Most individuals try dieting once for a variety of reasons, such as out of medical necessity, in an effort to eat healthier, or trying to maintain a healthy weight. On the other hand, eating disorders are severe mental illnesses. They are not a simple lifestyle choice for an individual or a diet taken a little bit too far for a short period. All eating disorders are associated with a significant increase in physical complications and mortality. Some reports even claim the mortality rate for those suffering from an eating disorder is the highest among all psychiatric illnesses. Whatever the case may be, understanding at least the basics of all of the different types of eating disorders is the first step in identifying them and being in a better position to treat them or find support for loved ones afflicted with them.
Anorexia nervosa, or simply anorexia, is characterized by weight loss or a lack of healthy weight gain in growing children, and issues in an individual who are trying to maintain a healthy weight for their height, age, or stature, as well as a distorted body image. Patients with anorexia nervosa significantly restrict the calories and types of food they eat. Though anyone can be affected, anorexia most frequently first appears during adolescence and women are more at risk of developing it. While anorexia is associated with severe underweight individuals, someone with a larger body can still suffer from anorexia.
Emotional and behavioral symptoms include dramatic weight loss, dressing in layers or baggy clothing to hide the body, frequently commenting on feeling fat despite weight loss, refusing to say they are hungry, avoiding situations involving food, and having an intense preoccupation with weight, food, calories, and fat. Some physical symptoms are fainting or dizziness, always feeling cold, stomach cramps, acid reflux, anemia, irregularities in the menstrual cycle, enamel erosion, dry and brittle nails, fine hair on the body, thinning hair, yellow skin, and cold and mottled hands and feet.
Similar to anorexia, those with bulimia nervosa, also called bulimia, have an intense preoccupation with weight and weight gain. However, those with bulimia deal with this preoccupation by going through a cycle of binge eating followed by purging. This means a patient will eat an inordinate amount of food and then engage in behaviors such as self-induced vomiting or consuming laxatives to purge and prevent their body from absorbing the calories. They also tend to feel out of control during the binge eating episodes and cannot regulate what or how much they consume.
Behavioral symptoms include going to the bathroom right after eating, feeling uncomfortable eating in public, drinking an excessive amount of water, frequent diets, purchasing a lot of laxatives or diuretics for no other discernable reason, hiding body with baggy clothes, and chewing a lot of gum. Bulimia has some of the same physical symptoms as anorexia, such as dizziness or fainting, thinning hair, dry and brittle nails, and menstrual cycle irregularities. Those suffering from bulimia also have frequent and noticeable weight fluctuations, were their weight continually goes up and down. Dental issues such as enamel erosion and tooth sensitivity are also common in bulimia, especially when the individual purges using self-induced vomiting.
Binge Eating Disorder
Binge eating disorder (BED) is severe and life-threatening like other eating disorders and is characterized by repeated binge eating episodes often to the point of significant discomfort in a short space of time. Individuals with BED also experience a feeling of loss of control during the binge eating episode and feelings of shame or guilt afterward. However, unlike bulimia, BED does not include purging to compensate for binge eating. Though it is one of the newest eating disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), BED is reportedly the most common eating disorder in the United States.
Binge eating episodes associated with BED display three or more of these signs including eating much quicker than usual, eating until uncomfortably full, and eating significant amounts of food when not hungry. Other signs include eating alone due to embarrassment about the amount of food they are eating, and feelings of disgust, guilt, or depression after the episode. Apart from this, other symptoms include frequent diets, creating schedules to make time for binge eating, a significant concern with weight and shape, weight fluctuations, developing strict food rituals, and disruptions in regular eating behaviors. Patients may also experience stomach cramps, acid reflux, and constipation.
Unlike other eating disorders previously discussed, orthorexia is not formally recognized as an eating disorder in the DSM-5, although awareness is on the rise for this condition. Orthorexia, coined in 1998, means an obsession with healthful eating. Expressing mild concern with the nutritional content of the food consumed is not an issue. The issue with orthorexia is that the individual affected by it becomes so fixated or obsessed with healthy eating that they damage their well-being. Unfortunately, because there are no formal criteria to diagnose orthorexia, it is hard to get a handle on exactly what this condition is, such as an eating disorder on its own, a subcategory of an existing eating disorder, or a subtype of obsessive-compulsive disorder.
Symptoms of orthorexia include compulsively checking nutritional labels and ingredient lists on packaged foods, cutting out more and more food groups, significant distress when healthy foods are not available, and a significant and unusually high interest in the nutrition of the food others are eating. Individuals often obsessively follow health food and lifestyle blogs and cannot eat anything but a narrow selection of foods deemed healthy or 'safe.'
Avoidant Restrictive Food Intake Disorder
Avoidant restrictive food intake disorder (ARFID), previously referred to as selective eating disorder, is another new diagnosis in the DSM-5. Similar to anorexia, those with ARFID have significant limitations in the amount or types of food eaten. However, ARFID does not include a significant fear of becoming or being fat. Unlike picky eating, individuals with ARFID do not consume enough calories to grow and develop properly or maintain healthy and basic body function. Children with ARFID may experience stalls in weight gain and height growth. Adults typically lose weight.
Individuals with ARFID display many of the same physical symptoms as someone with anorexia, such as being underweight, irregular menstrual cycles, dizziness or fainting, poor wound healing, lowered immune system function, thinning hair, as well as cold and mottled hands and feet. Other physical symptoms include lethargy, abdominal pain, constipation, and vague, but consistent gastrointestinal issues such as feeling full around mealtimes. Psychological and behavioral symptoms of ARFID include a significant restriction in the amount and types of food eaten, a lack of interest in food, the range of food eaten becomes significantly narrower over time, and dressing in layers or baggy clothes for warmth or to hide dramatic weight loss.
Pica is an eating disorder in which the patient feels compelled to eat items most would not think of as edible and those that do not have significant nutritional value. The specific items eaten will vary based on availability and age, as well as from person to person. Typical choices include dirt, hair, paper, soap, pebbles, chalk, and paint.
The compulsion to eat these items typically occurs over an extended period, usually longer than one month. Furthermore, eating these items must not be supported by the individual’s culture, as some cultures support eating clay for medicinal purposes, and must be inappropriate for the individual’s development. For children under two years old, putting small objects in their mouths allows them to develop their senses and as such is a normal stage of their development, although care should be taken to prevent choking or ingestion. Thus, children under two should not be diagnosed with pica. It is also important to note pica could be the result of deficiencies in the individual's diet, such as iron-deficiency anemia. For the most part, pica patients are not averse to consuming actual food.
Rumination disorder is the eating disorder in which an individual will regularly regurgitate their food for a minimum period of one month. The individual may either re-swallow, re-chew, or just spit out the regurgitated food. Additionally, patients with rumination disorder seem to regurgitate their food without effort. They often do not appear disgusted, upset, or otherwise exhibit signs of distress or stress about this action. The regurgitation must not be the result of another medical condition, such as gastrointestinal distress, or appear with another eating disorder, such as bulimia nervosa.
Although these are the eating disorders with individual definitions, whether formally recognized in the DSM-5 or not, there are still cases in which an individual’s symptoms may not match what is needed for one of these disorders, but still causes significant distress or health concerns. Thus, it is important to recognize unhealthy eating habits like these and treat them appropriately.