Flying Under the Radar: Subthreshold Eating Disorders
At some point or another, most of us will develop an uneasy relationship with food. As your body goes through its normal changes, you might find yourself skipping meals, obsessing over calorie counts, or running to the gym after dessert. These behaviors might not raise alarms; they might even seem healthy.
But beneath the veneer of self-discipline and ritual, something deeper may be going on—something that clinicians call a subthreshold eating disorder.
Subthreshold, or subclinical, eating disorders are just what they sound like: patterns of disordered eating that don’t quite meet the criteria for a full diagnosis like anorexia nervosa, bulimia, or binge-eating. They exist in a gray zone—disguised as healthy, but not yet catastrophic. And for that reason, they’re easy to miss. Easy to normalize, especially in our diet culture that praises/demands the pursuit of thinness at all costs.
Yet these conditions can cause real suffering. A person might not purge (or binge) every day, but they might still live with intense guilt after eating. They might not starve themselves to dangerous weights, but they may restrict just enough to feel constantly hungry, anxious, or tired. Their lives are often shaped by an invisible, exhausting negotiation with food and body image.
Many people live in these in-between places. Adolescents, especially, seem to inhabit this psychological limbo. In one study, nearly 27% of teenage girls reported disordered eating behaviors that didn’t meet diagnostic criteria—but that were strongly linked to depression, low self-esteem, and even suicidal ideation. Boys, too, are affected, though they’re less likely to talk about it or seek help.
Why do subthreshold eating disorders fly under the radar? In part, it’s because they can masquerade as virtue. A teen who won’t eat carbs might be seen as health-conscious. An adult who “makes up” for meals with extra workouts might be praised for their discipline. The language of wellness often obscures the warning signs of a disorder. Yet subthreshold eating disorders can also cause medical complications.
Subthreshold starvation, compensatory exercise, purging every once in a while creates wear and tear on a body. In time, it puts the body in a below optimal medical place.
And there’s another reason: many people struggling with subthreshold symptoms don’t believe they’re “sick enough” to ask for help. They compare themselves to the most extreme stories—hospitalizations, feeding tubes, emaciated bodies—and decide their pain doesn’t count. That belief can delay treatment and, in some cases, lead to more entrenched disorders down the line, particularly during periods of stress or transition, such as adolescence, job transitions, divorce, pregnancy, or menopause. As an eating disorders specialist, I have had numerous conversations with clients who tell they are fine or not sick enough, thin enough, etc to have an eating disorder. I have been in social situations where people, who know I am an eating disorders specialist, tell me they know somebody with a mild eating disorder. I have to tell them that mild eating disorders are concerning.
But here’s the thing: you don’t need to be at death’s door to deserve care.
Early intervention matters. Therapy, support groups, and nutritional counseling can all help people change their relationship with food and their bodies. Even a single conversation—with a parent, a teacher, a doctor, a friend—can make a difference. It can break the silence and offer a way forward.
If we want to support people in our communities—and ourselves—we need to stop drawing such rigid lines between “disorder” and “not-a-disorder.” Mental health exists on a spectrum, and healing starts with recognition. We need to name the gray zones, sit with their complexity, and create space for compassion, not just diagnosis.
References
The hidden burden of eating disorders: an extension of estimates from the Global Burden of Disease Study 2019; Damian F Santomauro , Sarah Melen , Deborah Mitchison , Theo Vos, Harvey Whiteford, Alize J Ferrari ; Lancet Psychiatry; 2021
Full syndromal versus subthreshold anorexia nervosa, bulimia nervosa, and binge eating disorder: a multicenter study ; Scott J Crow, W Stewart Agras, Katherine Halmi, James E Mitchell, Helena C Kraemer; International Journal of Eating Disorders; 2002
DSM-5 eating disorders and other specified eating and feeding disorders: is there a meaningful differentiation?; A Kate Fairweather-Schmidt , Tracey D Wade; International Journal of Eating Disorders; 2014
Defining "significant weight loss" in atypical anorexia nervosa; K Jean Forney, Tiffany A Brown, Lauren A Holland-Carter, Grace A Kennedy, Pamela K Keel; International Journal of Eating Disorders; 2017
Weight Loss and Illness Severity in Adolescents With Atypical Anorexia Nervosa; Andrea K Garber, Jing Cheng, Erin C Accurso , Sally H Adams, Sara M Buckelew, Cynthia J Kapphahn , Anna Kreiter , Daniel Le Grange, Vanessa I Machen, Anna-Barbara Moscicki , Kristina Saffran , Allyson F Sy, Leslie Wilson, Neville H Golden ; Pediatrics ; 2019
Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature; Erin N Harrop, Janell L Mensinger , Megan Moore, Taryn Lindhorst; International Journal of Eating Disorders; 2021
Are diagnostic criteria for eating disorders markers of medical severity?; Rebecka Peebles, Kristina K Hardy, Jenny L Wilson, James D Lock; Pediatrics ; 2010
Subthreshold Eating Disorders: Diagnostic Issues, Natural Evolution and Treatment Implications; P. Monteleone, P. Cotrufo, M. Maj; European Psychiatry; 2020