Understanding the Types of Eating Disorder

Eating disorders are complex and serious mental health conditions that can often go undiagnosed. Eating disorders are more than just eating a lot, puking the food you eat or not eating at all. Eating disorders impact the relationship of the person with food, body image issues, self-esteem, and many more psychological phenomena. Understanding the correct symptoms for the different types of eating disorders is the first step towards a healthier self.

Types of Eating Disorder according to DSM- V

The DSM-V mentions the following disorder under ‘Feeding and Eating Disorders.’ These disorders are “characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.”

1. Pica : Pica disorder is diagnosed when there is “persistent eating of nonnutritive, nonfood substances over the period of at least 1 month.”

This often causes a hinderance in the developmental level of the individual and might need clinical attention if it occurs in the context of another mental disorder like intellectual disability, autism spectrum disorder, or medical condition like pregnancy.

This is more common in those with intellectual disability and its onset may be seen in childhood, adolescence, or adulthood, with childhood being the most common.

2. Rumination Disorder : Rumination disorder is characterised by “repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.”  

This previously swallowed or digested food is bought up into mouth without nausea, involuntary retching, or disgust. The food is then re-chewed and then re-ejected from the mouth or re-swallowed. Regurgitation should occur at least 6-7 times a week, typically daily in rumination disorder.

It is common in individuals with intellectual disability. Psychological problems such as neglect, stressful life situations and issues in parent-child relationship might lead to this disorder.

3. Avoidant/Restrictive Food Intake Disorder (ARFID) : ARFID is characterised as an eating or feeding disorder where the individual feels “an apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating.”

The main diagnostic feature of ARFID is “avoidance or restriction of food intake.” This is manifested by “clinically significant failure to meet requirements for nutrition or insufficient energy intake through oral intake of food.” The following key features are also present-

• significant weight loss
• significant nutritional deficiency (or related health impact)
• dependence on enteral feeding or oral nutritional supplements, or
• marked interference with psychosocial functioning

4. Anorexia Nervosa : The three essential features of Anorexia nervosa are-

• persistent energy intake restriction
• intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain
• a disturbance in self-perceived weight or shape

An individual with anorexia nervosa will maintain body weight below the normal level for their age, sex, physical health, or developmental trajectory. Those with anorexia will often deny the problem and they lack insight into it. The starting and or purging behavior can often become life threatening. Those with anorexia might also have depressive signs and symptoms such as social withdrawal, insomnia, depressed mood and irritability.

5. Bulimia Nervosa : This is characterized by “recurrent episodes of binge eating” and followed by “recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.”

Both the behaviours occur at least once a week for 3 months for it to be classified as Bulimia nervosa.

6. Binge Eating Disorder : The two ways through which an episode of binge eating can be classified are-

1. 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.
2. 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).

In binge eating disorder, the binge eating episode will have the following disorders-

• 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.

Bing eating disorder is highly prevalent among US adults and more among females, than males. It is mostly seen in adolescent and college-age students.

7. Other Specified Feeding or Eating Disorder (OSFED) : This includes those disorders that meet the criteria for eating and feeding disorder, but do not meet full criteria for any disorder. These include:

1. Atypical anorexia nervosa- This meets the criteria for anorexia nervosa, except the weight is within or above the normal range rather than significant loss.
2. Bulimia nervosa (of low frequency and/or limited duration)- This meets the criteria for bulimia nervosa, except that binge eating and inappropriate compensatory behaviours occur, on average, less than once a week and/or for less than 3 months.
3. Binge-eating disorder (of low frequency and/or limited duration): Binge eating occurs, on average, less than once a week and/or for less than 3 months.
4. Purging disorder: The individual indulges in recurrent purging behaviour to influence weight or shape (e.g., self-induced vomiting; misuse of laxatives, diuretics, or other medications) in the absence of binge eating.
5. Night eating syndrome: The individual indulges in recurrent episodes of night eating, this includes eating after awakening from sleep or by excessive food consumption after the evening meal.

Orthorexia

Another eating disorder that has become extremely common these days is Orthorexia. Though this is not mentioned in the Diagnostic and Statistical Manual of Mental Disorders, Orthorexia is an unhealthy focus on eating in a healthy way. People with these disorders are obsessed with eating healthy or pure food or food they make themselves. This fixation might cause poor health and well- being. Eating healthy is good, but obsession that goes to such a high level is often more harmful than being good.

Eating disorders often need careful observation an at earlier stage so that it can be dealt with and resolved. At North Amercian Behavioural Health Services, we are committed to helping you and your loved ones recognise this and offer the correct remedial methods. Take the first step in understanding your relation with food and make it better.