Emotional eating is defined as overeating in order to relieve negative emotions. Thus, emotional eating is considered a maladaptive coping strategy. If an individual frequently engages in emotional eating, it can increase the risk of developing other eating disorders, like bulimia and anorexia nervosa. Research has also shown that the presence of an existing eating disorder increases the likelihood that an individual will engage in emotional eating. Given the relationship between serious eating disorders and emotional eating behavior, it is important for clinical psychologists and nutritionists to recognize the signs of emotional eating and provide individuals with treatment. Since emotional eating is utilized to manage negative emotions, treatment necessitates learning healthy and more effective coping strategies.

Disordered eating describes a variety of abnormal eating behaviors that, by themselves, do not warrant diagnosis of an eating disorder.

Disordered eating includes behaviors that are common features of eating disorders, such as:

- Chronic restrained eating.

- Compulsive eating.

- Binge eating, with associated loss of control.

- Self-induced vomiting.

Disordered eating also includes behaviors that are not characteristic of any eating disorder, such as:

- Irregular, chaotic eating patterns.

- Ignoring physical feelings of hunger and satiety (fullness).

- Use of diet pills.

- Emotional eating.

- Night eating.

- "Secretive food concocting": the consumption of embarrassing food combinations, such as mashed potatoes mixed with sandwich cookies. See also Food craving § Pregnancy and Nocturnal sleep-related eating disorder § Symptoms and behaviors.

The five OSFED examples that can be considered eating disorders include atypical AN, BN (of low frequency and/or limited duration), BED (of low frequency and/or limited duration), purging disorder, and NES. Of note, OSFED is not limited to these five examples, and can include individuals with heterogeneous eating disorder presentations (i.e., OSFED-other). Another term, Unspecified Feeding or Eating Disorder (UFED), is used to describe individuals for whom full diagnostic criteria are not met but the reason remains unspecified or the clinician does not have adequate information to make a more definitive diagnosis.

- Atypical Anorexia Nervosa: In atypical AN, individuals meet all of the criteria for AN, with the exception of the weight criterion: the individual's weight remains within or above the normal range, despite significant weight loss.

- Atypical Bulimia Nervosa: In this sub-threshold version of BN, individuals meet all criteria for BN, with the exception of the frequency criterion: binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for fewer than 3 months.

- Binge-eating disorder (of low frequency and/or limited duration): In this sub-threshold version of BED, individuals must meet all criteria for BED, with the exception of the frequency criterion: binge eating occurs, on average, less than once a week and/or for fewer than 3 months.

- Purging Disorder: In purging disorder, purging behavior aimed to influence weight or shape is present, but in the absence of binge eating.

- Night Eating Syndrome: In NES, individuals have recurrent episodes of eating at night, such as eating after awakening from sleep or excess calorie intake after the evening meal. This eating behavior is not culturally acceptable by group norms, such as the occasional late-night munchies after a gathering. NES includes an awareness and recall of the eating, is not better explained by external influences such as changes in the individual's sleep-wake cycle, and causes significant distress and/or impairment of functioning. Though not defined specifically in "DSM-5", research criteria for this diagnosis proposed adding the following criteria (1) the consumption of at least 25% of daily caloric intake after the evening meal and/or (2) evening awakenings with ingestions at least twice per week.

Binge eating is the core symptom of BED; however, not everyone who binge eats has BED. An individual may occasionally binge eat without experiencing many of the negative physical, psychological, or social effects of BED. This example may be considered an eating problem (or not), rather than a disorder. Precisely defining binge eating can be problematic, however binge eating episodes in BED are generally described as having the following potential features:

- Eating much faster than normal during a binge perhaps in a short space of time

- Eating until feeling uncomfortably full

- Eating a large amount when not hungry

- Subjective loss of control over how much or what is eaten

- Binges may be planned in advance, involving the purchase of special binge foods, and the allocation of specific time for binging, sometimes at night

- Eating alone or secretly due to embarrassment over the amount of food consumed

- There may be a dazed mental state during the binge

- Not being able to remember what was eaten after the binge

- Feelings of guilt, shame or disgust following a food binge

In contrast to bulimia nervosa, binge eating episodes are not regularly followed by activities intended to prevent weight gain, such as self-induced vomiting, laxative or enema misuse, or strenuous exercise. BED is characterized more by overeating than dietary restriction and over concern about body shape. Obesity is common in persons with BED, as are depressive features, low self-esteem, stress and boredom.

There are multiple medical conditions which may be misdiagnosed as a primary psychiatric disorder, complicating or delaying treatment. These may have a synergistic effect on conditions which mimic an eating disorder or on a properly diagnosed eating disorder.

- Lyme disease which is known as the "great imitator", as it may present as a variety of psychiatric or neurological disorders including anorexia nervosa.

- Gastrointestinal diseases, such as celiac disease, Crohn's disease, peptic ulcer, eosinophilic esophagitis or non-celiac gluten sensitivity, among others. Celiac disease is also known as the "great imitator", because it may involve several organs and cause an extensive variety of non-gastrointestinal symptoms, such as psychiatric and neurological disorders, including anorexia nervosa.

- Addison's Disease is a disorder of the adrenal cortex which results in decreased hormonal production. Addison's disease, even in subclinical form may mimic many of the symptoms of anorexia nervosa.

- Gastric adenocarcinoma is one of the most common forms of cancer in the world. Complications due to this condition have been misdiagnosed as an eating disorder.

- Hypothyroidism, hyperthyroidism, hypoparathyroidism and hyperparathyroidism may mimic some of the symptoms of, can occur concurrently with, be masked by or exacerbate an eating disorder.

- Toxoplasma seropositivity: even in the absence of symptomatic toxoplasmosis, toxoplasma gondii exposure has been linked to changes in human behavior and psychiatric disorders including those comorbid with eating disorders such as depression. In reported case studies the response to antidepressant treatment improved only after adequate treatment for toxoplasma.

- Neurosyphilis: It is estimated that there may be up to one million cases of untreated syphilis in the US alone. "The disease can present with psychiatric symptoms alone, psychiatric symptoms that can mimic any other psychiatric illness". Many of the manifestations may appear atypical. Up to 1.3% of short term psychiatric admissions may be attributable to neurosyphilis, with a much higher rate in the general psychiatric population. (Ritchie, M Perdigao J,)

- Dysautonomia: a wide variety of autonomic nervous system (ANS) disorders may cause a wide variety of psychiatric symptoms including anxiety, panic attacks and depression. Dysautonomia usually involves failure of sympathetic or parasympathetic components of the ANS system but may also include excessive ANS activity. Dysautonomia can occur in conditions such as diabetes and alcoholism.

Psychological disorders which may be confused with an eating disorder, or be co-morbid with one:

- Emetophobia is an anxiety disorder characterized by an intense fear of vomiting. A person so afflicted may develop rigorous standards of food hygiene, such as not touching food with their hands. They may become socially withdrawn to avoid situations which in their perception may make them vomit. Many who suffer from emetophobia are diagnosed with anorexia or self-starvation. In severe cases of emetophobia they may drastically reduce their food intake.

- Phagophobia is an anxiety disorder characterized by a fear of eating, it is usually initiated by an adverse experience while eating such as choking or vomiting. Persons with this disorder may present with complaints of pain while swallowing.

- Body dysmorphic disorder (BDD) is listed as a somatoform disorder that affects up to 2% of the population. BDD is characterized by excessive rumination over an actual or perceived physical flaw. BDD has been diagnosed equally among men and women. While BDD has been misdiagnosed as anorexia nervosa, it also occurs comorbidly in 39% of eating disorder cases. BDD is a chronic and debilitating condition which may lead to social isolation, major depression and suicidal ideation and attempts. Neuroimaging studies to measure response to facial recognition have shown activity predominately in the left hemisphere in the left lateral prefrontal cortex, lateral temporal lobe and left parietal lobe showing hemispheric imbalance in information processing. There is a reported case of the development of BDD in a 21-year-old male following an inflammatory brain process. Neuroimaging showed the presence of a new atrophy in the frontotemporal region.

The fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) renamed "Feeding Disorder of Infancy or Early Childhood" to Avoidant/Restrictive Food Intake Disorder, and broadened the diagnostic criteria. Previously defined as a disorder exclusive to children and adolescents, the DSM-5 broadened the disorder to include adults who limit their eating and are affected by related physiological or psychological problems, but who do not fall under the definition of another eating disorder.

The DSM-5 defines the following diagnostic criteria:

- Disturbance in eating or feeding, as evidenced by one or more of:

- Substantial weight loss (or, in children, absence of expected weight gain)

- Nutritional deficiency

- Dependence on a feeding tube or dietary supplements

- Significant psychosocial interference

- Disturbance not due to unavailability of food, or to observation of cultural norms

- Disturbance not due to anorexia nervosa or bulimia nervosa, and no evidence of disturbance in experience of body shape or weight

- Disturbance not better explained by another medical condition or mental disorder, or when occurring concurrently with another condition, the disturbance exceeds what is normally caused by that condition

In previous years, the DSM was not inclusive in recognizing all of the challenges associated with feeding and eating disorders in 3 main domains:

- Eating Disorders Not Otherwise Specified (EDNOS) was an all-inclusive, placeholder group for all individuals that presented challenges with feeding

- The category of Feeding Disorder of Infancy/ Early Childhood was noted to be too broad, limiting specification when treating these behaviors

- There are children and youth who present feeding challenges but do not fit within any existing categories to date

Children are often picky eaters, this does not necessarily mean they meet the criteria for an ARFID diagnosis. In addition, self-identification as having ARFID may contribute to ARFID.

Symptoms and complications vary according to the nature and severity of the eating disorder:

Some physical symptoms of eating disorders are weakness, fatigue, sensitivity to cold, reduced beard growth in men, reduction in waking erections, reduced libido, weight loss and failure of growth. Unexplained hoarseness may be a symptom of an underlying eating disorder, as the result of acid reflux, or entry of acidic gastric material into the laryngoesophageal tract. Patients who induce vomiting, such as those with anorexia nervosa, binge eating-purging type or those with purging-type bulimia nervosa are at risk for acid reflux. Polycystic ovary syndrome (PCOS) is the most common endocrine disorder to affect women. Though often associated with obesity it can occur in normal weight individuals. PCOS has been associated with binge eating and bulimic behavior. Other possible manifestations are dry lips, burning tongue, parotid gland swelling, and temporomandibular disorders.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without subsequent purging episodes (e.g. vomiting).

BED is a recently described condition, which was required to distinguish binge eating similar to that seen bulimia nervosa but without characteristic purging. Individuals who are diagnosed with bulimia nervosa and binge eating disorder exhibit similar patterns of compulsive overeating, neurobiological features of dysfunctional cognitive control and food addiction, and biological and environmental risk factors. Indeed, some consider BED a milder version of bulimia nervosa, and that the conditions are on the same spectrum.

Binge eating is one of the most prevalent eating disorders among adults, though there tends to be less media coverage and research about the disorder in comparison to anorexia nervosa and bulimia nervosa.

Sufferers of ARFID have an inability to eat certain foods. "Safe" foods may be limited to certain food types and even specific brands. In some cases, afflicted individuals will exclude whole food groups, such as fruits or vegetables. Sometimes excluded foods can be refused based on color. Some may only like very hot or very cold foods, very crunchy or hard-to-chew foods, or very soft foods, or avoid sauces.

Most sufferers of ARFID will still maintain a healthy or normal body weight. There are no specific outward appearances associated with ARFID. Sufferers can experience physical gastrointestinal reactions to adverse foods such as retching, vomiting or gagging. Some studies have identified symptoms of social avoidance due to their eating habits. Most, however, would change their eating habits if they could.

The three general categories for an EDNOS diagnosis are subthreshold symptoms of anorexia or bulimia, a mixture of both anorexia or bulimia, and eating behaviors that are not particularized by anorexia and bulimia. EDNOS is no longer considered a diagnosis in "DSM-5"; those displaying symptoms of what would previously have been considered EDNOS are now classified under Other Specified Feeding or Eating Disorder.

Other specified feeding or eating disorder or OSFED is the "DSM-5" category that replaces the category formerly called Eating Disorder Not Otherwise Specified (EDNOS) in "DSM-IV", and that captures feeding disorders and eating disorders of clinical severity that do not meet diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), pica, or rumination disorder. OSFED includes five examples: atypical AN, BN (of low frequency and/or limited duration), BED (of low frequency and/or limited duration), purging disorder, and night eating syndrome (NES).

Eating disorder not otherwise specified (EDNOS) is an eating disorder that does not meet the criteria for: anorexia nervosa, bulimia nervosa, or binge eating. Individuals with EDNOS usually fall into one of three groups: sub-threshold symptoms of anorexia or bulimia, mixed features of both disorders, or extremely atypical eating behaviors that are not characterized by either of the other established disorders.

People with EDNOS have similar symptoms and behaviors to those with anorexia and bulimia, and can face the same dangerous risks.

EDNOS is the most prevalent eating disorder; about 60% of adults treated for eating disorders are diagnosed with EDNOS. EDNOS occurs in both sexes.

Bulimia typically involves rapid and out-of-control eating, which may stop when the bulimic is interrupted by another person or the stomach hurts from over-extension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in more serious cases, several times a day and may directly cause:

- Chronic gastric reflux after eating, secondary to vomiting

- Dehydration and hypokalemia due to renal potassium loss in the presence of alkalosis and frequent vomiting

- Electrolyte imbalance, which can lead to abnormal heart rhythms, cardiac arrest, and even death

- Esophagitis, or inflammation of the esophagus

- Mallory-Weiss tears

- Boerhaave syndrome, a rupture in the esophageal wall due to vomiting

- Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat

- Russell's sign: calluses on knuckles and back of hands due to repeated trauma from incisors

- Perimolysis, or severe dental erosion of tooth enamel

- Swollen salivary glands (for example, in the neck, under the jaw line)

- Gastroparesis or delayed emptying

- Constipation

- Peptic ulcers

- Infertility

- Constant weight fluctuations are common

These are some of the many signs that may indicate whether someone has bulimia nervosa:

- A fixation on the number of calories consumed

- A fixation on and extreme consciousness of ones weight

- Low self-esteem and/or self harming

- Suicidal tendencies

- Low blood pressure

- An irregular menstrual cycle in woman

- Regular trips to the bathroom, especially soon after eating

- Depression, anxiety disorders and sleep disorders

- Frequent occurrences involving consumption of abnormally large portions of food

- The use of laxatives and diet pills

- Unhealthy/dry skin, hair, nails and lips

- A lack of energy

As with many psychiatric illnesses, delusions can occur, in conjunction with other signs and symptoms, leaving the person with a false belief that is not ordinarily accepted by others.

People with bulimia nervosa may also exercise to a point that excludes other activities.

Bulimia nervosa can be difficult to detect, compared to anorexia nervosa, because bulimics tend to be of average or slightly above or below average weight. Many bulimics may also engage in significantly disordered eating and exercise patterns without meeting the full diagnostic criteria for bulimia nervosa. Recently, the "Diagnostic and Statistical Manual of Mental Disorders" was revised, which resulted in the loosening of criteria regarding the diagnoses of bulimia nervosa and anorexia nervosa. The diagnostic criteria utilized by the DSM-5 includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight. The diagnosis also requires the episodes of compensatory behaviors and binge eating to happen a minimum of once a week for a consistent time period of 3 months. The diagnosis is made only when the behavior is not a part of the symptom complex of anorexia nervosa and when the behavior reflects an overemphasis on physical mass or appearance. Purging often is a common characteristic of a more severe case of bulimia nervosa.

Typically the eating is done rapidly and a person will feel emotionally numb and unable to stop eating.

Most people who have eating binges try to hide this behavior from others, and often feel ashamed about being overweight or depressed about their overeating. Although people who do not have any eating disorder may occasionally experience episodes of overeating, frequent binge eating is often a symptom of an eating disorder.

Binge-eating disorder, as the name implies, is characterized by uncontrollable, excessive eating, followed by feelings of shame and guilt. Unlike those with bulimia, those with binge-eating disorder symptoms typically do not purge their food, fast, or excessively exercise to compensate for binges. Additionally, these individuals tend to diet more often, enroll in weight-control programs and have a history of family obesity. However, many who have bulimia also have binge-eating disorder.

→Swollen of salivary glands lead to the change of facial shape

→If gastric juice is flown to the esophagus constantly, it will lead to a corrosion of the wall of esophagus(long term harmful effect)

→If gastric juice is flown to the oral cavity, it will lead to a corrosion of the oral tissue, dissolve the enamel and consequently cause the loss of teeth/increase chances for tooth decay

Emotional dysregulation in children can be associated with externalizing behaviors including

- exhibiting more extreme emotions

- difficulty identifying emotional cues

- difficulty recognizing their own emotions

- focusing on the negative

- difficulty controlling their attention

- being impulsive

- difficulty decreasing their negative emotions

- difficulty calming down when upset

A Food addiction, especially long-term, can result in negative consequences to all aspects of a person’s life, creating damaging and chronic symptoms.

A food addiction features compulsive overeating, such as binge eating behavior, as its core and only defining feature. There are several potential signs that a person may be suffering from compulsive overeating. Common behaviors of compulsive overeaters include eating alone, consuming food quickly, and gaining weight rapidly, and eating to the point of feeling sick to the stomach. Other signs include significantly decreased mobility and the withdrawal from activities due to weight gain. Emotional indicators can include feelings of guilt, a sense of loss of control, depression and mood swings.

Hiding consumption is an emotional indicator of other symptoms that could be a result of having a food addiction. Hiding consumption of food includes eating in secret; late at night while everybody else is asleep, in the car, and hiding certain foods until ready to consume in private. Other signs of hiding consumption are avoiding social interactions to eat the specific foods that are craved. Other emotional indicators are Inner guilt; which includes making up excuses to why the palatable food would be beneficial to consume, and then feeling guilty about it shortly after consuming.

Sense of loss of control is indicated in many ways which includes, going out of the way to obtain specific foods, spending unnecessary amounts of money on foods to satisfy cravings. Difficulty concentrating on things such as a job or career can indicate sense of loss of control by not being to organize thoughts leading to a decrease in efficiency. Other ways to indicate the sense of loss of control, are craving food despite being full. One may set rules to try to eat healthy but the cravings over rule and the rules are failed to be followed. One big indicator of loss of control due to food addiction is even though one knows they have a medical problem caused by the craved foods, they cannot stop consuming the foods, which can be detrimental to their health.

Food addiction has some physical signs and symptoms. Decreased energy; not being able to be as active as in the past, not being able to be as active as others around, also a decrease in efficiency due to the lack of energy. Having trouble sleeping; being tired all the time such as fatigue, oversleeping, or the complete opposite and not being able to sleep such as insomnia. Other physical signs and symptoms are restlessness, irritability, digestive disorders, and headaches.

In extreme cases food addiction can result in some suicidal thoughts.

Emotional dysregulation in children can be associated with internalizing behaviors including

- exhibiting emotions too intense for a situation

- difficulty calming down when upset

- difficulty decreasing negative emotions

- being less able to calm themselves

- difficulty understanding emotional experiences

- becoming avoidant or aggressive when dealing with negative emotions

- experiencing more negative emotions

Emotional eating is a form of disordered eating and is defined as "an increase in food intake in response to negative emotions" and can be considered a maladaptive strategy used to cope with difficult feelings. More specifically, emotional eating would qualify as a form of emotion-focused coping, which attempts to minimize, regulate and prevent emotional distress. Interestingly, a study conducted by Bennett et al. found that emotional eating sometimes does not reduce emotional distress but instead enhances emotional distress by sparking feelings of intense guilt after an emotional eating session. Not only is emotional eating a poor way to cope, but those individuals who frequently utilize emotional eating to cope with social or psychological stressors are at an increased risk of developing eating disorders. Emotional eaters are at an especially high risk of developing binge-eating disorder. 2.8% of Americans struggle with binge-eating disorder, which increases their risk of developing cardiovascular disease and high blood pressure. At the same time, the presence of other eating disorders increases the risk of an individual engaging in emotional eating. In a clinical setting, emotional eating disorders can be diagnosed by the Dutch Eating Behavior Questionnaire which contains a scale for restrained, emotional and external eating. While therapists may use positive psychology as a way to reduce the negative emotions that trigger emotional eating, reappraisal is often a complementary treatment with the primary treatment being focused on developing alternative coping strategies.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is sometimes a symptom of binge eating disorder or compulsive overeating disorder. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control.

Whereas vanity involves a quest to aggrandize the appearance, BDD is experienced as a quest to merely normalize the appearance. Although delusional in about one of three cases, the appearance concern is usually nondelusional, an overvalued idea.

The bodily area of focus can be nearly any, yet is commonly face, hair, stomach, thighs, or hips. Some half dozen areas can be a roughly simultaneous focus. Many seek dermatological treatment or cosmetic surgery, which typically do not resolve the distress. On the other hand, attempts at self-treatment, as by skin picking, can create lesions where none previously existed.

BDD shares features with obsessive-compulsive disorder, but involves more depression and social avoidance. BDD often associates with social anxiety disorder. Some experience delusions that others are covertly pointing out their flaws. Cognitive testing and neuroimaging suggest both a bias toward detailed visual analysis and a tendency toward emotional hyperarousal.

Most generally, one experiencing BDD ruminates over the perceived bodily defect up to several hours daily, uses either social avoidance or camouflaging with cosmetics or apparel, repetitively checks the appearance, compares it to that of other persons, and might often seek verbal reassurances. One might sometimes avoid mirrors, repetitively change outfits, groom excessively, or restrict eating.

BDD's severity can wax and wane, and flareups tend to yield absences from school, work, or socializing, sometimes leading to protracted social isolation, with some becoming housebound for extended periods. Social impairment is usually greatest, sometimes approaching avoidance of all social activities. Poor concentration and motivation impair academic and occupational performance. The distress of BDD tends to exceed that of either major depressive disorder or type-2 diabetes, and rates of suicidal ideation and attempts are especially high.

Eighty percent of self-harm involves stabbing or cutting the skin with a sharp object. However, the number of self-harm methods are only limited by an individual's inventiveness and their determination to harm themselves; this includes burning, self-poisoning, alcohol abuse, self-embedding of objects, hair pulling, bruising/hitting one's self, scratching to hurt one's self, knowingly abusing over the counter or prescription drugs, and forms of self-harm related to anorexia and bulimia. The locations of self-harm are often areas of the body that are easily hidden and concealed from the detection of others. As well as defining self-harm in terms of the act of damaging the body, it may be more accurate to define self-harm in terms of the intent, and the emotional distress that the person is attempting to deal with. Neither the DSM-IV-TR nor the ICD-10 provide diagnostic criteria for self-harm. It is often seen as only a symptom of an underlying disorder, though many people who self-harm would like this to be addressed.

Common signs that a person may be engaging in self harm include the following: they ensure that are always harmful objects close by, they are experiencing difficulties in their personal relationships, their behaviour becomes unpredictable, they question their worth and identity, they make statements that display helplessness and hopelessness.

Self-harm (SH), also referred to as "self-injury" (SI), "self-inflicted violence" (SIV), "nonsuicidal self injury" (NSSI) or "self-injurious behaviour" (SIB), refers to a spectrum of behaviours where demonstrable injury is self-inflicted. The behaviour involves deliberate tissue damage that is usually performed without suicidal intent. The most common form of self-harm involves cutting of the skin using a sharp object, e. g. a knife or razor blade. The term "self-mutilation" is also sometimes used, although this phrase evokes connotations that some find worrisome, inaccurate, or offensive. "Self-inflicted wounds" is a specific term associated with soldiers to describe non-lethal injuries inflicted in order to obtain early dismissal from combat. This differs from the common definition of self-harm, as damage is inflicted for a specific secondary purpose. A broader definition of self-harm might also include those who inflict harm on their bodies by means of disordered eating.

Nonsuicidal self injury has been listed as a new disorder in the DSM-5 under the category "Conditions for Further Study". This disorder occurs when a person is deliberately harming themselves in a physical way without the intent of committing suicide. Self-harm without suicidal intent can be seen on a spectrum, just like many other disorders (substance abuse, gambling addiction). Just like these other disorders, once the self harming behaviours cross a certain threshold, it then becomes classified as a mental health disorder. Criteria for NSSI include five or more days of self-inflicted harm over the course of one year without suicidal intent, and the individual must have been motivated by seeking relief from a negative state, resolving an interpersonal difficulty, or achieving a positive state.

A common belief regarding self-harm is that it is an attention-seeking behaviour; however, in many cases, this is inaccurate. Many self-harmers are very self-conscious of their wounds and scars and feel guilty about their behaviour, leading them to go to great lengths to conceal their behaviour from others. They may offer alternative explanations for their injuries, or conceal their scars with clothing. Self-harm in such individuals may not be associated with suicidal or para-suicidal behaviour. People who self-harm are not usually seeking to end their own life; it has been suggested instead that they are using self-harm as a coping mechanism to relieve emotional pain or discomfort or as an attempt to communicate distress. Alternatively, interpretations based on the supposed lethality of a self-harm may not give clear indications as to its intent: life risking behaviour may have no suicidal intent, whilst seemingly superficial cuts may have been a suicide attempt.

Studies of individuals with developmental disabilities (such as intellectual disability) have shown self-harm being dependent on environmental factors such as obtaining attention or escape from demands. Some individuals may have dissociation harboring a desire to feel real or to fit into society's rules.

Estimates of prevalence and gender distribution have varied widely via discrepancies in diagnosis and reporting. In American psychiatry, BDD gained diagnostic criteria in the "DSM-IV", but clinicians' knowledge of it, especially among general practitioners, is constricted. Meanwhile, shame about having the bodily concern, and fear of the stigma of vanity, makes many hide even having the concern.

Via shared symptoms, BDD is commonly misdiagnosed as social-anxiety disorder, obsessive-compulsive disorder, major depressive disorder, or social phobia. Correct diagnosis can depend on specialized questioning and correlation with emotional distress or social dysfunction. Estimates place the Body Dysmorphic Disorder Questionnaire's sensitivity at 100% (0% false negatives) and specificity at 92.5% (7.5% false positives).