Eating disorders can be difficult to understand unless you've been through one. While the general public is aware of anorexia and bulimia, the awareness often stops there. However, there are several other types of eating disorders — including some newer ones you likely haven't even heard of yet. Diagnosis for a particular eating disorder can get cloudy because of overlapping symptoms, and it's also possible to move between diagnoses at different points in your life. "Eating disorders tend to morph and change over time, especially if the person does not receive treatment," explains Landry Weatherston-Yarborough, LPC, CEDS, NCC, an eating disorder expert at Eating Recovery Center.
If you're experiencing what seems like eating disorder symptoms (some key ones include extreme anxiety around eating, avoidance or restriction of certain foods, or binge eating), know that it's not your fault. In fact, in many cases, it could be in your genes: "about 50% of the risk is attributable to genetic factors," says Weatherston-Yarborough. "Eating disorders are actually one of the most heritable mental health disorders." Other risk factors include a history of trauma and other mental health conditions. Anxiety, loneliness, anger, depression, feeling a lack of control in life, and low self-esteem are also likely to be red flags for eating disorders, adds Sanam Hafeez, PsyD, a New York City-based neuropsychologist and director of Comprehend the Mind. And with the recent resurfacing of these exact feelings for so many people globally, disordered eating behaviors have skyrocketed during the pandemic.
Whether you're here to find out more about your own potential diagnosis or here to support a friend or loved one who's recently been diagnosed with an eating disorder, there's plenty to learn in order to be better equipped to help yourself or someone in your life. Read more about these different types of eating disorders, and how to recognize the symptoms.
It may seem like the most recognizable eating disorder, but anorexia takes many forms and does not look the same for everyone. Anorexia nervosa in its classic form will look like restricting calories or certain foods in order not to gain weight. But there's also a bingeing and purging variety. People who have this type of anorexia often restrict their food intake or binge eat and then exhibit purging behaviors, including self-induced vomiting, use of laxatives, or over-exercising, Weatherston-Yarborough says.
Besides the behavioral signs, some hidden physical symptoms of anorexia are missing or irregular periods, thinning hair, dry skin, or issues with sleep, according to the National Eating Disorder Association. But it's important to note that looking incredibly thin or "ill" might not be a tell-tale sign: Some people are diagnosed with atypical anorexia nervosa if they demonstrate those restrictive eating behaviors, but aren't necessarily underweight.
The signs of bulimia nervosa might not be as easy to spot as anorexia. Someone with bulimia might have behaviors similar to someone who has anorexia of the bingeing-purging variety, like eating large quantities of food and then purging the body of that food. But bulimia isn't marked by dramatic weight loss like anorexia often is, says Weatherson-Yarborough.
If you suspect that someone you know might be struggling with bulimia, look for the hidden signs of empty food containers that might signify binge eating or evidence of diuretic or laxative bottles, dental issues, or calluses on their knuckles from vomiting. And of course, escaping to the bathroom after all meals is another telltale behavioral sign of bulimia.
3. Binge eating disorder
Diagnosis for an eating disorder can get cloudy, because the symptoms of a couple of common eating disorders can be so similar. Binge eating disorder might be confused for bulimia, because the person might be eating large quantities of food in a short period of time, often discreetly. But there's a slight difference. "A person with binge eating disorder typically engages in restricting and bingeing behaviors, but does not engage in purging behaviors," says Weatherston-Yarborough. Binge eating disorder can also affect people of any weight.
Again, like bulimia, it's important to notice the subtle signs of binge eating disorder, including hoarding food, or a person showing remorse after bingeing an abnormal amount of food. You may also take note of empty food wrappers or even hidden food containers, if the person is concealing their overeating habits.
4. Avoidant/restrictive food intake disorder (ARFID)
Avoidant/Restrictive Food Intake Disorder, or ARFID, is a newer eating disorder diagnosis that you might not be familiar with. It's common in children and adolescents, but can continue into adulthood as well. ARFID is often intricately tied with other psychological conditions, like OCD or anxiety: Often, people who have ARFID have a fear of vomiting from certain foods or having a dire allergic reaction from food and therefore restrict certain foods, Hafeez explains. It also can occur alongside developmental disabilities like autism, and symptoms may include aversions to certain foods, textures, flavors, she adds.
Having ARFID is usually not associated with a weight loss goal, according to Weatherston-Yarborough, though weight loss is possible when restricting food intake like that. The other issue is that it's usually linked to anxiety and depression, as well as improper nutrition from avoidance of foods that are crucial to a healthy, balanced diet.
There aren't concrete stats that show exactly how many people live with pica, but it's a rarer eating disorder diagnosis. It involves eating things that are not edible, such as paint, paper, dirt, chalk, or clay (and the list goes on). Typically, it's connected to another mental health condition, including schizophrenia, or an intellectual or developmental disability, says Hafeez. Having pica doesn't absolutely mean that that person has a severe mental health condition, though. Some people can develop intense pica-related cravings during pregnancy — there's speculation that it can occur because of iron or another nutrient deficiency.
The warning signs of pica are pretty clear, in terms of cravings for eating non-food items. Malnutrition could also be a cause. "Pica is a sign that the body is trying to rectify a nutrient deficiency," Hafeez says.
6. Other specified feeding and eating disorder (OSFED)
If an eating disorder doesn't seem to neatly fit the description of an anorexia, bulimia, or binge eating disorder diagnosis, it may be classified as an Other Specified Feeding and Eating Disorder (OSFED). Atypical anorexia fits under this umbrella, because people who have it don't necessarily fit the criteria of being underweight. "Often these individuals are at a higher weight when the eating disorder begins, and so at first their weight loss is not seen as a cause for concern by family and friends; it may even be celebrated," says Weatherston-Yarborough. Diet culture can be especially toxic for people who have atypical anorexia, because it might not recognize their weight loss or restrictive eating as a physical and mental illness. "It actually prevents them from being diagnosed and accessing treatment as quickly as people who are underweight," she adds.
Other eating disorders that fall under OSFED are bulimia or binge eating episodes that occur on an infrequent basis, purging disorder, which involves purging but without bingeing, and night eating syndrome (eating the majority of your food in the late evening, without having eaten much all day), the National Association of Anorexia Nervosa states. In general, it's best to watch out for signs of obsessive dieting or exercising, skipping meals and overeating at other meals, and other unhealthy dieting or self-esteem-related behaviors.
While it's not an official eating disorder diagnosis yet, orthorexia often involves disordered eating masked by a desire to eat "clean," "healthy," or "vegan." And that goal of eating super healthy can lead to an unhealthy relationship with food. Orthorexia is also fueled by toxic diet and wellness culture, Hafeez points out. "People with orthorexia worry about food quality, bury themselves in food research, and cut out an increasing number of food groups, among other symptoms," she says. The impulse for many people might not even be thinness, but weight loss is definitely possible with orthorexia.
It can be tricky to draw the line between simply eating a healthy and balanced diet (meal prepping is a great habit, within reason) and an illness. People who have symptoms of orthorexia may spend a lot of time (and money) ruminating on what food they will eat, even if they can't necessarily afford to, say, eat completely organic, Weatherston-Yarborough says. If it seems like someone you love is expending a great deal of energy thinking about meals or food ingredients, and cutting out a number of food groups, including meat, dairy, gluten, carbs, and sugar, check in on that person. It could be that they haven't even realized that they've gotten to that point in obsessing over their health and could benefit from professional help.
If you're struggling with disordered eating, NEDA has put together a list of free or low-cost COVID-19 resources, in addition to their confidential and toll-free National Eating Disorders helpline. You can also refer to their Black Lives Matter resources for additional support.
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