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Anorexia nervosa involves self-starvation; the body is denied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences.

Symptoms

• Resistance to maintaining body weight at or above a minimally normal weight for age and height.
• Intense fear of weight gain even if underweight.
• Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight.

Subtypes: Restricting type, binge-eating, or purging type.

Eating disorders experts have found that prompt intensive treatment significantly improves the chances of recovery. Therefore, it is important to be aware of some of the warning signs of anorexia nervosa.

Warning Signs

• Dramatic weight loss.
• Preoccupation with weight, food, calories, fat grams, and dieting.
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.).
• Frequent comments about feeling overweight despite weight loss.
• Anxiety about gaining weight.
• Denial of hunger.
• Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).
• Consistent excuses to avoid mealtimes or situations involving food.
• Excessive, rigid exercise regimen despite weather, fatigue, illness, or injury.
• The need to “burn off” meals.
• Withdrawal from usual friends and activities.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Health Consequences of Anorexia

• Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as heart rate and blood pressure levels sink lower.
• Reduction of bone density (osteoporosis), which results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin, hair loss is common.
• Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

About Anorexia

• Approximately 90% of anorexia nervosa sufferers are girls and women.
• Between 0.5–1% of American women suffer from anorexia nervosa.
• Anorexia nervosa is one of the most common psychiatric diagnoses in young women.
• Between 5-20% of individuals struggling with anorexia nervosa will die. The probability of death increases within that range depending on the length of the condition.
• Anorexia Nervosa has one of the highest death rates of any mental health condition.
• Anorexia Nervosa typically appears in mid to late adolescence.
• 33 to 50% of anorexia patients have a comorbid mood disorder, such as depression. Mood disorders are more common in the binge/purge subtype than in the restrictive subtype.
• About half of anorexia patients have comorbid anxiety disorders, including obsessive-compulsive disorder and social phobia.
• 1-5 percent of all females age 15-22 will develop anorexia, with an average onset age of 17.
• 10 percent of all anorexia sufferers are male.

More information about Anorexia from patient.info.

Bulimia nervosa (often just called bulimia) is a condition where you think a lot about your body weight and shape, frequently having intense feelings of guilt and/or shame. It affects your ability to have a ‘normal’ eating pattern as a cycle is often created – dieting, the subsequent “starvation reaction” or binge eating, followed by some manner of maladaptive compensatory behavior.

Individuals are often average weight for their height, but many are slightly above or below this- the incorrect assumption that someone must be underweight or “thin” to have an eating disorder is one of the reasons the warning signs of Bulimia can be missed.

Symptoms

• Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.
• Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise.
• Extreme concern with body weight and shape.

The chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa.

Warning Signs

• Evidence of binge eating, including the disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
• Excessive, rigid exercise regimen despite weather, fatigue, illness, or injury.
• The compulsive need to “burn off” calories taken in.
• Unusual swelling of the cheeks or jaw area.
• Calluses on the back of the hands and knuckles from self-induced vomiting.
• Discoloration or staining of the teeth.
• Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.
• Withdrawal from usual friends and activities.
• Loneliness, due to self-imposed isolation
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
• Continued exercise despite injury; overuse injuries.

Health Consequences of Bulimia Nervosa

Bulimia nervosa can be extremely harmful to the body. The recurrent binge-and-purge cycles can damage the entire digestive system and purging behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Some of the health consequences of bulimia nervosa include:

• Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death.  Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.
• Inflammation and possible rupture of the esophagus from frequent vomiting.
• Tooth decay and staining from stomach acids released during frequent vomiting.
• Chronic irregular bowel movements and constipation as a result of laxative abuse.
• Gastric rupture is an uncommon but possible side effect of binge eating.

About Bulimia Nervosa 

• Bulimia nervosa affects 1-2% of adolescent and young adult women.
• Approximately 80% of bulimia nervosa patients are female.
• Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health.
• Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment.
• Risk of death from suicide or medical complications is markedly increased for eating disorders.
• Research shows that bisexual and gay men are at greatest risk of experiencing bulimia compared to men who identify as heterosexual.

More information about Bulimia from patient.info.

Binge eating disorder is a severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort), a feeling of a loss of control during the binge, experiencing shame, distress, or guilt afterward, and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. It is the most common eating disorder in the United States.

Symptoms

• Frequent episodes of eating large quantities of food in short periods of time.
• Feeling out of control over eating behavior during the episode.
• Feeling depressed, guilty, or disgusted by the behavior.
• There are also several behavioral indicators of BED including eating when not hungry, eating alone because of embarrassment over quantities consumed, eating until uncomfortably full.

Health Consequences of Binge Eating Disorder

Some of the potential health consequences of binge eating disorder include:

• High blood pressure
• High cholesterol levels
• Heart disease
• Diabetes mellitus
• Gallbladder disease
• Musculoskeletal problems
• Depression

About Binge Eating Disorder

• The prevalence of BED is estimated to be approximately 1-5% of the general population.
• Binge eating disorder affects women slightly more often than men–estimates indicate that about 60% of people struggling with binge eating disorder are female, 40% are male.
• People who struggle with binge eating disorder can be of normal or heavier than average weight.
• BED is often associated with symptoms of depression.
• People struggling with binge eating disorder often express distress, shame, and guilt over their eating behaviors.
• People with binge eating disorder report a lower quality of life than a non-binge eating disorder.

Notes on Treatment

• It is important that weight loss/restrictive diets NOT be recommended to people with BED. Restriction perpetuates the illness.
• BED is often treated by using a combination of therapeutic approaches to bring awareness to the thoughts & feelings that precipitate or drive the binge. As well, it is important to eat full and balanced meals at regular intervals throughout the day to ensure the body is sufficiently nourished.
• Health Canada approved the drug Vyvanse in Sept 2016 for the treatment of moderate to severe BED. This medication is an amphetamine salt, originally designed to treat ADHD, which may help suppress appetite and increase impulsive control. It requires medical supervision of blood pressure, heart health and may induce mania in those with bipolar disorder. Vyvanse should NOT be used for weight loss. It may be habit-forming.
• A new drug, Dasotraline, is currently being tested for treatment of BED. It has had positive preliminary tests. It blocks pre-synaptic dopamine transporters (DAT) and norepinephrine transporters (NET).

Other Specified Feeding or Eating Disorder (OSFED) was formerly recognised as Eating Disorder Not Otherwise Specified (EDNOS) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). According to the DSM-5, a person with OSFED may present with many of the symptoms of other eating disorders such as Anorexia Nervosa, Bulimia Nervosa or Binge Eating Disorder but will not meet the full criteria for diagnosis of these disorders. The clinician will specify the reason for the diagnosis (see below).

Unspecific Feeding or Eating Disorder (UFED) is similar to OSFED, as the individual may present with many of the symptoms of other eating disorders without meeting full criteria for diagnosis. However, the clinician will not specify the reason for diagnosis, often due to a lack of information to make a more specific diagnosis (eg., in emergency room settings), or due to presenting symptoms that do not align with another disorder.

Symptoms

Symptoms people with OSFED may share with other types of eating disorders:

• Refusal to maintain body weight at or above a minimally normal weight for  height, body type, age, and activity level.
• Intense fear of weight gain.
• Feeling overweight despite dramatic weight loss.
• Loss of menstrual periods.
• Extreme concern with body weight and shape.
• Repeated episodes of bingeing and purging.
• Feeling out of control during a binge and eating beyond the point of comfortable fullness.
• Frequent dieting.
• Extreme concern with body weight and shape.

The following are some common examples of how OSFED is different from other eating disorders:

• All conditions are present to qualify for anorexia nervosa except the individual’s current weight is in the normal range or above.
• Purging or other compensatory behaviors are occurring at a frequency less than the strict criteria for bulimia nervosa
• Purging without bingeing—sometimes known as purging disorder
• Chewing and spitting out large amounts of food but not swallowing (See Chewing & Spitting Disorder)

The commonality in all of these conditions is the serious emotional and psychological suffering and/or serious problems in areas of work, school or relationships. If something does not seem right, but your experience does not fall into a clear category, you still deserve attention. If you are concerned about your eating and exercise habits and your thoughts and emotions concerning food, activity and body image, we urge you to consult an ED expert.

Also known as Selective Eating Disorder (SED).

This disorder can affect very young children and unlike other eating disorders, is not accompanied by a concern about weight or body shape. Some studies have shown a link with Autism Spectrum disorder, but this is not definitive. ARFID is distinguished from being a “picky eater” by the severity of the restricted range of foods, impacts on physical health (malnutrition) and level of emotional disturbance.

Details 

Individuals with ARFID may avoid foods based on certain sensory qualities, such as texture, color, taste, or temperature. They may also avoid foods for fear of averse consequences, such as vomiting or choking. An example could be a child who likes only foods that he does not have to chew, and who therefore has great difficulty consuming a range of foods adequate to sustain normal growth and development or a child who will only eat food that is beige in colour.

Other symptoms include:

• Inadequate intake based on a restricted range of foods eaten or a restricted caloric intake that may result in serious weight loss, nutritional deficiency or growth impairment.
• Reduced food intake may be due to an emotional disturbance related to eating
• ARFID interferes with normal social interactions and heightens stress at mealtimes for the entire family
• ARFID is not accompanied by a fear of gaining weight or concerns about body shape or weight, as is seen with other eating disorders like anorexia or bulimia.
• Can present in early childhood (before age of 6) and persist throughout life. May also appear later in life.
• Onset may follow an eating-related adverse event or trauma, such as a frightening episode of gagging, repeated vomiting, choking or having a tube put down one’s throat for other health concerns.

At this point, limited research has been done into effective treatment of ARFID, “however, given the prominent avoidance behaviours, it seems likely that behavioural interventions, such as exposure therapy, will play an important role.”

Further Reading

• A couple of articles defining the difference between ARFID and “picky eating”:
  What is ARFID?
  The Extreme Picky Eater
• What is ARFID and What Does It Have To Do With Feeding Dynamics and Eating Competence?
• ARFID may be accompanied by Autism Spectrum Disorder. Here are two research papers on feeding disturbances and families’ experiences of these challenges: Mothers’ Challenges in Feeding their Children with Autism Spectrum Disorder-Managing More than Just Picky Eating and a full thesis paper on the same issue.
• ARFID from a dietitian’s perspective
• ARFID – More than just picky eating
• Other ARFID articles that came across the BC Eating Disorder Community of Practice:
  http://www.edcatalogue.com/avoidantrestrictive-food-intake-disorder-new-kid-block/
  https://www.nationaleatingdisorders.org/blog/time-to-talk-about-arfid
  https://www.romper.com/p/is-my-kids-picky-eating-normal-theres-a-fine-line-between-a-problem-personal-preference-47659
• An Albertan mother has started up a group on Facebook to share resources, ideas and support for those impacted by ARFID or SED (Selective Eating Disorder). You can ask to join the group, by going to Facebook and searching “ARFID / SED Group of Alberta” or clicking here.
• From Duke Health: the basics of ARFID, parent care, and validation
• From FEAST-ED: a detailed description of ARFID from FEAST-ED

Pica is an eating disorder in which a person repeatedly eats things that are not food with no nutritional value. The behavior persists over for at least one month and is severe enough to warrant clinical attention.

Typical substances ingested vary with age and availability and might include paper, paint chips, soap, cloth, hair, string, chalk, metal, pebbles, charcoal or coal, or clay. Individuals with pica do not typically have an aversion to food in general.

Pica often occurs along with autism spectrum disorder and intellectual disability, but can occur in otherwise typically developing children.

A person diagnosed with pica is at risk for potential intestinal blockages or toxic effects of substances consumed (e.g. lead in paint chips).

Treatment for pica involves testing for nutritional deficiencies and addressing them if needed. Behavior interventions used to treat pica may include redirecting the individual from the nonfood items and rewarding them for setting aside or avoiding nonfood items.

Click here for more information about pica.

Rumination disorder involves the repeated regurgitation and re-chewing of food after eating whereby swallowed food is brought back up into the mouth voluntarily and is re-chewed and re-swallowed or spat out. Rumination disorder can occur in infancy, childhood and adolescence or in adulthood. To meet the diagnosis the behavior must:

• Occurs repeatedly over at least a 1-month period
• Not be due to a gastrointestinal or medical problem
• Not occur as part of one of the other behavioral eating disorders listed above
• Rumination can also occur in other mental disorders (e.g. intellectual disability) however the degree must be severe enough to warrant separate clinical attention for the diagnosis to be made.

Co-occurring Factors and Disordered Eating Not in the DSM

Orthorexia has not been officially recognized by the American Psychiatric Association, but it is getting a lot of attention. It is sometimes called Healthy Eating Disorder and is characterized by an obsession with eating only “pure” foods, rigid dietary restriction, compulsive exercising and often accompanied by cleanses and de-toxification rituals. For more information, please visit this ​NEDA page.