What Are Eating Disorders?
Eating disorders are behavioural conditions characterised by severe and persistent disturbance in eating behaviours and associated distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological and social function.
They can effect people of any age, gender/gender identity, race and/or socio-economic standing.
Eating disorders can only be officially diagnosed by a medical doctor, psychologist or psychiatrist. If you suspect you, a loved one or client has an eating disorder, please take them to and/or encourage them to see their GP, psychologist or psychiatrist so they can get the appropriate support needed.
Below is some information on the 7 types of eating disorders.
Anorexia Nervosa
Anorexia nervosa is characterised by self-starvation and weight loss resulting in low weight for height and age. Anorexia has the highest mortality of any psychiatric diagnosis other than opioid use disorder and can be a very serious condition. Body mass index or BMI, a measure of weight for height, is typically under 18.5 in an adult individual with anorexia nervosa.
Dieting behaviour in anorexia nervosa is driven by an intense fear of gaining weight or becoming fat. Although some individuals with anorexia will say they want and are trying to gain weight, their behaviour is not consistent with this intent. For example, they may only eat small amounts of low-calorie foods and exercise excessively. Some persons with anorexia nervosa also intermittently binge eat and or purge by vomiting or laxative misuse.
There are two subtypes of anorexia nervosa:
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Restricting type, in which individuals lose weight primarily by dieting, fasting or excessively exercising.
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Binge-eating/purging type in which persons also engage in intermittent binge eating and/or purging behaviours.
Over time, some of the following symptoms may develop related to starvation or purging behaviours:
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Menstrual periods cease in menstruating individuals
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Dizziness or fainting from dehydration
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Brittle hair/nails
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Cold intolerance
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Fine hair covering the body
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Muscle weakness and wasting
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Heartburn and reflux (in those who vomit)
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Severe constipation, bloating and fullness after meals
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Stress fractures from compulsive exercise as well as bone loss resulting in osteopenia or osteoporosis (thinning of the bones)
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Depression, irritability, anxiety, poor concentration and fatigue
Serious medical complications can be life threatening and include heart rhythm abnormalities especially in those patients who vomit or use laxatives, kidney problems or seizures.
Bulimia Nervosa
Individuals with bulimia nervosa typically alternate dieting, or eating only low calorie “safe foods” with binge eating on “forbidden” high calorie foods.
Binge eating is defined as eating a large amount of food in a short period of time associated with a sense of loss of control over what, or how much one is eating. Binging behaviours are usually secretive and associated with feelings of shame or embarrassment. Binges may be very large and food is often consumed rapidly, beyond fullness to the point of nausea and discomfort.
Binges occur at least weekly and are typically followed by what are called "compensatory behaviors" to prevent weight gain. These can include fasting, vomiting, laxative misuse or compulsive exercise. As in anorexia nervosa, persons with bulimia nervosa are excessively preoccupied with thoughts of food, weight or shape which negatively affect, and disproportionately impact, their self-worth.
Individuals with bulimia nervosa can be slightly underweight, normal weight or in a larger body.
If they are significantly underweight however, they are considered to have anorexia nervosa binge-eating/purging type not bulimia nervosa.
Family members or friends may not know that a person has bulimia nervosa because they do not appear underweight and because their behaviours are hidden and may go unnoticed by those close to them.
Possible signs that someone may have bulimia nervosa include:
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Frequent trips to the bathroom right after meals
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Large amounts of food disappearing or unexplained empty wrappers and food containers
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Chronic sore throat
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Swelling of the salivary glands in the cheeks
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Dental decay resulting from erosion of tooth enamel by stomach acid
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Heartburn and gastroesophageal reflux
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Laxative or diet pill misuse
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Recurrent unexplained diarrhea
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Misuse of diuretics (water flushing pills)
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Feeling dizzy or fainting from excessive purging behaviours resulting in dehydration
Bulimia can lead to rare but potentially fatal complications including oesophageal tears, gastric rupture, and dangerous cardiac arrhythmias.
Medical monitoring in cases of severe bulimia nervosa is important to identify and treat any possible complications.
Binge Eating Disorder
As with bulimia nervosa, people with binge eating disorder have episodes of binge eating in which they consume large quantities of food in a brief period, experience a sense of loss of control over their eating and are distressed by the binge behaviour.
Unlike people with bulimia nervosa however, they do not regularly use compensatory behaviours to get rid of the food by inducing vomiting, fasting, exercising or laxative misuse. Binge eating disorder can lead to serious health complications, including obesity, diabetes, hypertension and cardiovascular diseases.
The diagnosis of binge eating disorder requires frequent binges (at least once a week for three months), associated with a sense of lack of control and with three or more of the following features:
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Eating more rapidly than normal.
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Eating until uncomfortably full.
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Eating large amounts of food when not feeling hungry.
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Eating alone because of feeling embarrassed by how much one is eating.
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Feeling disgusted with oneself, depressed or very guilty after a binge.
Other Specified Feeding and Eating Disorder (OSFED)
**Having this diagnosis does not mean that you any LESS sick than other diagnoses, it just means that your symptoms are a little different or you have not met the time threshold for another eating disorder diagnosis quite yet.**
This diagnostic category includes eating disorders or disturbances of eating behavior that cause distress and impair family, social or work function but do not fit the other categories listed here.
In some cases, this is because the frequency of the behavior does not meet the diagnostic threshold (e.g., the frequency of binges in bulimia or binge eating disorder) or the weight criteria for the diagnosis of anorexia nervosa are not met.
An example of other specified feeding and eating disorder is "atypical anorexia nervosa". This category includes individuals who may have lost a lot of weight and whose behaviors and preoccupation with weight or shape concerns and fear of fatness is consistent with anorexia nervosa, but who are not yet considered underweight based on their BMI.
Since speed of weight loss is related to medical complications, individuals with atypical anorexia nervosa who lose a lot of weight rapidly by engaging in extreme weight control behaviours can be at high risk of medical complications, despite appearing normal or above average weight.
Avoidant Restrictive Food Intake Disorder (ARFID)
ARFID involves a disturbance in eating resulting in persistent failure to meet nutritional needs and extreme picky eating.
In ARFID, food avoidance or a limited food repertoire can be due to one or more of the following:
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Low appetite and lack of interest in eating or food.
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Extreme food avoidance based on sensory characteristics of foods e.g. texture, appearance, color, smell.
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Anxiety or concern about consequences of eating, such as fear of choking, nausea, vomiting, constipation, an allergic reaction, etc. The disorder may develop in response to a significant negative event such as an episode of choking or food poisoning followed by the avoidance of an increasing variety of foods.
The diagnosis of ARFID requires that difficulties with eating are associated with one or more of the following:
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Significant weight loss (or failure to achieve expected weight gain in children).
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Significant nutritional deficiency.
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The need to rely on a feeding tube or oral nutritional supplements to maintain sufficient nutrition intake.
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Interference with social functioning (such as inability to eat with others).
The impact on physical and psychological health and degree of malnutrition can be similar to that seen in people with anorexia nervosa.
However, people with ARFID do not have excessive concerns about their body weight or shape and the disorder is distinct from anorexia nervosa or bulimia nervosa.
Also, while individuals with autism spectrum disorder often have rigid eating behaviours and sensory sensitivities, these do not necessarily lead to the level of impairment required for a diagnosis of avoidant/restrictive food intake disorder.
ARFID does not include food restriction related to lack of availability of food; normal dieting; cultural practices, such as religious fasting; or developmentally normal behaviours, such as toddlers who are picky eaters.
Food avoidance or restriction commonly develops in infancy or early childhood and may continue in adulthood.
It can however start at any age. Regardless of the age of the person affected, ARFID can impact families, causing increased stress at mealtimes and in other social eating situations.
Pica
Pica is an eating disorder in which a person repeatedly eats things that are not food with no nutritional value. The behaviour persists over at least one month and is severe enough to warrant clinical attention.
Typical substances ingested vary with age and availability and might include paper, paint chips, soap, cloth, hair, string, chalk, metal, pebbles, charcoal or coal, or clay. Individuals with pica do not typically have an aversion to food in general.
The behaviour is inappropriate to the developmental level of the individual and is not part of a culturally supported practice. Pica may first occur in childhood, adolescence, or adulthood, although childhood onset is most common.
It is not diagnosed in children under age 2. Putting small objects into their mouth is a normal part of development for children under 2. Pica often occurs along with autism spectrum disorder and intellectual disability, but can occur in otherwise typically developing children.
A person diagnosed with pica is at risk for potential intestinal blockages or toxic effects of substances consumed (e.g. lead in paint chips).
Rumination Disorder
Rumination disorder involves the repeated regurgitation and re-chewing of food after eating whereby swallowed food is brought back up into the mouth voluntarily and is re-chewed and re-swallowed or spat out.
Rumination disorder can occur in infancy, childhood and adolescence or in adulthood.
To meet the diagnosis the behaviour must:
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Occurs repeatedly over at least a 1-month period
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Not be due to a gastrointestinal or medical problem
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Not occur as part of one of the other behavioral eating disorders listed above
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Rumination can also occur in other mental disorders (e.g. intellectual disability) however the degree must be severe enough to warrant separate clinical attention for the diagnosis to be made.