Rethinking the Eating Disorder Continuum: A Categorical Approach to Abnormal Eating

In this chapter we address the importance of considering independently, the contributions of psychological and behavioral symptoms of eating disorders when examining the continuum of eating disorders. Rather than eating disorders being continuous or discontinuous, we propose that the clinical behaviors of eating disorders are categorical (I vomit after eating) while the cognitive/psychological symptoms are continuous (I am terrified of being fat). We relate three areas of research to support this view: (1) psychological symptoms poorly discriminate between non-clinical and clinical groups but behaviors are excellent markers; (2) empirical studies of the latent factor structure of eating disorders show dimensional models when using psychological indicators but categorical models when using behavioral indicators; (3) psychological symptoms poorly discriminate between recovered and non-recovered patients and it is the cessation of behavioral symptoms which most often defines recovery. We conclude by discussing the theoretical, measurement and population screening implications of a categorical model of abnormal eating behaviors.