Eating Disorders

Although the term eating is in the name, eating disorders are about more than food. They’re complex mental health conditions that often require the intervention of medical and psychological experts to alter their course.

These disorders are described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

In the United States alone, an estimated 20 million women and 10 million men have or have had an eating disorder at some point in their life. Rates of eating disorders in Singapore have been steadily on the rise.

What are eating disorders?

Eating disorders are a range of psychological conditions that cause unhealthy eating habits to develop. They might start with an obsession with food, body weight, or body shape.

In severe cases, eating disorders can cause serious health consequences and may even result in death if left untreated.

Those with eating disorders can have a variety of symptoms. However, most include the severe restriction of food, food binges, or purging behaviors like vomiting or over-exercising.

Although eating disorders can affect people of any gender at any life stage, they’re most often reported in adolescents and young women. In fact, up to 13% of youth may experience at least one eating disorder by the age of 20.

This article describes 6 of the most common types of eating disorders and their symptoms.

1. Anorexia nervosa

Anorexia nervosa is likely the most well-known eating disorder.

It generally develops during adolescence or young adulthood and tends to affect more women than men.

People with anorexia generally view themselves as overweight, even if they’re dangerously underweight. They tend to constantly monitor their weight, avoid eating certain types of foods, and severely restrict their calories.

Common symptoms of anorexia nervosa include (8):

• being considerably underweight compared with people of similar age and height
• very restricted eating patterns
• an intense fear of gaining weight or persistent behaviors to avoid gaining weight, despite being underweight
• a relentless pursuit of thinness and unwillingness to maintain a healthy weight
• a heavy influence of body weight or perceived body shape on self-esteem
• a distorted body image, including denial of being seriously underweight
• Obsessive-compulsive symptoms are also often present. For instance, many people with anorexia are often preoccupied with constant thoughts about food, and some may obsessively collect recipes or hoard food.

Such individuals may also have difficulty eating in public and exhibit a strong desire to control their environment, limiting their ability to be spontaneous.

Anorexia is officially categorized into two subtypes — the restricting type and the binge eating and purging type.

Individuals with the restricting type lose weight solely through dieting, fasting, or excessive exercise.

Individuals with the binge eating and purging type may binge on large amounts of food or eat very little. In both cases, after they eat, they purge using activities like vomiting, taking laxatives or diuretics, or exercising excessively.

Anorexia can be very damaging to the body. Over time, individuals living with it may experience the thinning of their bones, infertility, brittle hair and nails, and the growth of a layer of fine hair all over their body.

In severe cases, anorexia can result in heart, brain, or multi-organ failure and death.

2. Bulimia nervosa

Bulimia nervosa is another well-known eating disorder.

Like anorexia, bulimia tends to develop during adolescence and early adulthood and appears to be less common among men than women.

People with bulimia frequently eat unusually large amounts of food in a specific period of time.

Each binge eating episode usually continues until the person becomes painfully full. During a binge, the person usually feels that they cannot stop eating or control how much they are eating.

Binges can happen with any type of food but most commonly occur with foods the individual would normally avoid.

Individuals with bulimia then attempt to purge to compensate for the calories consumed and relieve gut discomfort.

Common purging behaviors include forced vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise.

Symptoms may appear very similar to those of the binge eating or purging subtypes of anorexia nervosa. However, individuals with bulimia usually maintain a relatively normal weight, rather than becoming underweight.

Common symptoms of bulimia nervosa include:

• recurrent episodes of binge eating with a feeling of lack of control
• recurrent episodes of inappropriate purging behaviors to prevent weight gain
• a self-esteem overly influenced by body shape and weight
• a fear of gaining weight, despite having a normal weight
• Side effects of bulimia may include an inflamed and sore throat, swollen salivary glands, worn tooth enamel, tooth decay, acid reflux, irritation of the gut, severe dehydration, and hormonal disturbances (9Trusted Source).

In severe cases, bulimia can also create an imbalance in levels of electrolytes, such as sodium, potassium, and calcium. This can cause a stroke or heart attack.

3. Binge eating disorder

Binge eating disorder is believed to be one of the most common eating disorders, especially in the United States.

It typically begins during adolescence and early adulthood, although it can develop later on.

Individuals with this disorder have symptoms similar to those of bulimia or the binge eating subtype of anorexia.

For instance, they typically eat unusually large amounts of food in relatively short periods of time and feel a lack of control during binges.

People with binge eating disorder do not restrict calories or use purging behaviors, such as vomiting or excessive exercise, to compensate for their binges.

Common symptoms of binge eating disorder include:

• eating large amounts of foods rapidly, in secret and until uncomfortably full, despite not feeling hungry
• feeling a lack of control during episodes of binge eating
• feelings of distress, such as shame, disgust, or guilt, when thinking about the binge eating behavior
• no use of purging behaviors, such as calorie restriction, vomiting, excessive exercise, or laxative or diuretic use, to compensate for the binging

People with binge eating disorder often have overweight or obesity. This may increase their risk of medical complications linked to excess weight, such as heart disease, stroke, and type 2 diabetes.

4. Pica

Pica is another eating disorder that involves eating things that are not considered food.

Individuals with pica crave non-food substances, such as ice, dirt, soil, chalk, soap, paper, hair, cloth, wool, pebbles, laundry detergent, or cornstarch.

Pica can occur in adults, as well as children and adolescents. That said, this disorder is most frequently observed in children, pregnant women, and individuals with mental disabilities.

Individuals with pica may be at an increased risk of poisoning, infections, gut injuries, and nutritional deficiencies. Depending on the substances ingested, pica may be fatal.

However, to be considered pica, the eating of non-food substances must not be a normal part of someone’s culture or religion. In addition, it must not be considered a socially acceptable practice by a person’s peers.

5. Rumination disorder

Rumination disorder is another newly recognized eating disorder.

It describes a condition in which a person regurgitates food they have previously chewed and swallowed, re-chews it, and then either re-swallows it or spits it out (13Trusted Source).

This rumination typically occurs within the first 30 minutes after a meal. Unlike medical conditions like reflux, it’s voluntary.

This disorder can develop during infancy, childhood, or adulthood. In infants, it tends to develop between 3–12 months of age and often disappears on its own. Children and adults with the condition usually require therapy to resolve it.

If not resolved in infants, rumination disorder can result in weight loss and severe malnutrition that can be fatal.

Adults with this disorder may restrict the amount of food they eat, especially in public. This may lead them to lose weight and become underweight.

Summary Rumination disorder can affect people at all stages of life. People with the condition generally regurgitate the food they’ve recently swallowed. Then, they chew it again and either swallow it or spit it out.

6. Avoidant/restrictive food intake disorder

Avoidant/restrictive food intake disorder (ARFID) is a new name for an old disorder.

The term replaces what was known as a “feeding disorder of infancy and early childhood,” a diagnosis previously reserved for children under 7 years old. Although ARFID generally develops during infancy or early childhood, it can persist into adulthood. What’s more, it’s equally common among men and women.

Individuals with this disorder experience disturbed eating either due to a lack of interest in eating or distaste for certain smells, tastes, colors, textures, or temperatures.

Common symptoms of ARFID include:

• avoidance or restriction of food intake that prevents the person from eating sufficient calories or nutrients
• eating habits that interfere with normal social functions, such as eating with others
• weight loss or poor development for age and height
• nutrient deficiencies or dependence on supplements or tube feeding

It’s important to note that ARFID goes beyond normal behaviors, such as picky eating in toddlers or lower food intake in older adults.

Moreover, it does not include the avoidance or restriction of foods due to lack of availability or religious or cultural practices.

Other eating disorders

In addition to the six eating disorders above, less-known or less common eating disorders also exist. These generally fall under one of three categories:

Purging disorder

Individuals with purging disorder often use purging behaviors, such as vomiting, laxatives, diuretics, or excessive exercising, to control their weight or shape. However, they do not binge.

Night eating syndrome.

Individuals with this syndrome frequently eat excessively, often after awakening from sleep.

Other specified feeding or eating disorder (OSFED).

While not found in the DSM-5, this includes any other conditions that have symptoms similar to those of an eating disorder but don’t fit into any of the categories above.

One disorder that may currently fall under OSFED is orthorexia. Although increasingly mentioned in the media and scientific studies, orthorexia has yet to be recognized as a separate eating disorder by the current DSM.

Individuals with orthorexia tend to have an obsessive focus on healthy eating, to an extent that disrupts their daily lives.

For instance, the affected person may eliminate entire food groups, fearing they’re unhealthy. This can lead to malnutrition, severe weight loss, difficulty eating outside the home, and emotional distress.

Individuals with orthorexia rarely focus on losing weight. Instead, their self-worth, identity, or satisfaction is dependent upon how well they comply with their self-imposed diet rules (15).

Treatments and Therapies

It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible.

Treatment plans are tailored to individual needs and may include one or more of the following:

• Individual, group, and/or family psychotherapy
• Medical care and monitoring
• Nutritional counseling
• Medications

Psychotherapies

Family-based therapy, a type of psychotherapy where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appears to be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

Medications

Evidence also suggests that medications such as antidepressants, antipsychotics, or mood stabilizers may also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression.