Misidentification of Eating Disorders: Why They’re Overlooked & How to Improve Recognition

Understanding the Barriers to Diagnosis and How We Can Do Better

Eating disorders are complex, life-threatening illnesses that affect people of all ages, genders, races, body sizes, and socioeconomic backgrounds. Yet despite increasing awareness, many individuals with eating disorders go undiagnosed, misdiagnosed, or are not taken seriously until symptoms become severe.

Early detection is one of the most important factors in a successful recovery—so why are eating disorders still so often misidentified or overlooked?

In this post, we explore the reasons behind misidentification, the populations most affected, and what clinicians, families, and communities can do to improve recognition and response.

Why Eating Disorders Are Misidentified

1. Stereotypes About Who Gets Eating Disorders

One of the most pervasive myths is that eating disorders primarily affect:

• Thin

• White

• Teenage

• Female

• Affluent individuals

This outdated stereotype causes implicit bias among healthcare providers, educators, and even within families. As a result, individuals who don't fit the mold—such as boys, people of color, those in larger bodies, older adults, and LGBTQ+ individuals—are more likely to be ignored, dismissed, or misdiagnosed.

Research Insight:
Becker et al. (2003) found that clinicians were less likely to diagnose an eating disorder in patients who were not underweight or were from marginalized backgrounds, even when presenting with identical symptoms.

2. Focus on Weight Instead of Behaviors

Many providers and caregivers use weight as a primary indicator of whether someone has an eating disorder. However:

• Individuals with bulimia nervosa, binge eating disorder, or atypical anorexia nervosa may have serious symptoms while maintaining a “normal” or higher weight.

• Up to 40% of individuals with anorexia are not underweight, a subtype classified as atypical anorexia (Thomas et al., 2016).

• Weight restoration or gain can lead to the false assumption that someone is “better,” even if disordered behaviors and thoughts persist.

This reliance on physical appearance contributes to underdiagnosis and reinforces weight stigma in healthcare.

3. Medicalization of Symptoms Without Addressing Root Causes

Eating disorders often manifest in physical symptoms, such as:

• Gastrointestinal distress

• Dizziness and fainting

• Amenorrhea (loss of menstruation)

• Hair loss or brittle nails

• Dental erosion (in purging disorders)

These symptoms are frequently treated in isolation, without screening for underlying disordered eating. This “siloed” approach can delay diagnosis by months or even years.

Example:
A teen presenting with chronic constipation and fatigue may receive supplements or laxatives, while no one inquires about food intake or exercise behaviors.

4. Misdiagnosis as Other Mental Health Conditions

Because eating disorders often co-occur with other mental health issues—such as depression, anxiety, OCD, or trauma disorders—they are sometimes:

• Misdiagnosed as a primary mood or anxiety disorder, while the disordered eating is overlooked

• Masked by co-occurring symptoms, such as avoidance, perfectionism, or social withdrawal

Without a full psychosocial and behavioral assessment, these signs may be attributed to other diagnoses, leaving the eating disorder untreated and entrenched.

5. Minimization by the Individual or Family

Many individuals do not recognize their behaviors as harmful. Others may:

• Normalize restriction or dieting as “healthy”

• View compulsive exercise as “self-care” or “discipline”

• Hide or deny symptoms due to shame or fear of judgment

Families may also unintentionally minimize or justify behaviors, particularly if disordered eating is prevalent in the household or reinforced by cultural messages.

Populations Most Likely to Be Overlooked

• People in larger bodies (often told to lose weight or praised for restriction)

• Males (eating disorders are underrecognized and underreported in boys and men)

• People of color (less likely to be screened, more likely to be misdiagnosed)

• LGBTQ+ youth (especially transgender and nonbinary individuals)

• Young children (symptoms may be misattributed to "picky eating" or behavioral issues)

• Older adults (assumed to be too old to develop eating disorders)

Improving Recognition and Response

1. Broaden the Diagnostic Lens

• Screen for all eating disorder behaviors, not just those associated with weight loss

• Use tools like the SCOFF Questionnaire, EDE-Q, or ESP in routine care

• Be mindful of non-traditional presentations, such as excessive exercise, “clean” eating, or chronic dieting

2. Provide Weight-Inclusive Care

• Don’t assume health based on weight

• Avoid congratulating weight loss

• Understand that disordered behaviors can occur at any size, and eating disorders are not always visible

Clinical Tip: Always ask about food rules, body image concerns, and compensatory behaviors—regardless of BMI.

3. Educate Providers and Families

• Offer training in eating disorder recognition, especially for pediatricians, primary care physicians, school counselors, and coaches

• Emphasize that early intervention saves lives

• Encourage families to seek second opinions if concerns are dismissed

4. Use Inclusive Language and Imagery

• Promote eating disorder awareness campaigns that reflect diverse bodies and identities

• Use gender-neutral, non-stigmatizing language

• Avoid pathologizing food behaviors without context

5. Listen to the Individual’s Experience

• Validate distress, even when physical symptoms don’t “match” stereotypes

• Ask open-ended, curiosity-driven questions

• Trust the insight of caregivers, especially with children and teens

Final Thought

Eating disorders are among the most misdiagnosed and underdiagnosed mental health conditions—and the consequences of delayed treatment can be profound. But with increased awareness, inclusive screening, and a shift away from weight-based assumptions, we can improve early recognition and access to care.

No one should have to “look sick enough” to be believed.
No one should be denied care because they don't fit a stereotype.
And no one should suffer in silence because their pain went unseen.

We can do better—by listening more closely, screening more widely, and holding space for every story, in every body.

References

• Becker, A. E., Thomas, J. J., Franko, D. L., & Herzog, D. B. (2003). Disclosure patterns of eating and weight concerns to clinicians, educational professionals, family, and peers. International Journal of Eating Disorders, 34(1), 95–103.

• Thomas, J. J., Roberto, C. A., & Brownell, K. D. (2016). Anorexia nervosa and atypical anorexia nervosa: A comparison of restrictive eating disorders in DSM-5 and DSM-IV. Eating Disorders, 22(3), 195–205.

• Tylka, T. L., & Calogero, R. M. (2019). Applying a social justice framework to eating disorders. Journal of Counseling Psychology, 66(2), 169–183.

• Puhl, R. M., & Suh, Y. (2015). Health consequences of weight stigma: Implications for obesity prevention and treatment. Current Obesity Reports, 4(2), 182–190.

• Nagata, J. M., et al. (2020). Disordered eating and body dissatisfaction among transgender and gender nonbinary adolescents and young adults. International Journal of Eating Disorders, 53(6), 842–851.