By Alecia (eleutheromanial)

What is the first thing that comes to your mind when I write out the words eating disorders? When I was younger, two particular things came to mind; Anorexia Nervosa and Bulimia Nervosa. These are the two most-publicised ED's in the world. But they aren't the only ones that exist. In total, there are nine recognised and somewhat-publicised eating disorders. This is a short description, some signs and symptoms and the recovery process of each one in different categories (BDD-influenced, non-BDD-influenced--meaning Body Dysmorphic Disorder influenced and non Body Dysmorphic Disorder influenced).

NON-BDD-INFLUENCED

ED: ARFID (Avoidant-Restrictive Food Intake Disorder)

ARFID is a unique form of an eating disorder where an individual is unable to eat certain chemicals, substances or even entire food groups due to a multitude of factors. These factors include an individual's sensitivities to foods (presented in intense physical pain, headaches or stomachaches) or psychological barriers. It is believed to exist due to an incapability towards certain textures, compounds or sometimes even food colours. Most likely, those afflicted with ARFID will have severely low nutrients due to the foods they will not eat. This ED can also develop from a fear or phobia (like emetophobia--a fear of vomit) if vomiting or other fears were experienced after consuming a certain food. It is unrelated to Body Dysmorphic Disorder.

SIGNS:

A reluctance to eat full meals

Throwing foods away

Being afraid to go near other people that are eating

Refusing to eat or having to be forced to eat "unsafe foods"

Self-harm

Anxiety/Depression

Panic attacks or other expressions of anxiety when around "unsafe" foods

Weight-loss not relating to changes in exercise or other factors (sleep, puberty, illness etc.)

Mineral or chemical deficiencies that are found in uneaten foods

Taking exceptionally long amounts of time to finish meals, snacks or foods

Autism

RECOVERY:

As this eating disorder is not particularly well-known or extensively researched, there are currently no specific treatments plans in order for ARFID. If the disorder stems from fear, trauma therapy (what therapists use for PTSD victims) is sometimes utilised to condition the mind into not being afraid anymore.

CBT (Cognitive Behavioural Therapy), or alternatively DBT (Dialectical Behavioural Therapy), have also been known to come up with some successful results. Experts on ARFID and other uncommon eating disorders agree that regular ED rehab has a very low success rate in eradicating the behaviours and incapabilities due to the fact regular rehab is focused towards having a more positive body image.

ED: BED (Binge Eating Disorder)

Individuals with BED have frequent binge eating episodes with no continued or subsequent attempts to get rid of (or purge) what they have eaten. It is an eating disorder where the binges usually precede the stage where an individual feels "full". Some describe it as a compulsion where one does not actually want to eat, but does so because it feels good for the first while or because they don't know what else to do. This is not simply overeating--everyone does that once in a while--but eating far past what's comfortable; and frequently. These binges take place in fairly short periods of time and usually aren't over two hours long. Because an individual will consume so much food and not attempt to get rid of it repetitively, a person with this disorder will commonly be what is considered overweight or obese. This disorder does not stem from BDD, but may trigger BDD because of obesity or just weight gain.

SIGNS:

Showing shame when looking at themselves or talking about their body

Big quantities of food disappearing

Stomach pains, cramps and other gut-related pain

Being overweight or obese

Self-harm

Anxiety/Depression

Not wanting to eat around other people--only by themselves

Talking about wanting to go on a diet but not actually trying

Going on a healthy diet and not losing any weight

RECOVERY:

Psychotherapy (no specific type) has been proven to help with BED. It is utilised to develop a safe relationship with food and to have the compulsions subside. Family and Relationship counseling is also commonly used in treatment. Because this is a more common type of eating disorder, ED rehab is able to help with BED in most situations.

Lisdexamfetamine, or Vyvanse, is an FDA-approved drug that was developed to treat ADHD but has also been recommended and approved to treat BED. It calms the brain hyperactivity that happens during binge episodes. Certain anti-seizure drugs have a probational approval from the FDA due to some unwanted side effects.

ED: NES (Night Eating Syndrome)

Night Eating Syndrome is not technically considered an eating disorder--instead; a syndrome, but it's still every bit as valid. The disorder is categorised by binge-eating steadily during the night. With this ED, the circadian rhythm is disturbed and an individual will have compulsions to eat while most of the population is sleeping. It is unlike BED in the sense that the eating is steady and is done throughout the night, instead of quick spurts of binges. With NES, there is usually no or no frequent attempts to get rid of the food, although a person will be ashamed of what they have eaten. By morning, they will usually be full--sometimes even before that, so not wanting to eat in the morning is one of the biggest symptoms. This disorder is not triggered by BDD but may trigger BDD because of obesity or just weight gain.

SIGNS:

Not being hungry in the morning

Complaining about tiredness (and basically all other signs of Insomnia)

Feeling shame or remorse over weight

Being overweight or obese

Self-harm

Anxiety/Depression

Being reluctant to eat throughout the day

Falling asleep at random times throughout the day

RECOVERY:

Although regular ED rehab can help with this, there's another form of treatment that works surprisingly well; sleeping pills or melatonin supplements. Because those with NES have what would clinically be diagnosed as insomnia approximately 96.4% of the time (according to a study done on 1258 participants aged 7-89), adjusting the sleeping rhythm to match that of a baseline individual will make it so that people with NES only really eat during the day. If melatonin pills or sleeping pills don't work, sleep therapy is recommended.

Once the circadian rhythm has been brought back to normal, eating behaviours will still have to be enforced, but the boundaries of people around an individual and sunlight make it easier to monitor and treat.

Antidepressants in general also have a reputation of helping somewhat with Night Eating Syndrome, but most people don't even have to go that far.

ED: PICA

Pica is an eating disorder where individuals will consume substances or materials that are not universally considered edible. These materials can range from hot glue gun sticks to dried paint and everything in between. It will sometimes present itself due to the body needing specific nutrients (eg. An individual may eat nails because the body desperately wants iron and zinc). It is said that Pica will often start with ice-chewing. Any method of consumption (eating, snorting, inserting into bodily holes) counts as Pica, but in diagnostic terms only eating is validated. It is unrelated to Body Dysmorphic Disorder.

(This is only diagnosable when it does not occur during the first 18 months of life, periods of pregnancy or as a religious/spiritual practice)

SIGNS:

Ice-chewing

Intestinal/gut pain

Throwing up frequently without stimulation

Swollen lips

Medical concerns due to what may have been consumed

A low appetite

Mineral/nutrient deficiencies

Self-harm

Anxiety/Depression

An unwillingness to eat normal food

Autism

Panic attacks when not able to consume substance

RECOVERY:

In extreme circumstances, an invasive form of aversive conditioning is used. When somebody starts to someone starts to consume the substance, a foul tasting or sour tablet is placed on their tongue to create a muscle memory of a bad experience while consuming said substance. In other not-quite-as-concerning cases, a lighter form of aversive conditioning is used. There is a (usually negative) trigger word that the people around an individual must say when they engage in consuming the substance to let them know that it is not good.

CBT is the chosen therapy of choice for Pica, although a certain format of trauma therapy is sometimes also used. The object or substance is treated as a traumatic experience and the individual must then learn to become comfortable around it.

BDD-INFLUENCED

ED: AN (Anorexia Nervosa)

Anorexia is the most well-known eating disorder worldwide. It--unfortunately--has the highest mortality rate of any eating disorder and the third highest mortality rate of any psychiatric condition. Individuals with Anorexia Nervosa will (attempt to) starve themselves due to Body Dysmorphia and general dislike of how they look. Their desire is to be lighter or skinnier. If they don't meet their caloric goal for the day, Anorexics will often attempt to get rid of the calories with extensive exercise or other invasive measures. It has a 4% mortality rate.

Individuals will become obsessed with how they look and often see a distorted image of themselves in the mirror. Once this happens, it is often diagnosed as a subcategory of Anorexia; Anorexic Psychosis. Anorexic Psychosis is thought to exist in up to 73% of those with Anorexia.

SIGNS:

Being underweight

Exercising frequently

Hiding food

Weighing themselves frequently

Disguising starving as constant new diets

Loss of menstrual cycle (in biological females)

(Anorexic) Psychosis

Talking about wanting to lose weight or going on new diets obsessively

Using excuses for not eating repetitively (eg. I ate at my friend's house--three times in a week)

Self-harm

Anxiety/Depression

Visiting "thinspiration" websites or using pictures of emaciated models for aspiration

Being tired

Anemia

Sallow skin

Brittle nails

Cold or swollen hands and feet

Bloated or upset stomach

Downy hair covering the body

Low blood pressure

Osteoporosis

Refusing to eat in public

Planning and preparing elaborate meals for others, but not eating

Ritually cutting food into tiny pieces or other distracting behaviour utilised so that they can avoid eating

RECOVERY:

As this is considered the most well-known eating disorder, ED rehab is focused on Anorexia as one of the main treatment courses. At these centers, they focus first on regaining health and supervised weight gain, and then on building a safe relationship with food by doing things like baking cookies or even your own meals.

Antidepressants are often administered, though doctors must be careful to be aware of Psychosis as common Antidepressants such as Prozac have been known to cause suicidal ideations in those suffering from Psychosis previously. It must also be noted that Prozac has only been proven to treat Bulimia Nervosa and not yet Anorexia. Psychotherapy is utilised as well--most often to get to the root of the problem. CBT is most common, but for older patients, DBT can be found more successful.

This combination of medication, Psychotherapy and medical treatment has been tested and studied for several years, but it is said that there is still much room for improvement.

ED: EDNOS/OSFED (Eating Disorder Not Otherwise Specified/Otherwise Specified Feeding or Eating Disorder)

OSFED/ENDOS is a general term in diagnostic criteria that is used to cover eating disorders that don't quite fit the criteria for diagnosable eating disorders (diagnosable meaning ED's that are included in the latest DSM-which doesn't include most lesser-known eating disorders). If a professional doesn't feel comfortable diagnosing ARFID as ARFID, they may choose to diagnose it as OSFED/EDNOS.

OSFED is the official term, but EDNOS is what is recognised as that was the original term for it. Either works, but OSFED is used in diagnostic criteria. I put it under BDD-influenced because it is also commonly used for those with Anorexic/Bulimic tendencies without officially being able to be classified as Anorexia/Bulimia. An example of this is back when amenorrhea was a part of the criteria for diagnosing Anorexia but a biological male had Anorexic tendencies. It would then be diagnosed as OSFED/EDNOS. It can also be used for non-BDD influenced ED's, but with the statistics surrounding it, it's much more likely that that the root of it is BDD.

ED: BN (Bulimia Nervosa)

This is an eating disorder where an individual will have eating binges and then purge themselves of the calories. This purging can be done in many different forms; namely self-inflicted vomiting, intense physical exertion/exercise, enemas, diuretics, laxatives, starving after binges and water fasting. It is one of the most common eating disorders in the world.

Just as with Anorexia Nervosa and Purging Disorder, this eating disorder is influenced by BDD and most individuals will experience some form of distortion in the way they see themselves. The desire they have is to be skinnier or lighter. However, unlike AN, those with Bulimia are often overweight or even obese due to the fact that most forms of purging are not consistently effective in getting rid of the calories that are consumed on binges.

SIGNS:

"Chipmunk cheeks"

Clear/xanthic teeth/discoloration or staining of the teeth.

Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.

A feeling of being out of control during the binge-eating episodes.

Self-esteem overly related to body image.

Popped eye vessels.

Evidence of binge eating, including 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.

Calluses on the back of the hands and knuckles from self-induced vomiting.

Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.

Anxiety/Depression

Visiting "thinspiration" websites or using pictures of emaciated models for aspiration

Being tired

Anemia

Sallow skin

Brittle nails

Cold or swollen hands and feet

Bloated or upset stomach

Low blood pressure

Osteoporosis

Refusing to eat in public

RECOVERY:

As this is considered one of the most well-known eating disorders--after Anorexia--ED rehab can be focused on Bulimia as one of the main treatment courses. At these centers, they focus first on regaining health and supervised weight gain, and then on building a safe relationship with food by doing things like baking cookies or even your own meals. They also put a lot of time into supervision of mealtimes and bathroom time to build a mental barrier.

Antidepressants are often administered as well, as well as ADHD meds (stimulants) and occasionally anti-seizure medication. The brain chemicals that are affected when an individual has Bulimia vary far and inbetween, so plenty of different medications and treatments have been approved to work. Psychotherapy is utilised as well--most often to get to the root of the problem. CBT is most common, but for older patients, DBT can be found more successful.

This combination of medication, Psychotherapy and medical treatment has been tested and studied for several years, but it is said that there is still much room for improvement.

ED: ON (Orthorexia Nervosa)

Orthorexia is the media's new darling when it comes to eating disorders. It's portrayed in countless different ways, whether it's "The Crazy New Diet Phase" or the "Twisted Way to be Healthy". However, this eating disorder is not--like with most things the media says--a healthy diet. It is an ED where individuals will alter their eating habits to become healthy or pure. However, though the belief of these individuals is that what they're doing is helping them be healthy, they mostly use readily available sources such as the internet or "healthy living" magazines. These sources don't always give all the facts and are basically never approved by scientists or medical professionals, so it's not great for their health.

The anxiety surrounding being unhealthy will grow over time, and those suffering from Orthorexia might cut down from on certain substances or even entire food groups due to what they have come to believe. It is common to even begin to completely live off of dietary supplements. This is placed in BDD-influenced because that need/want to be pure can make them believe that they look unhealthy. It is not about being skinnier, lighter or fitter, but it's still BDD-influenced, because of the way they see themselves and imagine their insides.

SIGNS:

Obsession with being "healthy/pure"

Obsessive concern over the relationship between food choices and health concerns such as asthma, digestive problems, low mood, anxiety or allergies.

Increasing avoidance of foods because of food allergies, without medical advice.

Noticeable increase in consumption of supplements, herbal remedies or probiotics.

Drastic reduction in opinions of acceptable food choices, such that the sufferer may eventually consume fewer than 10 foods.

Irrational concern over food preparation techniques, especially washing of food or sterilization of utensils.

Feelings of guilt when deviating from strict diet guidelines.

Increase in amount of time spent thinking about food.

Regular advance planning of meals for the next day.

Feelings of satisfaction, esteem, or spiritual fulfillment from eating "healthy".

Thinking critical thoughts about others who do not adhere to rigorous diets.

Fear that eating away from home will make it impossible to comply with diet.

Distancing from friends or family members who do not share similar views about food.

Avoiding eating food bought or prepared by others.

Worsening depression, mood swings, anxiety or OCD.

RECOVERY:

Regular ED rehab isn't generally effective in treating Orthorexia because it's mostly related to treating those with the skinnier/lighter subcategory of BDD and whatever eating disorder comes with it. So regular rehab often isn't efficient because the staff are equipped to help with those that can't mentally eat caloric foods, rather than those who mentally can't eat foods that are deemed unhealthy.

Medication isn't favoured either, as the superstition spreads to pills and chemicals, so Psychotherapy is the most successful course of treatment. CBT and DBT both work equally well-but it's not the general course of treatment. It's usually altered in order to stop focussing on the facts and articles related to the food and just enjoying the food without the information. However, if the individual is okay with taking them, anti-anxiety medications such as Luvox or Lexapro will sometimes be prescribed by a licensed psychiatrist to ease some of the panic/anxiety that comes with eating "impure" foods.

ED: MD (Muscle Dysmorphia)

This is an eating disorder that is medically referred to as the opposite of Anorexia Nervosa. Afflicted individuals feel that they are too lean, weak or skinny and have an obsession with becoming fitter, more muscular or having a more "impressive" physique. People with Muscle Dysmorphia will adjust several habits and schedules in their life once developing the ED. One part of it is frequent exercise. Individuals will visit gyms and other exercise-centered locations on a very regular basis to "improve" their physique. They will focus on equipment such as weights and other machines and exercises commonly used to increase muscle mass--often to a point of exhaustion close to where they pass out or become frighteningly light-headed. This will become a compulsion.

Secondly, they will eat foods that can help them bulk up, and unfortunately, result to steroids a shocking percentage of the time (it is thought that up to 53% percent of individuals with Muscle Dysmorphia will at least experiment with steroids if they are readily available to them). If they grow very focused on what they consume concerning drinks and food, their eating behaviour can begin to look like that of an Orthorexic, with the sole differences that those with MD exercise an unhealthy amount and outfit their food obsession with becoming muscular/having a larger mass. The numbers for male Muscle Dysmorphia and female Anorexia Nervosa are thought to be highly comparable; and are therefore thought of as opposites by many. This disorder stems from BDD.

The exercising that is done can have negative impacts in many ways as well. In a lot of cases, frequently exercising without letting your body cool down and relax can cause injuries and strains on the muscles and ligaments. Most people with MD will have become so obsessed with becoming fitter that they will continue exercising while injured, which can cause long-lasting or even permanent damage to the area affected.

[Note: some individuals will only alter their eating habits to reach their goal, and in this case, diagnostic criteria hits a blank. It may then be diagnosed as Orthorexia, Muscle Dysmorphia or OSFED/EDNOS. None of the above are incorrect, and it is up to the physician whether they want to acknowledge the reason behind the eating behaviours or not.]

SIGNS:

Frequently visiting exercise locations/gyms

Taking steroids

Talking about how "weak/thin" they are and wanting to change it

Suddenly adjusting schedules and postponing "lazy" activities to work out

Being unwilling to eat in public

All signs of Orthorexia when it comes to eating habits

Bruises, strains, sprains and twists that aren't getting any better

Anxiety/Depression

Other mood disorders

Self-Harm

RECOVERY:

Although this ED is not diagnostically similar to the ED's that regular eating disorder rehab is fine-tuned for, it shares some of the same traits, and the same line of thinking, even if the end goal isn't the same. Therefore, ED rehab has been proven to help with it a fairly large percentage of the time. The plan for recovery is altered to be similar to Anorexic treatment, except the patient is taught to be comfortable around "unhealthy" foods and is supplemented with healthy amounts of exercise proportionate to their height and weight.

Medication can have the the same problem as Orthorexia, but due to the fact that some people with MD will take steroids, they can sometimes be more comfortable taking antidepressants/anti-anxiety meds. It always depends on the situation, of course, but they have seemed to improve the rigid way of thinking that individuals have and loosen the boundaries a bit to allow lenience around food and exercise

ED: PURGING DISORDER

Purging Disorder is an ED where an individual will frequently purge, usually following consumption of foods or beverages, but also in other circumstances. An individual can purge in many different ways, namely enemas, diuretics, laxatives, self-induced vomiting, extreme physical exertion, and uncommonly; starving. Unlike Bulimia Nervosa, once the ED has developed, the purging is rarely to make up for anything, instead as a sort of addiction.

Individuals that were surveyed say that the purging doesn't necessarily feel good, but it's almost a self-destructive behaviour done out of habit. However, this habit forms because of BDD (most of the time) and individuals will rarely feel good about their bodies and even despise them. If the behaviour is not out of habit, it's usually following an episode of one not feeling good about themselves. It's rare that someone with Purging Disorder will only purge after full meals, in fact, it is common that they will purge after eating small snacks, drinking anything but water, and in extreme cases, even doing things like using toothpaste.

Although the theory is not fully developed, there is an idea that there should be a subcategory of Purging Disorder where an individual has sensitivities and doesn't like the taste of food in their mouth (this would only be valid to self-inflicted vomiting). Although there are quite a few potent differences between Bulimia and Purging Disorder, the latter is often misdiagnosed as the former. They are similar in the purging context, but not why, when or the behaviours.

SIGNS:

"Chipmunk cheeks"

Clear/xanthic teeth/discoloration or staining of the teeth.

Self-esteem overly related to body image.

Popped eye vessels.

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 as well as in other circumstances

Excessive, rigid exercise regimen- despite weather, fatigue, illness, or injury, the compulsive need to "burn off" calories taken in--or calories that haven't even been taken in

Calluses on the back of the hands and knuckles from self-induced vomiting.

Creation of lifestyle schedules or rituals to make time for purge sessions.

Anxiety/Depression

Visiting "thinspiration" websites or using pictures of emaciated models for aspiration

Being tired

Anemia

Sallow skin

Brittle nails

Cold or swollen hands and feet

Bloated or upset stomach

Low blood pressure

Being underweight

Osteoporosis

Refusing to eat in public

RECOVERY:

This disorder is treated in almost the same manner as Bulimia. First, supervised weight gain is imposed, and then individuals are taught to be comfortable with their bodies and eating/food. Bathroom time, supplements and exercise are controlled and monitored, and therapy is utilised commonly.

Sometimes, to soothe the insides, a massage therapist is employed to ease the muscles that are used when throwing up. They also put a lot of time into supervision of mealtimes and bathroom time to build a mental barrier.

Antidepressants are often administered as well, as well as ADHD meds (stimulants) and occasionally anti-seizure medication. The brain chemicals that are affected when an individual has Purging Disorder vary far and inbetween, so plenty of different medications and treatments have been approved to work (mostly for Bulimia, but the two go hand-in-hand). Psychotherapy is utilised as well--most often to get to the root of the problem. CBT is most common, but for older patients, DBT can be found more successful.

This combination of medication, Psychotherapy and medical treatment has been tested and studied for several years, but it is said that there is still much room for improvement.

ED: CACHEXIA, RUMINATION, GOURMAND SYNDROME, AUTOIMMUNE YOUTH ANOREXIA NERVOSA, DIABULIMIA, DRUNKOREXIA, and PRADER-WILLI SYNDROME

These ED's are all real and valid; I am in no way disregarding their existence or impact, but there is overall very little known about each of them; and therefore, I will only include a short definition of each one.

CACHEXIA: A syndrome where a cancer patient will not get enough nutrients and minerals, often due to their illness, and sometimes stemming from them restricting their own calories by using cancer.

RUMINATION: Also called chewing and spitting. An ED where an individual will put food in their mouth, chew and let it linger to activate the brain's sensory nerves so that they sense the taste but do not consume the calories. The food is then spit out afterwards. Individuals with this disorder are often malnutritioned.

GOURMAND SYNDROME: A very rare syndrome where an individual will become increasingly obsessed with food preparation, appearance and taste. It is thought to originate from serious head injuries (such as multiple severe concussions or a traumatic car crash).

AUTOIMMUNE YOUTH ANOREXIA NERVOSA: There is very little known about this, but doctors are exploring the possibility of it being a common diagnosis for young children with a low weight even they're provided plenty of healthy food. It is thought to be infection triggered where the mind and body do not connect in forms of eating. It is a very new diagnosis.

DIABULIMIA: A syndrome where a Type 1 Diabetes patient will neglect their insulin or take smaller amounts to lose weight. They often have BDD.

DRUNKOREXIA: A syndrome where an individual will starve themselves throughout the day to make up for the calories while they get drunk at night.

PRADER-WILLI SYNDROME: More of an outright medical condition, but can be considered an eating disorder because the most serious symptom is uncontrollable eating. There is a deficiency in the brain when born so that once an individual reaches their teen years, their appetite is insatiable due to the Hypothalamus not reacting to the food consumed.