Types of Eating Disorders
Eating disorders are mental illnesses involving disordered eating behaviours. Eating disorders can affect any person, regardless of age, gender, race or circumstance. The causes of eating disorders are complex and wide ranging, but can include psychological, biological, genetic, social and environmental factors. Commonly, eating behaviours become a coping mechanism for dealing with difficult situations or emotions. There are several types of eating disorders, which are described in more detail below. The prevalence of these disorders continues to rise, with both men and women being affected. It is estimated that 1.25 million people in the UK have an eating disorder, approximately a quarter of whom are men. Evidence suggests that early intervention is key. Recovery is possible at any time, but seeking early specialist treatment within the first three years has been shown to improve recovery outcomes.
Anorexia Nervosa
Anorexia nervosa is characterised by a restriction of food intake which leads to the person being underweight for their height or age. They may have an intense fear of gaining weight or becoming fat and often have a distorted view of their body image. By restricting their food intake, the person may feel ‘in control’. The person’s self-worth can be largely or entirely based on their weight or shape. A person with anorexia nervosa may also engage in compulsive or excessive exercise as a way to control their weight. There are two sub-types of anorexia nervosa. ‘Restrictive’, in which the person restricts their food intake and ‘binge-purge’, where the person restricts their food intake but also engages in episodes of eating a large amount of food and then engaging in purging behaviours, such as self-induced vomiting, laxative or diuretic use or over-exercise.
Bulimia Nervosa
Bulimia nervosa is characterised by episodes of binge eating, where the person eats a large amount of food and experiences a sense of lack of control. The person then engages in compensatory behaviours, in order to prevent weight gain. These may include self-induced vomiting, laxative or diuretic use, fasting or over-exercise. The person’s self-worth can again be largely or entirely based on their weight or shape.
Binge Eating Disorder
Binge Eating Disorder is characterised by recurrent episodes of binge eating, without any compensatory behaviours. During the episode of binge eating, the person may feel out of control and experience feelings of distress. These episodes are often associated with eating very quickly, eating until uncomfortably full, eating when not hungry, eating alone due to being embarrassed, and feeling ashamed, guilty or depressed afterwards.
Avoidant Restrictive Food Intake Disorder (ARFID)
ARFID is characterised by an avoidance of certain foods or types or food, or a restriction of food intake (or both), which can have a significant impact on daily life. The avoidance or restriction can be based on the sensory nature of food, such as the taste, texture, smell, look or temperature. It could be due to a concern about adverse consequences of eating the food. For example, if the person previously experienced a traumatic or distressing incident such as choking, or witnessed someone else choking. Another reason may be that the person has a lack of interest in food. They may not experience hunger in the same way as other people, become distracted, or may see eating as a ‘chore’. Those with ARFID do not restrict their eating in order to change their weight or shape.
ARFID can affect any person from any background, age or gender. It can often co-occur with medical conditions (such as gastro-intestinal disorders), anxiety disorders, obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or other learning difficulties, but it can also occur on it’s own.
ARFID can lead to nutritional deficiencies. The person may experience significant weight loss or failure to meet expected height and weight, but equally the person may be normal weight or overweight. A person with ARFID may only accept a narrow variety of foods. They may be dependent on nutritional supplements or enteral feeding via the mouth or tube feeding. Their psychosocial functioning (ie, their ability to manage their daily activities) may also be affected.
Our team is trained in the diagnosis and treatment of ARFID. The main treatment is psycho-behavioural therapy, but it must also include nutritional support and treatment for any other physical or mental health comorbidities. The treatment can include a combination of the following, depending on the individual needs of the person: occupational therapy, dietetics/nutrition, speech and language therapy, family therapy and/or individual therapy, which may include a special type of CBT called CBT-AR. It has had good results in research trials and is used for patients aged 10+. Treatment usually takes 20 sessions and is in four stages. You can read more about this in our section about treatment.
Other specified feeding and eating Disorder (OSFED)
A person may be diagnosed with OSFED if their symptoms do not meet the criteria for any other eating disorder. For example, if the person is not underweight for their age of height, but meets the rest of the criteria for anorexia nervosa; or if a person engages in binge/purge episodes but at a reduced frequency.
Rumination Disorder
Rumination disorder involves the regurgitation of food. This regurgitated food may be re-chewed, re-swallowed, spit out.
PICA
Pica is a disorder where the person eats things which are not considered food items and have no nutritional value, such as tissue paper, clay, dirt or paint.