What Are Eating Disorders?

Eating disorders are illnesses in which the people experience severe disturbances in their eating behaviors and related thoughts and emotions. People with eating disorders typically become pre-occupied with food and their body weight.

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people’s eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder

Eating disorders affect several million people at any given time, most often women between the ages of 12 and 35; however there is burgeoning research that indicates more and more men are developing eating disorders as well.

There are three main types of eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder.

People with anorexia nervosa and bulimia nervosa tend to be perfectionists with low self-esteem and are extremely critical of themselves and their bodies. They usually “feel fat” and see themselves as overweight, sometimes even despite life-threatening semi-starvation (or malnutrition). An intense fear of gaining weight and of being fat may become all-pervasive. In early stages of these disorders, patients often deny that they have a problem.

In many cases, eating disorders occur together with other psychiatric disorders like anxiety disorders, panic disorder, obsessive compulsive disorder, and alcohol and drug abuse problems. New evidence suggests that heredity may play a part in why certain people develop eating disorders, but these disorders also afflict many people who have no prior family history. Without treatment of both the emotional and physical symptoms of these disorders, malnutrition, heart problems and other potentially fatal conditions can result. However, with proper medical care, those with eating disorders can resume suitable eating habits, and return to better emotional and psychological health.

While eating disorders may seem to be about beauty, weight, and image, they’re actually about control or avoidance of stress and emotional issues. Eating disorders may be a result of being unable to express strong feelings and emotions.

Those who suffer from eating disorders generally try to hide the problem, but there are signs of a problem if you know what to look for. Early detection and treatment of eating disorders makes for an easier recovery. It’s important to note that, while you may confront someone whom you suspect has an eating disorder, you cannot force someone with an eating disorder into treatment. Making an effort to be a caring, compassionate support system is often the best thing that can be done when a loved one suffers from an eating disorder.

Eating disorders involve extreme disturbances in eating behaviors, such as gorging, following rigid diets, throwing up after meals, and counting calories obsessively; they are more than just an unhealthy eating habit. The core of eating disorders involves self-critical, distorted attitudes about weight, body image, and food, all of which lead to the damaging eating behaviors.

Food, for those with eating disorders, is used to deal with painful emotions. Restricting food (as is the case with anorexia nervosa) is used to feel in control. Overeating soothes sadness, anger, and loneliness. Purging combats feelings of self-loathing and helplessness. Over time, food and weight obsessions dominate the life of someone with an eating disorder.

What Are Some Common Warning Signs of Eating Disorders?

In the early stages of an eating disorder, it may be really hard to ascertain the difference between an eating disorder and normal weight concerns and dieting. As an eating disorder progresses, the red flags and warning signs become more apparent. Those who suffer eating disorders are particularly good at hiding their disorders, so knowing the common warning signs may help to spot an eating disorder.

• Hoarding high-calorie food
• Constant dieting – even when thin
• Rapid unexplained weight gain or loss
• Preoccupation with body or weight
• Binging – usually performed in secret
• Purging – disappearing after every meal or frequent trips to the bathroom
• Obsession with food, calories or nutrition
• Usage of laxatives, diuretics, or diet pills
• Compulsive exercising
• Making excuses to get out of eating
• Eating tiny portions or refusing to eat
• Intense fear of being fat
• Distorted body image
• Strenuous exercising (for more than an hour)
• Hoarding and hiding food
• Eating in secret
• Disappearing after eating—often to the bathroom
• Large changes in weight, both up and down
• Social withdrawal
• Depression
• Irritability
• Hiding weight loss by wearing bulky clothes
• Little concern over extreme weight loss
• Stomach cramps
• Menstrual irregularities—missing periods
• Dizziness
• Feeling cold all the time\
• Sleep problems
• Cuts and calluses across the top of finger joints (from sticking finger down throat to cause vomiting)
• Dry skin
• Puffy face
• Fine hair on body
• Thinning of hair on head, dry and brittle hair
• Cavities, or discoloration of teeth, from vomiting
• Muscle weakness
• Yellow skin
• Cold, mottled hands and feet or swelling of feet

What Are Some Common Myths About Eating Disorders?

There are many myths about the causes eating disorders, how serious they are, and who develops an eating disorder. Let’s dispel them now:

Are eating disorders a choice?

Eating disorders are not a choice. They are complex medical and psychiatric illnesses that people don’t opt to have. Eating disorders are bio-psycho-social diseases, which means that genetic, biological, environmental, and social elements all play a role.

• Several decades of genetic research show that biological factors are an important influence in who develops an eating disorder. A societal factor (like the media-driven thin body ideal) is an example of an environmental trigger that has been linked to increased risk of developing an eating disorder.
• Environmental factors also include physical illnesses, childhood teasing and bullying, and other life stressors.
• Eating disorders commonly co-occur with other mental health conditions like major depression, anxiety, social phobia, and obsessive-compulsive disorder. Additionally, they may run in families, as there are biological predispositions that make people more vulnerable to developing an eating disorder.

Are eating disorders really that serious?

Eating disorders have the highest mortality rate of any psychiatric illness. Besides medical complications from binge eating, purging, starvation, and over-exercise, suicide is also common among individuals with eating disorders. Potential health consequences include heart attack, kidney failure, osteoporosis, and electrolyte imbalance. People who struggle with eating disorders also have intense emotional distress and a severely impacted quality of life.

The consequences of eating disorders can be life-threatening, and many individuals find that stigma against mental illness (and eating disorders in particular) can obstruct a timely diagnosis and adequate treatment.

Doesn’t everyone have an eating disorder?

Although our current culture is highly obsessed with food and weight, and disordered patterns of eating are very common, clinical eating disorders are less so.

About 20 million women and 10 million men will struggle with an eating disorder at some point during their lives. A study in 2007 found that:

• 0.9% of women and 0.3% of men had anorexia during their life
• 1.5% of women and 0.5% of men had bulimia during their life,
• and 3.5% of women and 2.0% of men had binge eating disorder during their life

If eating disorders are linked to my genetic makeup, how do I recover?

Biology isn’t destiny. There is always hope for recovery.

While biological factors do play a large role in the onset of eating disorders, they are not the only factors.

The predisposition towards disordered eating may reappear during times of stress, but there are many good techniques people who have eating disorders can learn that will help manage their emotions and keep behaviors from returning.

Early intervention is a key part of eating disorder prevention, and helps reduce serious psychological and health consequences. Recovery from an eating disorder can be a long process and requires a qualified team of professionals and the love and support of family and friends.

Aren’t eating disorders a ‘girl thing’?

Eating disorders can affect anyone, regardless of their gender or sex.

While eating disorders are more common in females, researchers and clinicians are becoming aware of a growing number of males and non-binary individuals who now are seeking help for eating disorders. A 2007 study by the Centers for Disease Control and Prevention found that up to one-third of all eating disorder sufferers are male, and a 2015 study of US undergraduates found that transgender students were the group most likely to have been diagnosed with an eating disorder in the past year (Diemer, 2015).Eating disorders most often affect girls and women, but boys and men can also have an eating disorder.

One out of every four pre-teen kids with anorexia is a boy.  Binge eating disorder affects females and males about equally.

It’s currently unclear whether eating disorders are actually increasing in males and transgender populations or if more of those people who are suffering are seeking treatment or being diagnosed. As some physicians may have preconceptions about who eating disorders affect, their disorders have generally become more severe and entrenched at the point of an actual diagnosis.

Don’t you have to be underweight to have an eating disorder?

People who have eating disorders come in all shapes and sizes – many of those people happen to be normal or overweight.The two best-known types of eating disorders are anorexia nervosa and bulimia nervosa and can occur separately or in the same person, additionally, binge-eating is another type of eating disorder.

Aren’t people with eating disorders super vain?

It’s not actually vanity that drives people with eating disorders to obsess about their food. Eating disorders are a product of feelings of shame, poor body image, anxiety, and powerlessness.

Do parents cause eating disorders?

Organizations from around the world, including the Academy for Eating Disorders, the American Psychiatric Association, and NEDA, have published materials that indicate that parents don’t cause eating disorders.

Parents, especially mothers, were frequently blamed for their child’s eating disorder, but recent research discovered that eating disorders have a firmer biological root. Eating disorders develop differently for each person, and there is no single set of rules that parents can follow to guarantee prevention of an eating disorder, however there are things everyone in the family system can do to play a role in creating a recovery-promoting environment. such as including parents and other family members in the treatment process.

Can someone be too young or too old to develop an eating disorder?

Eating disorders can develop or re-emerge at any age. Eating disorder specialists are reporting an increase in the diagnosis of children, some as young as five or six. Many eating disorder sufferers report that their thoughts and behaviors started much earlier than anyone realized, sometimes even in early childhood. Although most people report the onset of their eating disorder in their teens and young adulthood, there is some evidence emerging that people are being diagnosed at younger ages.

It’s not clear whether people are actually developing eating disorders at younger ages or if an increased awareness of eating disorders in young children has led to improved recognition and diagnosis.

Men and women at midlife and beyond are being treated for eating disorders, either due to a relapse, ongoing illness from adolescence or young adulthood, or due to the new onset of an eating disorder.

Doesn’t recovery from an eating disorder take a long time?

Recovery time from any mental illness varies from person to person. Some people get better relatively quickly, while others take longer to improve. While not everyone who has an eating disorder will recover fully, many people do improve with treatment. Even with full recovery, many people with eating disorders find that they have to take steps to make sure they stay well. This can include:

• planning meals
• regular check-ins with a therapist, dietitian, or doctor
• medication
• proper support
• proper education
• stress management

What Are The Types of Eating Disorders?

Currently, doctors have discovered that there are 6 types of eating disorders.

Anorexia Nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many people, a  distorted body image.Avoidant Restrictive Food Intake Disorder (ARFID), once referred to as “selective eating disorder,” involves limitations in the amount and/or types of food consumed without any distress about body shape or size, or fears of being overweight.

Bulimia Nervosa is characterized by a cycle of binge eating and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Binge eating disorder is the most common eating disorder in the United States and is characterized by episodes of eating large quantities of food; a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures to counter the binge eating.

Orthorexia was coined in 1998 to describe an obsession with proper or ‘healthful’ eating.

Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and/or paint chips.

Rumination disorder involves the regular regurgitation of food that occurs for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.

Unspecified feeding or eating disorder (UFED) applies to presentations where symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class.

What Is Anorexia?

Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many people, a distorted body image. People who have anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.

Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years.

Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.

Most turn to this obsession as a sense of control in a reality where they feel they have none.

People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, often exercise excessively, and/or may force themselves to vomit or use laxatives to lose weight. Anorexia nervosa has the highest mortality rate of any mental disorder.

Anorexia, with severity in relation to length of time, is a potentially life-threatening disorder marked by extreme fasting or restriction of food intake, often eating as little as 200 calories a day. Anorexics have an intense fear of weight-gain; even while underweight, they see themselves as fat. Females with anorexia develop amenorrhea, or the absence of menstruation.

While many people with this disorder die from complications associated with starvation, others die by suicide.

If you or someone you know is in crisis and needs immediate help, call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week.

This eating disorder can affect males, females, and non-binary people, however, 90-95% of those diagnosed are girls and women and of these, it’s estimated that 5-20% of people affected by this eating disorder will die,

Do I Have Anorexia?

If you think you may have anorexia, please make an appoint to see your doctor as soon as possible. Delaying treatment can make recovery a bit more challenging. Your doctor will probably ask you if you have experienced any of the below questions:

• Have you recently noticed a drastic decrease in weight?
• Do you struggle with maintaining a healthy self-esteem?
• Are you overly concerned about gaining weight?
• Do you find yourself refusing or making excuses not to eat?
• Are you self-conscious about your body image?
• Do you exercise excessively?
• Do you obsess over dieting?
• Have you been distancing yourself from friends and family?
• Are you often depressed?
• Have you noticed dry or yellow tinted skin?

How Is Anorexia Diagnosed?

To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:

1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.

Other diagnostic criteria can include:

• A person 15% below their ideal weight
• Person with an intense fear of being fat, even though they are underweight
• He/She/They may have a distorted view of their body or deny that their low weight is a problem
• (among women) missing at least 3 periods in a row
• People who have anorexia may or may not also binge and purge, use laxatives, or other means of losing weight

 If left untreated anorexia can have devastating effects.

When the body is starved of proper nourishment, the system slows down to conserve energy and can lead to injury of the organs, and even death.

What Are The Dangers Of Anorexia?

Systemic Symptoms: 

• Heart rates drop to an abnormally slow rate
• Blood pressure drops
• Blood count becomes abnormal
• Risk of heart failure increases
• Risk of osteoporosis and reduction in bone density
• Muscles deteriorate
• Body suffers from dehydration, leading to kidney failure

Physical Symptoms

• Extreme thinness
• Irregular periods in women
• Lower testosterone in men
• Feeling weak, fatigued, or dizzy, or experiencing fainting spells
• Dry skin that may also take on yellowish tint
• Bluish color on the tips of the fingers
• Dry hair and hair loss
• Downy hair that grows over the skin in order to keep warm

Anorexia affects all of the organs in the body. If left untreated, the body becomes severely malnourished. This can result in damage that is not treatable, even if the disease is taken under control.

Emotional Symptoms

• Lying about whether or not you have eaten
• Irritability
• Withdrawing from social activities
• Emotionally flat affect
• Obsessing over weight gain
• Feeling insecure about the way you look
• Decreased interest in sex
• Feeling depressed
• Thoughts of suicide

If the above resonates with anything you’re experiencing, it’s time to see a doctor.

Medical attention doesn’t have to be scary. Think of it as a moment of clarity that’s bringing you closer to your desired result of being a healthy, happy human being.

Mortality and Binge Eating Disorders:

It is well known that anorexia nervosa is a deadly disorder, but death rate varies considerably between studies. This variation may be due to length of follow-up, or ability to find people years later, or other reasons. In addition, it has not been certain whether other subtypes of eating disorders also have high mortality. Several recent papers have shed new light on these questions by using large samples followed up over many years. Most importantly, they get around the problem of tracking people over time by using national registries which report when people die.Overall people with anorexia nervosa had a six fold increase in mortality compared to the general population. Reasons for death include starvation, substance abuse, and suicide.

In summary, these findings underscore the severity and public health significance of all types of eating disorders.

What Is Bulimia?

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

How is Bulimia Diagnosed?

According to the DSM-5, the official diagnostic criteria for bulimia nervosa include:

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating, in a discrete period of time (such as within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
  • A feeling of lack of control over eating during the episode (such as a feeling that one cannot stop eating or control what or how much they are eating).
• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of anorexia nervosa

It’s really important to remember that people with bulimia may be anywhere from underweight, to normal weight, to overweight.

Common Warning Signs That Of Bulimia: 

Emotional and behavioral 

• Generally speaking, new behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns
• Evidence of binge eating, such as disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
• Appears uncomfortable eating around others
• Develops food rituals (including eating only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)
• Skips meals or takes small portions of food at regular meals
• Fears of eating in public or with other people
• Steals or hoards food in strange places
• Drinks excessive amounts of water or non-caloric beverages
• Uses excessive amounts of mouthwash, mints, and gum
• Hides body with baggy clothes
• Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories
• Creates lifestyle schedules or rituals to make time for binge-and-purge sessions
• Withdraws from friends and activities
• Shows extreme concern with body weight and shape
• Frequent checking the mirror for feared flaws in appearance
• Secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most people would eat under similar circumstances); feels lack of control over ability to stop eating
• Purges after a binge (such as self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)
• Extreme mood swings

Physical Symptoms of Bulimia:

• Unusual swelling of the cheeks or jaw area
• Calluses on the back of the hands and knuckles from self- induced vomiting
• Teeth are discolored, stained from vomiting
• Noticeable fluctuations in weight, both up and down
• Body weight is typically within the normal weight range; may be overweight
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux)
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
• Dizziness
• Bloating from fluid retention
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dry skin
• Dry and brittle nails
• Swelling around area of salivary glands
• Fine hair on body
• Thinning of hair on head, dry and brittle hair
• Muscle weakness
• Cold, mottled hands and feet or swelling of feet
• Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
• Poor wound healing
• Increased infections due to poor immune response

Many people with bulimia nervosa also struggle with co-occurring conditions, such as:

• Self-injury (cutting and other forms of self-harm without suicidal intention)
• Substance use and abuse
• Impulsivity (risky sexual behaviors, shoplifting, drugs)
• Diabulimia (intentional misuse of insulin for type 1 diabetes)

What Is Binge Eating Disorder?

Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder that is characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress, or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. It is the most common eating disorder in the United States.

BED is one of the newest eating disorders formally recognized in the DSM-5. Before the most recent revision in 2013, BED was listed as a subtype of EDNOS (now referred to as OSFED). The change is important because some insurance companies will not cover eating disorder treatment without a DSM diagnosis.

What Are The Diagnostic Criteria for Binge Eating Disorder?

According to the DSM-5, the official diagnostic criteria for bulimia nervosa include:

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
  • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
• The binge eating episodes are associated with three (or more) of the following:
  • Eating much more rapidly than normal.
  • Eating until feeling uncomfortably full.
  • Eating large amounts of food when not feeling physically hungry.
  • Eating alone because of feeling embarrassed by how much one is eating.
  • Feeling disgusted with oneself, depressed, or very guilty afterward.
• Marked distress regarding binge eating is present.
• The binge eating occurs, on average, at least once a week for 3 months.
• The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

What Are The Warning Signs for Binge Eating Disorder?

Emotional and Behavioral Signs and Symptoms

• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
• Appears uncomfortable eating around others
• Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
• Fear of eating in public or with others
• Steals or hoards food in strange places
• Creates lifestyle schedules or rituals to make time for binge sessions
• Withdraws from usual friends and activities
• Frequently diets
• Shows extreme concern with body weight and shape
• Frequent checking in the mirror for perceived flaws in appearance
• Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
• Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting
• Developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, and not allowing foods to touch).
• Eating alone out of embarrassment at the quantity of food being eaten
• Feelings of disgust, depression, or guilt after overeating
• Fluctuations in weight
• Feelings of low self-esteem

Physical Symptoms of Binge Eating Disorder

• Noticeable fluctuations in weight, both up and down
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Difficulties concentrating

What Are The Health Risks of Binge Eating Disorder?

The health risks of BED are most commonly those associated with clinical obesity, weight stigma, and weight cycling (aka, yo-yo dieting). Most people who are labeled clinically obese do not have binge eating disorder. However, of individuals with BED, up to two-thirds are labelled clinically obese; people who struggle with binge eating disorder tend to be of normal or higher-than-average weight, though BED can be diagnosed at any weight.

What Is Orthorexia? 

While not formally recognized in the Diagnostic and Statistical Manual, awareness about orthorexia is on the rise. The term ‘orthorexia’ was coined in 1998 and means an obsession with proper or ‘healthful’ eating. Although being aware of and concerned with the nutritional quality of the food you eat isn’t a problem in and of itself, people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being.

Without formal diagnostic criteria, it’s difficult to get an estimate on precisely how many people have orthorexia. We still don’t know whether orthorexia if is a stand-alone eating disorder, a type of existing eating disorders like anorexia, or a form of obsessive-compulsive disorder. Studies have shown that many people with orthorexia also have been diagnosed with obsessive-compulsive disorder.

What Are Some Of The Symptoms of Orthorexia?

• Compulsive checking of ingredient lists and nutritional labels
• An increase in concern about the health of ingredients
• Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
• An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
• Unusual interest in the health of what others are eating
• Spending hours per day thinking about what food might be served at upcoming events
• Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
• Obsessive following of food and ‘healthy lifestyle’ blogs on social media
• Body image concerns may or may not be present

What Are The Health Consequences of Orthorexia?

Like anorexia, orthorexia involves restriction of the amount and variety of foods eaten, making malnutrition likely. Therefore, the two disorders share many of the same physical consequences.

How Is Orthorexia Treated?

There are currently no clinical treatments developed specifically for orthorexia, but many eating disorder experts treat orthorexia as a variety of anorexia and/or obsessive-compulsive disorder. Thus, treatment usually involves psychotherapy to increase the variety of foods eaten and exposure to anxiety-provoking or feared foods, as well as weight restoration as needed.

What is Avoidant Restrictive Food Intake Disorder?

Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis in the DSM-5, and was previously called “Selective Eating Disorder.” ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of being overweight.

While many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly and, in adults, to maintain basic body function. In children, this results in stalled weight gain and vertical growth; in adults, this results in weight loss. ARFID can also result in problems at school or work, due to difficulties eating with others and extended times needed to eat.

How is ARFID Diagnosed?

According to the DSM-5, ARFID is diagnosed when:

• An eating or feeding disturbance (such as, apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
  • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
  • Significant nutritional deficiency.
  • Dependence on enteral feeding or oral nutritional supplements.
  • Marked interference with psychosocial functioning.
• The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
• The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
• The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

What Are The Risk Factors for Developing ARFID?

As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors will interact differently in different people, which means two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms. Researchers know much less about what puts someone at risk of developing ARFID, but here’s what they do know:

• People with autism spectrum conditions are much more likely to develop ARFID, as are those with ADHD and intellectual disabilities.
• Children who don’t outgrow normal picky eating, or in whom picky eating is severe, appear to be more likely to develop ARFID.
• Many children with ARFID also have a co-occurring anxiety disorder; these children are also at high risk for other psychiatric disorders.

What Are The Warning Signs of ARFID?

Behavioral and psychological 

• Dramatic weight loss
• Dresses in layers to hide weight loss or stay warm
• Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
• Reports consistent, vague gastrointestinal issues (“upset stomach”, feels full, etc.) around mealtimes that have no known cause
• Dramatic restriction in types or amount of food eaten
• Will only eat certain textures of food
• Fears of choking or vomiting
• Lack of appetite or interest in food
• Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens).
• No body image disturbance or fear of weight gain

Physical

Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.

• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Menstrual irregularities—missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
• Female after puberty loses menstrual period
• Dizziness
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Dry skin
• Dry and brittle nails
• Fine hair on body (lanugo)
• Thinning of hair on head, dry and brittle hair
• Muscle weakness
• Cold, mottled hands and feet or swelling of feet
• Poor wound healing
• Impaired immune functioning

What Are The Health Consequences of ARFID?

In ARFID, the body is denied the essential nutrients it needs to function normally.  Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences. The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death.

Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body

What is Pica?

Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and paint chips.

• It is unclear how many people are affected by pica. It most likely is more prevalent in developing countries.
• Pica can affect children, adolescents, and adults of any genders.
• Those who are pregnant and craving nonfood items should only be diagnosed with pica when their cravings lead to ingesting nonfood items, and the ingestion of those items poses a potential medical risk (either due to the quantity or type of item being ingested).
• Pica can be associated with intellectual disability, trichotillomania (hair-pulling disorder), and excoriation (skin picking) disorder
• There are no laboratory tests for pica. Instead, the diagnosis is made from a clinical history of the patient.
• Diagnosing pica should be accompanied by tests for anemia, potential intestinal blockages, and toxic side effects of substances consumed (i.e., lead in paint, bacteria or parasites from dirt).

What Are The Warning Signs of Pica?

• The persistent eating, over a period of at least one month, of substances that are not food and do not provide nutritional value.
• The ingestion of the substance(s) is not a part of culturally supported or socially normative practice (e.g., some cultures promote eating clay as part of a medicinal practice).
• Typical substances ingested tend to vary with age and availability. They may include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice.
• The eating of these substances must be developmentally inappropriate. In children under two years of age, mouthing objects—or putting small objects in their mouth—is a normal part of development, allowing the child to explore their senses. Mouthing may sometimes result in ingestion. In order to exclude developmentally normal mouthing, children under two years of age should not be diagnosed with pica.
• Generally, those with pica are not averse to ingesting food.

What Are The Risk Factors for Pica?

• Pica often occurs with other mental health disorders associated with impaired functioning (e.g., intellectual disability, autism spectrum disorder, schizophrenia).
• Iron-deficiency anemia and malnutrition are two of the most common causes of pica, followed by pregnancy. In these individuals, pica is a sign that the body is trying to correct a significant nutrient deficiency. Treating this deficiency with medication or vitamins often resolves the problems.
• A medical professional should assess if the behavior is sufficiently severe to warrant independent clinical attention (e.g., some people may eat nonfood items during pregnancy, but their doctor may determine that their actions do not indicate the need for separate clinical care).

How is Pica Treated?

The first-line treatment for pica involves testing for mineral or nutrient deficiencies and correcting those. In many cases, problematic eating behaviors disappear as deficiencies are corrected. If the behaviors aren’t caused by malnutrition or don’t stop after nutritional treatment, a variety of behavioral interventions are available.

Scientists in the autism community have developed several different effective interventions, including redirecting the person’s attention away from the desired object and rewarding them for discarding or setting down the non-food item.

What Is Rumination Disorder?

Rumination disorder involves the regular regurgitation of food that occurs for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out. Typically, when someone regurgitates their food, they do not appear to be making an effort, nor do they appear to be stressed, upset, or disgusted.

How is Rumination Disorder Diagnosed?

The DSM-5 criteria for rumination disorder are:

• Repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
• The repeated regurgitation is not due to a medication condition (e.g., gastrointestinal condition).
• The behavior does not occur exclusively in the course of anorexia nervosa, bulimia nervosa, BED, or avoidant/restrictive food intake disorder.
• If occurring in the presence of another mental disorder (e.g., intellectual developmental disorder), it is severe enough to warrant independent clinical attention.

What Is The Treatment for Rumination Disorder?

Once a physical cause for rumination disorder has been ruled out, the most common way rumination disorder is treated involves a combination of breathing exercises and habit reversal. A child with rumination disorder is taught to recognize the signs and situations when rumination is likely, and then they learn diaphragmatic breathing techniques to use after eating that prevent them from regurgitating their food. They eventually learn to prevent the rumination habit by replacing it with deep breathing techniques.

Seeking Treatment for Eating Disorders:

Recovery from an eating disorder can be a long process that requires not only a qualified team of professionals, but also the love and support of family and friends. It is not uncommon for someone who suffers with an eating disorder to feel uncertain about their progress or for their loved-ones to feel disengaged from the treatment process. These potential roadblocks may lead to feelings of ambivalence, limited progress, and treatment drop out. Therefore, knowing about the Stages of Change Model, as defined by Prochaska and DiClemente, will help everyone involved better negotiate the road to recovery.

The Stages of Change in the process of recovery from an eating disorder are a cycle rather than a linear progression. The person may go through this cycle more than one time or may need to revisit a particular stage before moving on to the next. They may also go through the stages for each individual eating disorder symptom. In other words, if they are recovering from anorexia, they could be in the Action Stage for restrictive eating (e.g., eating three meals a day along with snacks, engaging in social eating, and utilizing support system) while, at the same time, they could be going through the Contemplation Stage for body image and weight concerns (e.g., becoming aware of how body image is tied to self-esteem and self-worth, defining oneself as a body or number, and identifying the negatives of striving for the “perfect body”). This is precisely why recovery from an eating disorder is complex and individualized.

If you are a parent or friend of someone struggling, you no doubt suffer right along with them, so it is crucial for you to pay attention to your own needs as well as be present for your child or friend during her recovery process.

What Are The Stages of Change?

There are five Stages of Change that occur in the recovery process: Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance. Let’s examine them further.

1) The Pre-Contemplation Stage is evident when a person does not believe they have a problem. Close family and friends are bound to pick up on symptoms such as restrictive eating, the binge/purge cycle, or a preoccupation with weight, shape, and appearance even before the person admits to it. They may refuse to discuss the topic and deny they need help. At this stage, it is necessary to gently educate the person about the devastating effects the disorder will have on their health and life, and the positive aspects of change.

• Do not be in denial of your child or friend’s eating disorder.
• Be aware of the signs and symptoms.
• Avoid rationalizing their eating disordered behaviors.
• Openly share your thoughts and concerns with your child or loved one.

2) The Contemplation Stage occurs when an person is willing to admit that they have a problem and are now open to receiving help. The fear of change may be very strong, and it is during this phase that a psychotherapist should assist the person in discovering the reason they have an eating disorder so they can understand why it is in their life and how it no longer serves them. This, in turn, helps the person move closer toward the next stage of change.

• If your child is under the age of 18, insist that they receive professional help from a qualified eating disorder specialist.
• Educate yourself about the disorder.
• Be a good listener.
• Do not try to “fix” the problem yourself.
• Seek your own encouragement from a local eating disorder support group for family and friends.

3)The Preparation Stage the person transitions into the Preparation Stage when they are ready to change, but aren’t sure how to do it. Time is spent establishing specific coping skills such as appropriate boundary setting and assertiveness, effective ways of dealing with negative eating disorder thoughts and emotions, and ways to tend to their personal needs. Potential barriers to change are identified. This is usually when a plan of action is developed by the treatment team, (i.e. psychotherapist, nutritionist, and physician) as well as the person and designated family members. This generally includes a list of people to call during times of crisis.

• If supporting a loved one in their recovery, identify what your role is in the recovery process.
• Explore your own thoughts and beliefs about food, weight, shape, and appearance.
• Ask your child/loved one and the treatment team how you can be best involved in the recovery process and what you can do to be supportive.
• ACTION STAGE

4) The Action Stage begins when the person is ready to start their strategy and confront the eating disorder behavior head on. By now, they are open to trying new ideas, behaviors, and are willing to face fears in order for change to occur. Trusting the treatment team and their support network is essential to making the Action Stage successful.

• Follow the treatment team’s recommendations.
• Remove triggers from your environment: no diet foods, no scales, and no stress.
• Be warm and caring, yet appropriate and determined with boundaries, rules, and guidelines.
• Reinforce positive changes without focusing on weight, shape, or appearance.

5) The Maintenance Stage evolves when the person has sustained the Action Stage for approximately six months or longer. During this period, they actively practice new behaviors and new ways of thinking as well as consistently use both healthy self-care and coping skills. Part of this stage also includes revisiting potential triggers in order to prevent relapse, establishing new areas of interests, and beginning to live their life in a meaningful way.

• Applaud your loved one’s efforts and successes.
• Continue to adjust to new developments.
• Redefine the boundaries at home as necessary.
• Maintain positive communications.
• Be aware of the possibility of recovery backsliding and relapse to prior distorted eating.

6) The Termination Stage & Relapse Prevention. Relapse is sometimes grouped with the maintenance stage since recovery doesn’t occur all at once, and it’s normal for some relapsing behaviors.

So, how do you know when it is time to discontinue treatment? With the understanding that this decision is best made in consultation with your treatment team, ask yourself the following questions:

• Have I mastered the Stages of Change in the major areas of my eating disorder?
• Do I have the coping skills necessary to maintain these changes?
• Do I have a relapse prevention plan in place?
• Am I willing to resume treatment in the future if necessary?

To prevent relapsing ask for help, communicate your thoughts and feelings, address and resolve problems as they arise, live a healthful and balanced life, and remember that you would not have made it this far if it were not for your strong determination and dedication toward recovery.