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Eating disorders, the most lethal of all the psychiatric disorders, are frequently misdiagnosed as benign weight management problems, which contribute to their being underdiagnosed and under-reported. Though eating disorders are typically first identified through easily discernible weight change, their unseen origins lie in genetic propensities, neurobiology, environmental and family influences, inborn temperament, and trauma. Non-integrative, behaviorally based weight management solutions that call for dieting and meal plans alone, by ignoring the psychological underpinnings and neurobiological origins of dysfunctions driving these disorders, can potentially lead to loss of life and/or life quality. Conversely, generic psychotherapy protocols typically fail to address and enforce the behavioral prerequisite to re-feed the malnourished eating disordered brain and body, which is required to optimize therapy outcomes. It is for the intuitive and skillful diagnostician to determine whether the patient’s desire for weight change is based on healthful autonomous discretion or on the dictates of compulsions based in lifethreatening pathology, thus informing treatment. Eating disorders are disorders of the core Self of self-regulation, self-perception, self-esteem and self-care, affecting life spheres far exceeding eating-lifestyle and weight management. Healing weight management problems requires integrative diagnosis and care, re-establishing one’s healthy relationship with food, weight, and eating, as well as with one’s re-integrated core self.

Discretion or Disorder? The Impact of Weight Management Issues on the Diagnosis and Treatment of Disordered Eating and Clinical Eating Disorders