What are Eating Disorders?
Eating disorders are a group of complicated mental health issues that can lead to severe physical health issues if left untreated in the long-term. Even in the field of mental health, eating disorders continue to be misunderstood and have a terrible reputation of being hard to work with, which they definitely can be.
Each type of eating disorder comes along with its specific diagnostic criteria (which are outlined in the DSM-5), but the nuances between each of them are only a little bit relevant in clinical practice. It is more helpful to understand eating disorders as complicated illnesses that are characterized by a challenging relationship with food, accompanied by intrusive thoughts about food and the body that lead to unhealthy and abnormal patterns of eating. The three primary symptoms experienced by patients with eating disorders are bingeing, purging, and restricting.
What Are Some Different Types of Eating Disorders?
The primary or most common eating disorders are anorexia nervosa, bulimia nervosa, binge eating disorder, orthorexia, and a newer diagnosis, OSFED (which stands for other specified feeding and eating disorders). It is common for patients to either never officially receive a diagnosis or to have an initial diagnosis that changes over time, which is why the labels aren’t overly useful in clinical practice. Usually, someone seeking treatment for an eating disorder will be experiencing one or more symptoms of bingeing, purging, and restriction and will feel burdened by their relationship with food and the way it takes over their life.
Patients who become medically unstable and require medical treatment will typically get an official diagnosis. Most of the time, this is a diagnosis of anorexia since the symptoms of this disorder result in dangerously low body weights. Patients who are struggling with orthorexia, bulimia, or binge eating disorder often look normal, and their struggle can be relatively or easily concealed. Because of the shame inherent in sharing personal struggles with symptoms, patients will regularly leave this out when visiting doctors or therapists and may never be diagnosed. So, regardless of whether someone has been diagnosed or not, eating disorder treatment may be a necessity.
Some types of eating disorders include:
Anorexia is characterized primarily by restriction. Patients exhibit the following symptoms:
- Restriction of caloric intake leading to a significant weight loss and a lower body weight than what would be normal or healthy for their height or development
- Intense, often paralyzing fear of weight gain, which perpetuates the restrictive behaviours
- Disregard for the seriousness of low body weight and distorted body image
In many cases, anorexia is the “gateway” eating disorder. It is most commonly diagnosed in teens or adolescents but can affect a person at any age. If the weight loss is significant enough, refeeding in a hospital setting may be required. Once someone is refed, the intensity of the psychological upset can be amplified, resulting in a patient looking healthy on the outside but deeply distressed on the inside. It is the lack of attention to this internal distress that has patients slip right back into restrictive behaviour, thus repeating the cycle.
A patient may initially present with restriction as their primary symptom, but that restriction could lead to bingeing, or bingeing and purging, complicating their initial diagnosis. It is important to remember that a patient who previously struggled with anorexia can look like they are healthy and recovered, but the reality could be far from that.
Recurring episodes of bingeing and purging characterize Bulimia. Patients exhibit the following symptoms:
- Binge: Eating an objectively large amount of food in a short amount of time (under 2 hours) in a way that is different from what other individuals would do in the same time in the same circumstance.
- Binge: A feeling of being out of control during the food intake
- Purge: Inappropriate compensatory behaviours following the binge to prevent weight gain. The most common form of purging is vomiting, followed by exercise. Additional methods of purging include laxative or diuretic use.
The episodes of bingeing and purging happen at least once each week for three months for an official diagnosis
Binge Eating Disorder
Recurring episodes of binge eating are the main feature of Binge Eating Disorder (BED). Patients exhibit the following symptoms:
- Eating an objectively large amount of food in a short amount of time (under 2 hours) in a way that is different from what other individuals would do in the same period in the same circumstance.
- A feeling of being out of control during the food intake
- Episodes of binge eating include three or more of the following:
- Eating more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not hungry
- Eating alone due to the shame or embarrassment associated with the quantity of food
- Feeling depressed or disgusted with self after
The episodes of bingeing must happen at least once each week for three months.
Purging disorder is not an officially recognized diagnosis by the DSM but is a disorder where a person engages in purging behaviour to influence their body weight or shape without bingeing. Purging behaviour includes vomiting, misuse of diuretics and laxatives, and excessive exercise.
Signs that someone could be purging are:
- Self-isolation during and after meals
- Avoiding big parties or meals with friends where purging after eating might be difficult
- Regularly visiting the restroom immediately after eating
- Consistent diarrhea for a person without gastrointestinal problems can indicate laxative abuse
- Preoccupation with thoughts of eating disorders
- A feeling that vomiting is automatic
- Concerns with body image
- More gastrointestinal distress after meals, than that of a healthy person
Orthorexia is an eating disorder characterized by an obsession with eating only healthy or clean foods that becomes intrusive and increasingly more restrictive for the person experiencing it. Patients often over identify food as the cause for undesired or uncomfortable experiences they are experiencing, which perpetuates the fear of these foods. Each person suffering from orthorexia has a food preference and their own rules. The irony of orthorexia is that the pursuit of health through extremely clean eating becomes very unhealthy.
Symptoms of orthorexia are:
- Feelings of isolation from or superiority to people who consume a kind of food that the person rejects.
- Limiting food choices excessively and often avoiding some or many food groups altogether.
- Paying unusual attention to the health of foods being eaten by others
- Inability to eat foods that are not part of a limited group of what the person deems ‘pure’ or ‘healthy’ foods.
- Demonstrating increased levels of distress when healthy or safe foods are unavailable.
- Spending hours daily thinking about the types of food that might be available at upcoming events
- An obsession with following ‘healthy lifestyle’ and food blogs on social media
- Increased interest in the health of food ingredients
- Sometimes, the person may have concerns about their body image
Exercise addiction is a behavioural condition that is often caused by underlying issues such as eating disorders or a distorted body image. Exercise addiction is not recognized formally as a clinical diagnosis. However, some people struggle with it, just like other substance or process addictions.
Symptoms of exercise addiction include:
- Feelings of intense irritability, anxiety, guilt, or depression after skipping a workout and accompanied by discomfort while inactive or resting
- Withdrawal and isolation from family and friends to create time for the unhealthy workouts. Exercise is often ill-timed, happens in improper settings and interferes with other priorities
- Using exercise as an escape from emotions arising from life’s situations instead of reducing stress and addressing difficulties directly
- Following a consistent, rigid, excessive workout regimen even when exhausted, injured, or sick.
- Happiness or mood depend solely on the results of how the body looks, how fit the person feels, and the results of the latest exercise session.
- Feelings of inadequacy leading to overtraining and a continuous extension of workouts without specific training goals or monitoring from a medical professional
- Exercise ceases to be fun and play and becomes more of a chore.
The term Eating Disorder Not Otherwise Specified (EDNOS) was previously used to describe what is currently known as Other Specified Feeding or Eating Disorders (OSFED). OSFED is a condition where a patient exhibits symptoms and behaviours of an eating disorder that cause clinically significant levels of impairment and distress but do not fully meet the criteria for any specific disorder. These patients do often have a mixture of symptoms seen across multiple eating disorders.
OSFED is a diagnosis of exclusion or a catch-all diagnosis and is made through addressing the reasons why the symptoms that a person exhibits do not fit a specific disorder. In reality, most patients with an eating disorder will not fit perfectly into one of the recognized eating disorders because of the dynamic nature of symptoms.
Indications for a diagnosis of OSFED include:
- Atypical Anorexia Nervosa: The patient exhibits all the signs of Anorexia Nervosa, but their weight remains above or within the normal range.
- Bulimia Nervosa: The symptoms of Bulimia Nervosa are evident, but the frequency of binging and improper compensatory behavior is lower and occurs for three months or less.
- Binge Eating Disorder: The symptoms meet the criteria for BED, but the frequency is lower and occurs for three months or less.
- Purging: Continual purging behaviour without binge eating, to influence body shape or weight.
- Night Eating Syndrome: Repetitive night eating episodes, either by excessive consumption of food after an evening meal or eating after the person awakens from sleep.
Talk to a Health Practitioner!
Living with any eating disorder is unique experience for each individual. Even when two people are suffering from the same eating disorder, the treatment approach is often different for each person. We customize our treatment for you because our objective is a recovery that extends beyond refeeding and interrupting symptoms. The first step to enjoying a healthy life is to book your appointment with one of our practitioners. After you overcome your symptoms and eating disorder, you will be in control and feel secure, capable, and resilient.