Awareness of eating disorders and their impact on people has increased in recent years, in large part due to the growth of eating disorder recovery and body positivity accounts on social media. These platforms, which can be double-edged swords with the fatphobic, diet-industry imagery that are also present, have changed the way people with eating disorders can express themselves. More and more people who would never have ordinarily known the first thing about eating disorders are seeing what survivors have gone through.
Despite this increased awareness, however, there is still a common perception of what eating disorders are and what the people who have them look like. Ask most people outside the eating disorder community, and the first thing they’ll think of is someone who eats very little and is severely underweight. Maybe if they’re more aware, they’ll mention purging behaviors after a person eats. However, these characteristic symptoms of anorexia nervosa and bulimia nervosa, respectively, are only the tip of the iceberg when it comes to eating disorders.
Just as there are characteristics of eating disorders that are relatively unknown, there is also a common misconception of what people with eating disorders look like. Namely, it’s the idea that everyone with an eating disorder is underweight and malnourished. And while this is common in anorexia nervosa, disordered eating behaviors can cause potential physical and mental health complications without causing weight loss or inability to gain weight. There are many other kinds of eating disorders beyond the trio of anorexia nervosa, bulimia nervosa, and binge eating disorder. They don’t fit into any preconceived notion of what eating disorders “should be,” and a person with any of them can be at a variety of body shapes and sizes. Read on to learn more about some lesser-known eating disorders.
Unlike most eating disorders, which involve disordered actions concerning food and body image, pica is a form of eating disorder not associated with food per se. Instead, a person suffering from pica will routinely ingest items that are not considered food, with no nutritional or digestive value. Common things that are eaten in a case of pica might consist of rocks, dirt, hair, or paint chips. There are no medical or laboratory tests for pica, so the diagnosis must be made by analyzing behaviors, namely, persistently eating “non-foods” over at least a month. In some cases, nutritional deficiencies or pregnancy may trigger cravings for minerals, which is not a risk warning for pica. Untreated, pica can cause gastrointestinal issues and blockages.
Orthorexia is a form of eating disorder, still unrecognized in the DSM, wherein a person becomes obsessed with “healthy eating.” While many people make a point to be aware of the ingredients and sourcing of their food, orthorexia can become detrimental to the person’s health. Orthorexia causes people to identify specific food or food groups as “proper,” “healthy,” or “pure.” Eventually, certain foods or entire groups are removed from the person’s diet; they might also begin to obsess over the ingredients in their foods, spending hours each day planning meals. This often begins to interfere with the person’s social life, precluding activities where there might be “bad” foods. Food ingredients might also become the person’s only topic of conversation. Health consequences might include a variety of gastrointestinal and nutritional imbalances. It can also cause many of the same health risks as anorexia nervosa, as the person’s caloric intake may be severely restricted. Orthorexia is also a common co-occurring disorder associated with OCD.
ARFID (Avoidant Restrictive Food Intake Disorder)
Another eating disorder that doesn’t necessarily include behaviors driven by distorted or negative body image, ARFID is however recognized in the most recent diagnostic manual, the DSM-V. With this disorder, a person will strictly avoid certain foods to the detriment of their health. Unlike orthorexia, however, the avoidance of certain foods isn’t driven by notions of the food’s healthiness or purity, but rather by a severe aversion to the food’s flavor, texture, or odor (although concerns about spoilage or food poisoning may also be present). People with ARFID often have phobias about choking on certain foods or getting food poisoning or vomiting if they eat that food. Over time, more and more foods become untenable, leading to an extremely limited palette of acceptable foods.
Formerly known as selective eating disorder, ARFID often begins in childhood and progressively worsens over time. It’s relatively common for children to be “picky eaters” and everyone has preferences for what they eat, but if it becomes compulsive and detrimental to a person’s health, it warrants a check-in with an eating disorder treatment specialist. Like orthorexia, untreated ARFID can cause psychosocial complications, and also severe nutritional imbalances. Also like orthorexia, a negative or distorted body image is not necessarily a cause of the disorder. ARFID is normally treated using talk therapy and cognitive retraining such as Cognitive Behavioral Therapy (CBT).
Unlike most eating disorders which normally first present during adolescence, rumination disorder is most common in infancy and early childhood, although it can persist into adulthood. A person with rumination disorder routinely regurgitates food, which they may spit out or chew and then swallow again. Normally, they do not experience stress or disgust when regurgitating, nor do they appear to make an effort to vomit (as seen in bulimia nervosa). Rumination disorder is often a reaction to an irrational fear of illness caused by eating, although its causes are less well-understood than other eating disorders. Treatment normally involves talk therapy as well as behavioral therapy such as training to use deep breathing techniques when regurgitation appears to be coming. Rumination disorder is listed in the DSM-V.
One of the most dangerous forms of eating disorder, ED-DMT1 (colloquially called diabulimia), occurs when a person with type-1 diabetes intentionally skips their insulin dosage to lose weight. Diabulimia is listed as one of the many unspecified eating disorders under the catchall term OSFED (Other Specified Feeding r Eating Disorder). It can be triggered by the intense focus on food intake and body weight that diabetes brings on, but it can also be a result of body image distortions and the desire to lose weight.
Restricting insulin as well as food can be quite dangerous; lowness to heal from cuts and bruises, dizziness and fainting, organ failure caused by diabetic ketoacidosis, strokes, various staph, and other infections, and death can result unless insulin is properly administered. Eating disorder treatment is often focused around talk therapy, but diabulimia normally required a residential treatment facility where medical support can be applied 24/7.
While not strictly an eating disorder since it does not center on food or eating, compulsive exercise or “exercise addiction” is a common behavior associated with many eating disorders. It can exist without an eating disorder being present as well. Although exercise is recommended by virtually every doctor and medical professional, it can become detrimental to a person’s physical and mental health if it becomes compulsive. People with an exercise addiction will exercise at inappropriate times and situations, and their need to exercise can begin to interfere with their social life and even employment. Other signs that exercising has become compulsive include exercising in bad weather, exercising being required as “permission” to eat, and continuing to exercise after an injury or illness.
Excessive exercise, especially when combined with disordered eating behaviors, can cause difficulties with bone density, bone and tendon injuries, and heart difficulties. It’s a common enough symptom of eating disorders such as anorexia nervosa and bulimia nervosa that most eating disorder treatment programs include a segment related to promoting mindful movement that can alleviate compulsions to work out. Even if an eating disorder isn’t apparent, exercise addiction can warrant mental health treatment.
Less Well-Known, but Still Treatable
Although public awareness of the major eating disorders and body positivity is growing, it can still be a frightening experience to be diagnosed with an eating disorder. That might be made even worse if it’s not an eating disorder with a higher profile. However, there is no need to fear if you or a loved one is showing any signs and symptoms of these less well-known eating disorders. They are all treatable and people have recovered from each of them with professional help and therapy. When the symptoms of any of these disorders have been made clear, don’t hesitate. Reach out to your doctor, therapist, or an eating disorder treatment center today, and get started on a full recovery.