Lesser Known Eating Disorders: Beyond Anorexia and Bulimia

When we think of people with eating disorders, we tend to imagine frail, thin young women who severely restrict calories or binge and purge. This image is based on a cultural stereotype of anorexia nervosa and bulimia nervosa, two of the most well-known eating disorders.

But not only is this image an incorrect portrayal of anorexia and bulimia – people of any gender can get these disorders, and they don’t always cause weight loss – these also aren’t the only two eating disorders out there. There is a much wider variety of eating disorders, and it’s important to challenge stereotypes and understand eating disorders encompass a broader spectrum.

In this article, we’ll introduce five lesser-known types of eating disorders, including ARFID, orthorexia, and pica.

Lesser-known types of eating disorders

In addition to bulimia and anorexia, which most people are familiar with, there are several other types of eating disorders.

Binge-eating disorder

Binge-eating disorder is the most common eating disorder in the United States, far more common than anorexia or bulimia.

You may have heard of binge eating before, but people with binge-eating disorders are often misunderstood. Because they typically don’t experience the extreme weight loss associated with anorexia or bulimia, the public may not think of binge eating as an eating disorder. But make no mistake – binge-eating disorder is an eating disorder and can have devastating health consequences.

Symptoms of binge-eating disorder

The symptoms of binge-eating disorder include:

• Having time-limited periods (usually lasting around 2 hours) when you eat more quickly or in more significant amounts than you usually do
• Feeling like you have no control over your eating during these periods
• Eating until you’re uncomfortable during binge-eating periods
• Feelings of disgust, shame, and self-loathing that follow each binge-eating period
• Eating alone or in secret because you’re embarrassed

Although body image concerns aren’t listed as a diagnostic criterion for binge-eating disorder, most people with this condition do have issues with their body size or appearance. They may connect their sense of self-worth to their body.

Consequences of binge-eating disorder

The shame and guilt associated with binge-eating disorder is one of the most complex parts to deal with. This can significantly affect your mental health and self-esteem. In addition, post-binge shame can lead to yo-yo dieting – when you restrict calories after a binge-eating period to “make up for it.”

Binge-eating disorder is highly linked with depression. Binge-eating disorder and depression can become locked in a never-ending cycle, with depressive episodes making binge-eating worse and vice versa. Binge-eating disorder can also lead to rapid weight gain and obesity and its associated health risks like heart disease.

Avoidant/restrictive food intake disorder (ARFID)

Avoidant/restrictive food intake disorder, or ARFID, is a lesser-known eating disorder that causes people to be extremely picky with their food to the point where it becomes dangerous. It’s more common in children, although it does happen in adults. People with autism and ADHD are at higher risk of developing ARFID.

Symptoms of ARFID

The symptoms of ARFID include:

• Being uninterested in or disgusted by food because of taste, texture, smell, appearance, or another characteristic
• Being so disgusted and picky with food you aren’t able to eat enough to meet your nutritional or caloric needs
• Significant weight loss, nutritional deficiencies, or dependency on a feeding tube
• Food avoidance gets in the way of interpersonal relationships; for example, you might refuse to share mealtimes with family members

ARFID is unique among eating disorders in that people who live with it aren’t concerned about body image. It’s more about avoiding certain foods for reasons unrelated to wanting to lose weight.

Consequences of ARFID

Because ARFID causes food restriction so severe your diet no longer meets your caloric or nutritional needs, it can cause severe weight loss and serious health consequences.

Because of the severe weight loss, ARFID and anorexia have some similar health consequences. For example, people with untreated ARFID may:

• Be malnourished
• Have anemia or low hormone levels
• Have dry, brittle nails and skin
• Experience muscle weakness
• Get dizzy or faint
• Always feel cold and have cold, swollen feet
• Experience hair loss
• Have a damaged immune system

When left untreated, the malnourishment associated with ARFID can lead to malnutrition, low heart rate, stomach problems, iron deficiency, electrolyte imbalance, and more.

In addition, ARFID often has a severe negative impact on interpersonal relationships. ARFID can make mealtimes stressful and can drive loved ones away.

Pica

Pica has only been officially designated as an eating disorder since the latest edition of the DSM (DSM-V), but that doesn’t mean it’s a new disorder. The term has been used since the 1500s to describe this set of symptoms. The name comes from a type of bird that eats unusual things^[1].

People with pica have a compulsion to eat and swallow things that are not food, which can sometimes cause severe health effects. Pica is more common in children under six years of age and pregnant people. Mostly, people with pica also don’t have severe worries about body image. The causes of pica are still poorly understood.

Symptoms of pica

According to the DSM-V, the symptoms of pica include^[2]:

• Persistently eating non-food items for over a month
• Eating these items even when it’s developmentally inappropriate (for example, it is common for babies to put toys in their mouth; this wouldn’t be considered a form of pica)
• Eating these items when it’s not culturally significant

There is a wide range of things that people with pica may eat, including:

• Ice
• Dirt
• Soap
• Paper
• Chalk
• Feces
• Pet food
• Hair

Consequences of pica

Regarding health consequences, how harmful pica is depends on what you have a compulsion to eat. For example, many pregnant women are compelled to eat ice and may be able to do so safely.

This isn’t true for other compulsions, like eating feces or harmful toxins. Some items can cause damaged teeth, parasitic or bacterial infections, or ingesting dangerous poison.

In addition, pica can be very harmful to mental health as people with pica can feel ashamed and guilty for their behaviors. This might lead to symptoms of depression and damaged relationships.

Rumination disorder

“Rumination disorder” can sound like it describes someone who ruminates on negative thoughts, but this isn’t the case. Rumination disorder is an eating disorder that causes people to regurgitate undigested food repeatedly and then chew it again^[3].

Rumination disorder is different from purging in that people aren’t intentionally trying to regurgitate their food – it happens without effort. People who purge do so on purpose to try to avoid calories. People with rumination disorder typically don’t have body image concerns and aren’t intentionally trying to lose weight.

Although rumination often happens in children and people with developmental disabilities, we now know it can happen at any age. People with depression, anxiety, and other mental health conditions are more likely to develop rumination disorder.

Symptoms of rumination disorder

The symptoms of rumination disorder are:

• Effortlessly regurgitating undigested or partially digested food, usually within minutes of eating, but can happen for up to 2 hours after a meal
• Rechewing the regurgitated food and swallowing it again or spitting it out
  Pressure or pain in the stomach is relieved by regurgitation
• Regurgitation isn’t due to another health condition like GERD or gastroparesis
• Regurgitation isn’t nausea, vomiting, or retching. It’s effortless and painless

Consequences of rumination disorder

Rumination disorder itself isn’t life-threatening, but it can cause health problems that can be serious and often debilitating when left untreated.

Some of the complications of rumination disorder include:

• Unintended weight loss and malnourishment, mainly if regurgitated food is spat out
• Damage to teeth
• Bad breath
• Sensitive GI tract, which can lead to nausea and bloating
• Damage to esophagus

In addition, rumination disorder can negatively affect interpersonal relationships and lead to social isolation.

Orthorexia

Orthorexia, in essence, is “clean eating” taken to the extreme. People with orthorexia become so obsessed with “healthy,” acceptable foods it starts to affect their daily lives negatively.

Orthorexia isn’t an official diagnosis that’s included in the Diagnostic Statistical Manual (DSM). However, the term “orthorexia nervosa” is sometimes used within mental health circles, and experts say it’s becoming more and more common.

Symptoms of orthorexia

Because orthorexia isn’t included in either the DSM or the International Classification of Diseases (ICD), there is not yet a defined list of diagnostic criteria for this condition. However, according to experts, symptoms of orthorexia include:

• Excessive worries about the nutritional value or “cleanness” of the food they’re consuming
• Valuing the nutritional content of food over the taste or experience
• Compulsively checking food labels or checking whether a food is organic or pesticide-free
• Spending over 3 hours every day thinking about the food they consume
• Being very strict about how food is prepared and refusing to eat food others have prepared

These symptoms may or may not be accompanied by body image concerns.

Consequences of orthorexia

If orthorexia is severe enough to cause food restriction and weight loss, then it could have similar health consequences to those associated with anorexia or ARFID. These include:

• Malnutrition
• Weakened immune system
• Brittle bones and nails
• Anemia
• Electrolyte imbalance

Even when orthorexia doesn’t cause weight loss, it can cause severe life disruptions – for example, refusing to eat out at restaurants or others’ houses can negatively impact social life.

Whole-person eating disorder treatment

No matter what eating disorder you live with, these conditions make life incredibly challenging – and when left untreated, many can have life-threatening consequences. Thankfully, eating disorders can be successfully treated and managed with the proper support.

The Center • A Place of HOPE has been helping people beat eating disorders for four decades. Our founder, Dr. Gregory Jantz, created our proven Whole Person Care method in the 1980s, understanding successful treatment must address your physical, emotional, and spiritual health.

The Center offers eating disorder treatment that combines psychotherapy and nutritional counseling. We accept many insurance plans, and financing is also available.

Get in touch with our intake department today to learn more about admissions.

1 – https://publications.aap.org/pediatrics/article-abstract/44/4/548/78285/THE-ORIGIN-OF-THE-WORD-PICA?redirectedFrom=fulltext
2 – https://www.ncbi.nlm.nih.gov/books/NBK532242/
3 – https://www.ncbi.nlm.nih.gov/books/NBK576404/