment, family issues, bullying, emotional trauma and cultural factors may increase a person’s risk of developing the condition

According to Julie Alvira, MD: 

Bigorexia––Adonis Complex

A type of body dysmorphic disorder known as bigorexia, reverse anorexia or Adonis complex is becoming very popular among men gym goers. It is widely known that for many men muscularity equals masculinity. A man with bigorexia is not the typical person that seeks to maintain a healthy lifestyle. This is the male bodybuilder that becomes obsessed with his body because he is unhappy, one whom sometimes seeks injectable anabolic steroids, chest implants, and other type of cosmetic procedures to feed an emotional emptiness, which in some cases can be an underlying depression. Bigorexia can be misdiagnosed because there are a great number of men who just want to improve their physical appearance to attract partners. The problem here is when a vicious circle forms. According to Brown University, the more a person focuses on his body, the worse he tends to feel about how he looks. There are a number of factors that can lead to body dissatisfaction ranging from the comments of family and friends to deeper emotional issues such as different kinds of abuse, discrimination, and sensory experiences.

Nowadays, exposures like social media does not help because of the increase popularity of body image acceptance and idealization of bodies leading to an increase comparison of a person’s body to others. A study at Stanford University showed that when a man feels uncomfortably obsessed with his body, sometimes it can result in sexual problems and risky behaviors.

Dr. Murray, a clinical psychologist explains that unless a man acknowledges the problem and seeks help, treatment can’t be offered. In our society, it is very hard for this kind of man to seek help because of the “no pain, no gain” mentality and masculinity. If treatment occurs, it is done with the same techniques used to treat anorexia disorders. On the other hand, recent research by Phillips (2015) in the American Journal of Psychiatry presents that body dysmorphic disorder in general, is related to obsessive compulsive disorder (OCD) and benefits from psychosocial treatment and motivational interviewing techniques to engage and retain patients in treatment. Both disorders have many similarities but also differences that are still under research to find better approaches to the underlying symptoms and causes.

According to the National Eating Disorder Association (NEDA), BED has the following signs and impact:

Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. It is the most common eating disorder in the United States.

BED is one of the newest eating disorders formally recognized in the DSM-5. Before the most recent revision in 2013, BED was listed as a subtype of EDNOS (now referred to as OSFED). The change is important because some insurance companies will not cover eating disorder treatment without a DSM diagnosis.

DIAGNOSTIC CRITERIA

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.

A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

The binge eating episodes are associated with three (or more) of the following:

Eating much more rapidly than normal.

Eating until feeling uncomfortably full.

Eating large amounts of food when not feeling physically hungry.

Eating alone because of feeling embarrassed by how much one is eating.

Feeling disgusted with oneself, depressed, or very guilty afterward.

Marked distress regarding binge eating is present.

The binge eating occurs, on average, at least once a week for 3 months.

The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

WARNING SIGNS & SYMPTOMS OF BINGE EATING DISORDER

Emotional and behavioral

Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.

Appears uncomfortable eating around others

Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

Fear of eating in public or with others

Steals or hoards food in strange places

Creates lifestyle schedules or rituals to make time for binge sessions

Withdraws from usual friends and activities

Frequently diets

Shows extreme concern with body weight and shape

Frequent checking in the mirror for perceived flaws in appearance

Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating

Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting

Developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, and not allowing foods to touch).

Eating alone out of embarrassment at the quantity of food being eaten

Feelings of disgust, depression, or guilt after overeating

Fluctuations in weight

Feelings of low self-esteem

Physical

Noticeable fluctuations in weight, both up and down

Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

Difficulties concentrating

HEALTH CONSEQUENCES OF BINGE EATING DISORDER

The health risks of BED are most commonly those associated with clinical obesity, weight stigma, and weight cycling (aka, yo-yo dieting). Most people who are labeled clinically obese do not have binge eating disorder. However, of individuals with BED, up to two-thirds are labelled clinically obese; people who struggle with binge eating disorder tend to be of normal or higher-than-average weight, though BED can be diagnosed at any weight.

According to the National Eating Disorder Association (NEDA) BN has the following signs and impact:

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

DIAGNOSTIC CRITERIA

According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).

Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.

Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of anorexia nervosa.

WARNING SIGNS & SYMPTOMS OF BULIMIA NERVOSA

Emotional and behavioral

In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns

Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

Appears uncomfortable eating around others

Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)

Skips meals or takes small portions of food at regular meals

Disappears after eating, often to the bathroom

Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

Fear of eating in public or with others

Steals or hoards food in strange places

Drinks excessive amounts of water or non-caloric beverages

Uses excessive amounts of mouthwash, mints, and gum

Hides body with baggy clothes

Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories

Shows unusual swelling of the cheeks or jaw area

Has calluses on the back of the hands and knuckles from self- induced vomiting

Teeth are discolored, stained

Creates lifestyle schedules or rituals to make time for binge-and-purge sessions

Withdraws from usual friends and activities

Looks bloated from fluid retention

Frequently diets

Shows extreme concern with body weight and shape

Frequent checking in the mirror for perceived flaws in appearance

Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating

Purges after a binge (e.g. self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)

Extreme mood swings

Physical

Noticeable fluctuations in weight, both up and down

Body weight is typically within the normal weight range; may be overweight

Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

Difficulties concentrating

Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

Dizziness

Fainting/syncope

Feeling cold all the time

Sleep problems

Cuts and calluses across the top of finger joints (a result of inducing vomiting)

Dental problems, such as enamel erosion, cavities, and tooth sensitivity

Dry skin

Dry and brittle nails

Swelling around area of salivary glands

Fine hair on body

Thinning of hair on head, dry and brittle hair (lanugo)

Cavities, or discoloration of teeth, from vomiting

Muscle weakness

Yellow skin (in context of eating large amounts of carrots)

Cold, mottled hands and feet or swelling of feet

Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

Poor wound healing

Impaired immune functioning

Many people with bulimia nervosa also struggle with co-occurring conditions, such as:

Self-injury (cutting and other forms of self-harm without suicidal intention)

Substance abuse

Impulsivity (risky sexual behaviors, shoplifting, etc.)

Diabulimia (intentional misuse of insulin for type 1 diabetes)

Learn more about co-occurring conditions >

HEALTH CONSEQUENCES OF BULIMIA NERVOSA

The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.

The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.

According to the National Association of Eating Disorders (NEDA) 

Other specified feeding and eating disorder (OSFED), formerly known as eating disorder not otherwise specified (EDNOS) in previous versions of the DSM, is less well known than higher-profile diagnoses like anorexia nervosa, bulimia nervosa, and binge eating disorder. Despite its lack of public attention, as a catch-all category that includes a wide range of symptoms, OSFED is actually the most common eating disorder diagnosis, representing an estimated 32% to 53% of all people with eating disorders.1 It was developed to encompass people who did not meet the full diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder.

Like other eating disorders, symptoms include behavioral, emotional, and physical aspects.

Behavioral symptoms of OSFED often include a preoccupation with weight, food, calories, fat grams, dieting, and exercise,2 including:

• Refusing to eat certain foods (restriction against categories of food like no carbs, no sugar, no dairy)
• Frequent comments about feeling “fat” or overweight
• Denial about feeling hungry
• Fear of eating around others
• Binge eating
• Purging behaviors (frequent trips to the bathroom after meals, signs and/or smells of vomiting, wrappers or packages of laxatives or diuretics)
• Food rituals (such as excessive chewing or not allowing foods to touch)
• Skipping meals or eating small portions at regular meals
• Stealing or hoarding food
• Drinking excessive amounts of water (or non-caloric beverages)
• Using excessive amounts of mouthwash, mints, and gum 
• Hiding body with baggy clothes 
• Exercising excessively (despite weather, fatigue, illness, or injury) 

The emotional symptoms of OSFED can include:

• Low self-esteem
• Depression
• Strong need for approval
• Anxiety
• Little motivation to engage in relationships or activities
• Easily irritated
• Extremely self-critical

The physical symptoms of OSFED include:

• Noticeable fluctuations in weight
• Gastrointestinal symptoms (such as stomach cramps, constipation, and acid reflux)
• Menstrual irregularities and amenorrhea (missing periods)
• Difficulty concentrating
• Anemia
• Low thyroid and hormone levels
• Low potassium
• Low blood cell counts
• Slow heart rate
• Dizziness
• Fainting/syncope
• Feeling cold all the time
• Sleep troubles
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dental problems (such as discolored teeth, enamel erosion, cavities, and tooth sensitivity)
• Dry skin
• Dry and brittle nails
• Swelling around area of salivary glands
• Fine hair on body
• Thinning of hair or dry and brittle hair
• Muscle weakness
• Yellow skin (from eating large quantities of carrots)
• Cold, mottled hands and feet
• Swelling of feet
• Poor wound healing
• Impaired immune system

Causes

OSFED is a complex illness and, while we don’t know the exact cause, genetics and environmental factors both appear to play a role. When it comes to eating disorders, it’s often said that “genes load the gun, but environment pulls the trigger.”

In other words, in those who are genetically vulnerable, certain situations and events contribute to or trigger the development of an eating disorder.

Environmental factors include:

• Dieting
• Weight stigma
• Bullying
• Abuse
• Illness
• Puberty
• Stress
• Life transitions
• Media influence

One problem with psychiatric diagnoses, in general, is that many patients do not fit neatly into the typical diagnostic categories. It’s not always clear-cut. Sometimes people meet most but not all of the criteria for a diagnosis.

In the case of eating disorders, a person who does not qualify for a specific eating disorder diagnosis would be classified as OSFED. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) includes five examples of patients who would be classified as OSFED: