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November 1, 2018

What are the Different Types of Eating Disorders?

Types of Eating Disorders

What are the Different Types of Eating Disorders?

When one thinks of an eating disorder, one generally thinks of a person who is obsessed with being thin and will do anything to be that way.  In reality, this is a rather large category of disorders, some of which affect a person’s behavior with food only and others that also include an obsessive drive for thinness.  So, it is important to differentiate between a Feeding Disorder and an Eating Disorder because they may superficially appear to be similar but they have very different causes and treatments. In this post, we will review different types of eating disorders and characterizations of each type.

  1. Pica Eating Disorder
  2. Rumination Eating Disorder
  3. Avoidant Restrictive Food Intake Disorder (ARFID)
  4. Anorexia Nervosa
  5. Bulimia Nervosa
  6. Binge Eating Disorder
  7. Eating Disorder NOS

The first three (numbers 1 through 3) in the list above are feeding disorders. The last four (numbers 4 through 7) are eating disorders. Typically, feeding disorders start earlier in childhood than an eating disorder does.

 

Let’s explore the different types of feeding disorders:

 

Pica Eating Disorder

Pica Eating Disorder is characterized by eating non-nutritive or non-food substances such as paper, paste, dirt, hair, or clay. Here are some characterizations of Pica eating disorder:

  • This behavior lasts for at least a month and is severe enough to warrant clinical or medical attention.
  • Person capable and willing to eat normal food outside of this behavior.
  • Often seen in individuals with other psychological conditions or developmental disorders.

Rumination Eating Disorder

Rumination Eating Disorder is characterized by repeated regurgitation of partially digested food that is either re-chewed, re-swallowed, or spit out for a period of at least one month. Here are some characterizations of Rumination Eating Disorder:

  • Medical conditions such as GERD or pyloric stenosis are fully ruled out.
  • Onset can be at any stage of life
  • May see the person deliberately restrict their intake in order to avoid engaging in this behavior when around others.
  • May see weight loss or social impairments due to the disorder.
  • Treatment often involves behavioral therapy with a focus on relaxation skills.

Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant Restrictive Food Intake Disorder (ARFID), sometimes referred to as Selective Eating Disorder, is characterized by a lack of interest in food or an avoidance of certain types of food. Here are some characterizations of Avoidant Restrictive Food Intake Disorder (ARFID):

  • Often related to sensory issues, fear of a negative consequence such as choking or allergy, fear of new foods.
  • Aversion to food causes severe weight loss, failure to grow properly and nutritional deficiency.
  • Person is not avoiding these foods due to a fear of weight gain. It is due to a fear or aversion to the food itself.
  • Person often demonstrates a phobic response to the food itself. May even see the person gag, vomit, or cry if forced to eat these foods.
  • Generally, this disorder develops in early childhood. These children are often labelled “picky eaters” initially, but over time, their resistance to try new foods, or to incorporate foods to create a more balanced diet becomes a source of tension and conflict in the home.  The range of foods these individuals eat is markedly different from their peers and can make socializing difficult due to lack of access to their preferred foods.

 

Now that we’ve reviewed the types of feeding disorders, let’s take a look at the different types of eating disorders:

 

Anorexia Nervosa (AN)

Anorexia Nervosa is a type of eating disorder characterized by a definite restriction in caloric intake that results in low body weight. Here are some characterizations of Anorexia Nervosa Eating Disorder:

  • Person endorses an intense fear of gaining weight or becoming fat
  • Person repeatedly engages in behavior that interferes with weight gain, even though at an unusually low weight.
  • The individual has a distorted sense of their own appearance and weight. Will often see themselves as much larger or more overweight than others do, even in the face of evidence that they are at too low of a weight.
  • Often, individuals with anorexia begin to show medical complications related to starvation, such as loss of menses, loss of hair, changes in hair and nails, feeling cold, and feeling more tired.
  • Individuals with anorexia will often develop an obsession with cooking and recipes, even though they will not eat these foods. They will often cook or bake for others but not allow themselves to eat the foods.
  • Restricting type: individual restricts intake only. Does not engage in bingeing, purging, use of laxatives, enemas, or diuretics
  • Binge-eating/purging type: this is often confused with Bulimia Nervosa.  In this type, individuals will binge or purge (or both) during a 3 month period.  Of note, the binges in anorexia are often (but not always) smaller than the binges seen in Bulimia Nervosa.

Bulimia Nervosa

Bulimia Nervosa is a type of eating disorder characterized by having two distinct features: episodes of binge eating and recurrent compensatory behaviors in order to prevent weight gain.  Both behaviors must be present to receive this diagnosis. Here are some characterizations of Bulimia Nervosa Eating Disorder:

  • A binge is when a person eats an unusually large amount of food (beyond what most people would consider typical or appropriate) in a relatively short amount of time (a couple of hours or so).
  • Generally, individuals describe a feeling of loss of control over this behavior. Some people even go so far as to say that they feel “checked out” or “numb” when they engage in binge eating.
  • After engaging in the binge eating, the individual does something to try to “rid” themselves of the food, such as self-induced vomiting, misusing laxatives, excessive exercise, fasting, or diuretics.
  • Individuals with bulimia tend to hide their behaviors from others and the behaviors can go on in secret for many years.
  • Like Anorexia, individuals struggling with Bulimia are preoccupied with their appearance and their weight. They often articulate a high drive for thinness even if their weight is normal.
  • Individuals with Bulimia Nervosa are typically “normal weight” and therefore often go a long time without detection because there is a misconception that people with eating disorders are emaciated. This is not true.  One can be at any weight and still have a pernicious eating disorder that causes great damage to one’s body and well-being.
  • Individuals with Bulimia Nervosa will often use the fact that they are not severely underweight as rationalization for not getting treatment. They will tell themselves that it could not be “that serious” because they are not dangerously underweight, even though the behaviors are extremely risky and can lead to serious medical complications, including death.

Are you looking for bulimia nervosa treatment? Read our full guide here.

Binge Eating Disorder

Binge Eating Disorder is a type of eating disorder not formally recognized until the publication of the DSM-V in 2013. This is extremely significant because it acknowledged a whole subgroup of those affected by this eating disorder and gave it the same clinical acknowledgement as the other eating disorders.  In addition, with this new diagnosis come the ability to bill insurance companies which allows for greater access to care and treatment. Here are some characterizations of Binge Eating Disorder:

  • Many individuals with BED have a long history of dieting because they have also struggled with their weight and because our society and culture focuses weight as the problem, rather than the relationship with food as the problem. Dieting makes this condition worse because of the deprivation and caloric restriction associated with dieting.
  • Often, individuals with BED recognize that they eat emotionally but feel unable to cope without food to soothe themselves.
  • This disorder is marked by recurrent episodes of binge eating (as in Bulimia Nervosa).
  • A binge is when a person eats an unusually large amount of food (beyond what most people would consider typical or appropriate) in a relatively short amount of time (a couple of hours or so).
  • Generally, individuals describe a feeling of loss of control over this behavior. Some people even go so far as to say that they feel “checked out” or “numb” when they engage in binge eating.
  • According to the DSM-V, the binge eating episodes must have 3 or more of the following criteria.
    • 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.

Eating Disorder NOS

Eating Disorder NOS is a diagnostic category for those who present with symptoms found in these disorders but don’t quite meet criteria. These symptoms cause significant impairments in functioning and are readily viewed by the person, or others, as being disordered.

Eating Disorder NOS examples include:

  • Atypical Anorexia Nervosa-where the individual meets criteria behaviorally but may not be underweight.
  • Bulimia Nervosa or Binge Eating Disorder that occurs less frequently for or for a shorter duration than is required to make the formal diagnosis.
  • Purging disorder involves use of the compensatory behaviors found in BN but without the recurrent binge eating, in order to affect weight.
  • Night Eating Syndrome-essentially binge eating but only late at night after awakening from a sleep. Bingeing at night, before bed, is typically considered BED.  Late night eating, before going to sleep at night, is a very common pattern in BED and is often confused with this disorder.

 

To review, these are the different types of eating disorders and feeding disorders:

  1. Pica Eating Disorder
  2. Rumination Eating Disorder
  3. Avoidant Restrictive Food Intake Disorder (ARFID)
  4. Anorexia Nervosa
  5. Bulimia Nervosa
  6. Binge Eating Disorder
  7. Eating Disorder NOS

 

Do you find yourself relating to any of these different types of eating disorders? Eating disorder recovery can be a process that may be difficult to handle all on your own. Thankfully, you don’t have to.

I’m Dr. Amy Boyers, a Clinical Psychologist in Miami who specializes in the treatment of eating disorders (all types) and other long term conditions, including addictions, bipolar, and OCD. I offer personalized and sophisticated eating disorder treatment services, individual and family psychotherapy, family member support and education, in-home meal support, coordination of a treatment team, and much more.

Have any questions about the eating disorder recovery process? I’d be happy to answer them. Simply reach out to me and I’ll be sure to answer anything you want to know.

I look forward to helping you obtain a brighter tomorrow.

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