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What are the definitions of specific types of Eating Disorders, their symptoms and consequences?

In this part of the series on Eating Disorders, I will give you an overview of each named disorder in article one. Their definitions, the behaviour of a person with the disorder and the health consequences of the disorder.

1. ANOREXIA - SELF-STARVATION.

The definition is simple, but there is nothing simple about this mental health disorder. It has the highest case mortality rate and second-highest crude mortality rate of any mental illness. It may start very innocently. “Want to eat healthy”, “Want to lose weight”, “Want to look good”…etc.

There are two subtypes of anorexia nervosa:

• Restricting: losing weight by dieting, fasting or excessively exercising.

• Binge-eating/purging: intermittent binge eating and/or purging behaviours.

Some of the mental symptoms, that you may also find in other ED too are:

• Overly focused on and/or secretive behaviour around food

• Self-consciousness when eating in front of others. Sometimes to the extent of not eating in company of others.

• Low confidence and self-esteem

• Poor body image, dysmorphia. They don’t see themselves as others see them.

• Irritability and mood swings

• Tiredness

• Social withdrawal

• Feelings of shame, guilt, and anxiety

• Difficulty concentrating

• Lying

Some physical consequences of Anorexia and other ED:

• Ceasing of Menstrual periods and other hormonal problems

• Dehydration

• Dizziness or fainting from dehydration

• Brittle hair/nails

• Cold intolerance

• Muscle weakness and wasting

• Heartburn and reflux (in those who vomit)

• Severe constipation, bloating and fullness after meals

• Stress fractures from compulsive exercise as well as bone loss resulting in osteopenia or osteoporosis (thinning of the bones)

• Fatigue

• Food intolerance like histamine, casein, lactose or other food intolerance because of a weakened digestive system

• Secondary malabsorption MAS. In general MAS has many reasons, but in this case it is the weakening of the gastrointestinal tract from starvation. The body stops absorbing nutrients and even after starting to eat properly, the person either doesn’t gain weight or still looses weight. This many times is misdiagnosed as the person still deceiving the healing system and is still holding on to anorectic behaviour.

• Changes in the brain/Decoding of the brain like in time loosing appetite, no more feelings of hunger, altered processing of taste, elimination of likes and dislikes in food.

• and many other

2. Bulimia Nervosa - SELF-INDUCED VOMITING or PURGING after eating.

People with bulimia are usually caught in a cycle of eating and throwing up, or using laxatives. Bulimia is often associated with Binge Eating, which is the compulsive eating of large amounts of food (overeating) and then trying to compensate for this overeating by vomiting, and/or using laxatives or diuretics, or/and excessive exercise. A bulimic person may not overeat, but they may feel that the food they just ate may cause them to gain weight, so they start throwing up.

Just as with Anorexia people with bulimia place strong emphasis on their weight and shape, and may see themselves as much larger than they are. But what is interesting and people do not realise that unlike anorexia, people with bulimia are often a normal weight. For example vomiting cannot get rid of all the calories ingested, even when done immediately after eating. Even using laxatives doesn’t help a person lose weight. Because eating disorders are a mental health issues, you may find that there is sometimes no real logic behind the actions.

The consequences of Bulimia are similar to Anorexia, but we must add the possibility of destructing of the digestive system from purging and acid in vomit like

• Tooth decay

• Gum disease

• Damage to the esophagus

• Esophagus burst

• Swollen neck face “Bulimia face”

• Hoarse voice

• other

3. Binge Eating - (BED) EATING LARGE QUANTITY OF FOOD OVER A SHORT PERIOD OF TIME

Binge eating is one of the most common ED. It is not about “overindulging” that many of us have once in a while. It is not even when working all day forgetting to eat and then eat everything that is in sight in the evening once we are at home. It may start by wanting to diet, so a person starves during the day, but later the hunger overcomes the person and it drives him or her to consume whatever is at hand at the moment. Binge Eating is diagnosed when a person experiences BE at least once a weak during a three months period.

Binge eating episode can include one or more of these processes:

• eating much faster than normal

• eating until feeling uncomfortably full

• eating large amounts of food when not physically hungry

• eating alone through embarrassment at the amount being eaten

• feelings of disgust, shame or guilt during or after the binge

• feeling disconnected from what they are doing during the episode

• stealing or hoarding food

• creating rituals or schedules for BED

Binge eating is many times associated with strong negative or even positive emotions that the person may be overwhelmed with. It can also be stemmed from boredom which is very common. This specific disorder is more common with men than other disorders. Around 40% of people who are diagnosed with BED are male.

4. Compulsive Eating - EXCESSIVE OVEREATING

For someone to be considered a compulsive overeater, they have to eat large amounts of food whether they’re hungry or not.

There are two types:

• eating large amounts of food at one time. It can also fall under the definition of Binge eating when it’s done once every couple of days, but when someone excessively eats everyday even many times during the day than it is considered an overeating compulsive disorder.

• Grazing. Grazing is when someone continually snacks throughout the day, even if they aren’t hungry.

Binge Eating and Overeating has many long term health risks that can be even fatal. Here are some:

• Type 2 diabetes

• Heart disease

• Center types of cancer

• other

Interesting fact. BED and overeaters in general do not have to be obese even though it is the most common physical attribute of people diagnosed with these disorders. People in smaller or average-sized bodies can also struggle with compulsive eating and binge eating. How is it possible and how to diagnose it? Well they may have faster metabolism than others so they can burn more calories, or they may even exercise excessively. So how do we know that they have the disorder or not, or it is just a normal eating habit for them?

When it is connected to an inability to cope with trauma and emotions. Another common reason for overeating or BED is emotional compensation or even emotional numbness which means the inability to even feel any kind of emotions.

5. ARFID - Avoidant/Restrictive Food Intake Disorder - AVOIDING CERTAIN FOODS OR TYPES OF FOOD.

There are these types:

• Sensory-based avoidance or restriction of intake. People with this disorder are very sensitive to the taste, texture, smell, or appearance of certain types of food, or only able to eat foods at a certain temperature.

• Fear or anxiety of the consequences of eating induced by a traumatic experience in the past, like for example choking on some food. They restrict their intake to “safe foods”. Sometimes they do not realise the specific reason for their fear.

• Low interest in eating (low or no appetite). I have met many people who do not recognise that they are hungry. They take eating as a chore. There are many reasons for this inability to feel hunger and it can be because of some health issue or an unknown past traumatic experience.

6. Orthorexia - AN UNHEALTHY OBSESSION WITH EATING “PURE” OR “HEALTHY FOOD.

It is important to emphasise the word OBSESSION. It is used as a coping mechanism to cope with negative thoughts and emotions, or to feel in control to have some kind of sense of security. Food considered “pure/healthy” or “impure/unhealthy” can vary from person to person.

Another symptom is a strong feeling of guilt after eating anything that may be considered unhealthy or impure to them and that can cause depression or anxiety.

The biggest problem with this kind of eating disorder is that a person diagnosed with this specific disorder may in time find through “unprofessional” recommendations, opinions, that all foods are unhealthy and they stop eating food with important nutrients for their body or stop eating food at all.

This disorder, as many other, may start with wanting to be healthy and eat healthy and after a while it gets out of control because of all the contradicting information. They go as far as taking an existing theory about healthy eating and adapting it with additional beliefs of their own. It may even stem from fear of death. People with Orthorexia and other ED have an extreme disability to give themselves permission to indulge in food and enjoy it to the fullest.

7. OSFED - OTHER SPECIFIED FEEDING or EATING DISORDER

When a person doesn’t exactly fit the description of any disorder definition. They may have atypical symptoms like low frequency bulimia or binge eating. Atypical anorexia with all the symptoms, but the weight remains within a “normal” range.

8. PICA - EATING NON-FOOD SUBSTANCES

Eating for example paper, soap, paint, chalk, ice, nails, glass or other. When small children stuff their mouthes with toys it isn’t considered a disorder, because it is a normal behavioural aspect for babies under the age of two. It is very common with pregnant women when they start having strange cravings for non-food substances like biting walls or chewing chalk … etc. But many pregnant women do not give into these strange cravings. According to doctors, it can occur due to some mineral deficiency like Iron deficiency, or calcium deficiency.

Some non-food substances can be very dangerous and must be dealt with immediately after consumption like nails and glass and some influence the person’s health after consuming it for a longer period of time like paper, cotton and other.

People with pica don’t usually avoid eating regular food.

9. Rumination Disorder - REPETITIVE, HABITUAL BRINGING UP, VOMITING OF FOOD

The person may re-chew and re-swallow the food or just spit it out. The food might be even partly digested. People with this disorder may have the feeling of satisfaction with this kind of behaviour.

10. Bigorexia - MUSCLE DYSMORPHIA THAT A PERSON IS NOT BIG ENOUGH

It is the opposite of the need for a slim/thin body. It is the preoccupation with the idea that your body is not big enough or not muscular enough. It may not be considered an eating disorder, but may bring a lot of extremely unhealthy relationship with foods or artificial substances that support the build of muscle mass. It is also characterised by individuals' desire to have less fat mass.

11. Alcohorexia - SUPPRESSING FOOD INTAKE TO REPLACING IT WITH ALCOHOLIC BEVERAGES

With this diagnosis people commonly avoid consuming any type of food for hours or even days before drinking alcohol. It is as if not eating calories in food to be able to drink alcohol beverages. They are many times very knowledgeable about the detailed caloric content of each drink. People with Alcohorexia want to lose weight but don’t want to give up alcohol in their lives. It is also called drunkorexia, because it is associated with alcoholism. It affects 3 times more women than men. It is also more frequent with university students.

The following complications may occur from this disorder (similar to classic alcoholism)

• Memory impairment

• Alcohol-Induced Organic Mental Disorders

• Fatty liver and cirrhosis

• Chronic tiredness

• Arrhythmias

• Speech disturbance

12. Night Eating Syndrome (NES) - A COMPULSION TO WAKE UP AT NIGHT TO EAT

This eating disorder that causes people to wake up and eat several times a night in order to fall back to sleep. People with NES feel like they won’t be able to get back to sleep without eating. The craving for food during the night isn’t influenced by not having dinner. Many people with this syndrome will have the compulsion even after having dinner. NES can lead to poor quality of sleep and a number of chronic health conditions.

NES may arise when the body’s internal clock does not synchronise sleep and meal patterns with one another. Researchers estimate that approximately 1.5% of people have night eating syndrome. It appears that people with this syndrome have lower levels of leptin at night. Leptin is a hormone that causes feelings of fullness, so lower leptin levels might increase appetite. Those with NES may also experience changes to other hormones, such as ghrelin, melatonin, cortisol, and thyroid-stimulating hormone, which regulate sleep-wake cycles, hunger, and stress levels.

CONCLUSION

Again, ED is a mental health issue and is not the fault of the person with the disorder. The disorder itself is not a cause, but a consequence of other psychological problems, which can be different from person to person. Their main cause is not how a person actually looks and wants to look like, but how they feel and what they really think about himself. During interviews with patients with ED who, for example, wanted to reach a specific number on the scale, they admitted that it did not bring them the happiness they were looking for and they did not feel good psychologically for a long time.

In the next, last article of this series, I will write about how a person with ED can behave, how the environment can detect it and how to help, and what are the treatment methods.