When it comes to the various types of clinical eating disorders (i.e. the types of disorders that are considered “official” diagnoses per the Diagnostic and Statistical Manual of Mental Disorders), there are just a few — but there is still a great deal most people don’t know about eating disorders. Many have heard of anorexia (characterized by food restriction, malnutrition, and a fear of weight gain) and bulimia (episodes of overeating, otherwise known as bingeing, followed by purging). Even though it’s the most common eating disorder, fewer people are as familiar with the nuances of binge eating disorder (BED), characterized by recurrent binges accompanied by a feeling of a loss of control, as well as shame, distress, or guilt.
But there are other diagnosable forms of eating disorders according to the DSM, as well, and even more variations on eating disorders that are poorly understood and rarely discussed.
Types of eating disorders you may have heard of
The latest edition of the DSM (the DSM-5) has increased the number of eating disorder diagnoses from three to eight. In addition to anorexia, bulimia, and BED, the DSM includes criteria for pica, rumination disorder (RD), and Avoidant/Restrictive Food Intake Disorder (ARFID) . Additionally, there are also two broader “umbrella diagnoses”: Other Specified Feeding or Eating Disorder (OSFED) and Unspecified Feeding or Eating Disorder (UFED). There are also other variations on other categories of eating disorders, like a binge-eating and purging subtype of anorexia known as AN-BP, which is characterized by restriction, binge eating, and/or purging.
All these variations and categorizations are important to recognize as they reflect a variety of experiences. But according to experts like Cara Bohon, VP of Clinical Programs at Equip, it’s also important to acknowledge how labels can sometimes inadvertently silo and separate disorders that exist on a spectrum — a spectrum that can be dangerous or even deadly no matter how a disorder specifically manifests. “Sometimes listing OSFED and UFED separate from the formal diagnoses can minimize the dangers, which is why I like to think about how they actually fit into our existing diagnoses, which most people know we need to take seriously,” Bohon explains.
Bellow are the lesser known eating disorder variations many people may be unfamiliar with — and why shedding more light on them is important for legitimating the complexities of eating disorders.
Less common eating disorders
Avoidant Restrictive Food Intake Disorder (ARFID): Formerly known as “Selective Eating Disorder,” ARFID involves limiting the amounts or types of food one eats. Although it’s similar to anorexia because it involves restriction, it doesn’t typically involve anxiety and distress over body image or fear of fatness, which are characteristic of anorexia. However, the potential long-term complications of ARFID can be just as severe as those of anorexia, including electrolyte imbalances, which can lead to sudden death.
Pica: Individuals with pica may eat items that are not typically thought of as food and do not contain significant nutritional value. Some examples of items people with pica might consume include dirt, hair, and paint chips. Diagnosing the disorder involves taking a patient’s clinical history and possibly reviewing lab tests for anemia, potential intestinal blockages, and toxic side effects of substances consumed (like lead in paint or bacteria/parasites from dirt).
It’s unclear how many people are affected by pica, but anyone of any age can develop it. The symptoms of pica may include persistent eating (i.e. over a period of at least one month) of substances that aren’t considered food and are not part of a culturally or socially normative practice. Typically, people with pica don’t have an aversion to eating actual food.
Rumination Disorder: There are various forms of rumination disorder, but in general, the condition involves regularly regurgitating food and then either re-chewing it, re-swallowing it, and/or spitting it out. Most people with this disorder don’t appear to be making an effort to do these actions, nor do they seem upset, stressed, or disgusted by what they’re doing. People with rumination disorder usually aren’t engaging in these behaviors because of any underlying medical condition, and the behaviors themselves aren’t necessarily part of any other eating disorder diagnosis like anorexia, bulimia, or BED (but they can be correlated with anxiety and can accompany another eating disorder). The most common treatment for rumination disorder involves breathing exercises and habit reversal, meaning the person experiencing it learns to recognize the signs and situations that trigger the behavior, and then practices deep breathing techniques in an effort to prevent the regurgitation from happening.
Other Specified Feeding or Eating Disorders (OSFED): Previously referred to as Eating Disorder Not Otherwise Specified (EDNOS), OSFED is a “catch-all’ classification that was initially developed to include the many individuals who did not necessarily meet the strict diagnostic criteria for anorexia or bulimia, and were still at risk for serious — even life-threatening — consequences. There are myriad examples of OSFED, but a few common ones include:
- Atypical Anorexia Nervosa, which means a person meets all the criteria for anorexia but their weight remains within or above what is considered “typical” for age and height (it’s important to note “typical” numbers and ranges are often informed by arbitrary and/or outdated criteria).
- Purging Disorder, which involves recurrent purging (i.e. self-induced vomiting, use of laxatives, exercise, and other methods) that occurs in the absence of binge eating and is intended to influence weight or body shape.
- Night Eating Syndrome involves recurrent episodes of eating after awakening from sleep, or eating excessively after an evening meal.
Unspecified feeding or eating disorder (UFED) — other forms of disordered eating: Otherwise known as UFED, unspecified feeding or eating disorder refers to situations in which symptoms are characteristic of an eating disorder and cause significant distress or impairment, but the symptoms themselves may not meet the full criteria for any one specific disorder.
While there are many forms of disordered eating and a spectrum of behaviors and symptoms, some terms that have received recognition in the media over the last few years include orthorexia, diabulimia, and drunkorexia. While none of these are “official” clinical diagnoses, they can and do wreak significant havoc on the lives of those who suffer from them, and can have devastating consequences, just like any other form of disordered eating.
- Orthorexia involves an obsession with proper or “healthful” eating that can lead to intense fixation and compulsive behaviors.
“Orthorexia is not a formal diagnosis, but can lead to severe impairment or health consequences,” Bohon says. “Indeed, many people may end up with a diagnosis of obsessive-compulsive disorder if the ‘pro-health’ behaviors end up meeting a level of obsessionality or compulsion that warrants the diagnosis. Or alternatively, the behaviors could rise to the level of anorexia nervosa where the ‘healthy eating’ has become severe food restriction of entire nutrients due to fear of fatness, resulting in malnutrition despite the supposed goal of achieving ‘health.’” While there are no clinical treatments developed specifically for orthorexia, the condition is often addressed with the same forms of psychotherapy and exposure therapy experts use to treat anorexia and/or obsessive-compulsive disorder.
- Diabulimia typically occurs in individuals with type-1 diabetes, and involves purposefully restricting insulin in an effort to lose weight. Some medical professionals call this “Eating Disorder-Diabetes Mellitus Type 1” (ED-DMT1), which is used to describe any form of disordered eating that co-occurs with type-1 diabetes.
“Diabulimia is really a form of bulimia nervosa, but rather than the compensatory behavior of vomiting or laxative abuse as many think about in bulimia nervosa, people with diabulimia misuse their insulin to impact their weight and shape,” Bohon explains. “It requires particular close medical monitoring, by skilled physicians given the particular medical dangers involved.”
- Drunkorexia refers to a form of disordered eating in which individuals restrict their caloric intake and/or exercise excessively in an attempt to “mitigate” the calories from alcohol consumption. The affected individual may suffer from an eating disorder, substance use disorder, or both. Reducing food calories in favor of alcohol can have significant risks, including overconsumption of alcohol and a greater degree of intoxication, an increased risk of nutrient deficiencies, and other serious consequences associated with other forms of disordered eating.
Regardless of whether an individual is formally diagnosed with an eating disorder defined by the DSM or is suffering from a more nuanced form of disordered thoughts and behaviors, the implications can be serious and even deadly. Reaching out for help, support, and treatment is essential to full recovery, no matter if the issue comes with a recognized label or not. If you're concerned about yourself or a loved one, talk to your doctor or schedule a consultation with our team.