Eating disorders are behavioral conditions and are primarily characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. These conditions can lead to various complications, and in severe cases affects physical, psychological, and social function.1
Different types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, other specified feeding and eating disorder, pica, and rumination disorder.1
Types of Eating Disorders
Anorexia nervosa is the most familiar and well-documented eating disorder and develops during adolescence and occurs more in women than men. It has the highest rate of mortality of any eating-associated psychiatric disorder.
The characteristics features of anorexia nervosa are mentioned below: -
Individuals with Anorexia nervosa, in the long run, might have osteopenia, brittle hair/nails, dry skin, constipation, hypotension, bradycardia, hypothermia, lanugo hair, amenorrhea, infertility, or muscle wasting.
It is best to make an early diagnosis of psychologically associated weight loss, rather than reach a diagnosis by exclusion.
Bulimia nervosa is a condition that occurs most commonly in adolescent females. It is characterized by indulgence in binge eating, and inappropriate compensatory behaviors to prevent weight gain (Fear of gaining weight despite weighing normal range). The characteristic features of bulimia nervosa include consumption of substantial amounts of food in a short period and loss of control during binge eating. Bulimia nervosa can be manifested with a sore throat, swollen salivary glands, tooth decay, acid reflux, severe dehydration, electrolyte imbalance, and hormonal disturbances.
In addition, the Diagnostic and Statistical Manual of Mental Disorders- 5th edition (DSM V) criteria for diagnosing bulimia nervosa require at least one binge-eating episode with compensatory behavior in a week for a minimum of 3 months.
Binging episodes are followed by inappropriate compensatory behavior to prevent weight gain:
Binge Eating Disorder (BED)2,3,5,6
BED is the most common eating disorder. It usually begins in adolescence and male are more affected than females. Binge eating disorders also pose a high risk of obesity and complications associated with obesity.
Binge-eating disorder (BED) is characterized by: -
Treatment for binge eating disorder should target decreasing binge eating behavior. The focus of treatment should never be targeting weight loss because this will increase binge eating behavior.
Avoidant or Restrictive Food Intake Disorder (ARFID)1,2,7
ARFID is a new entity in DSM V, previously referred to as "Selective Eating Disorder". ARFID is described as a failure to meet nutritional needs leading to low weight, nutritional deficiency, dependence on supplemental feedings, and/or psychosocial impairment.
It usually occurs during childhood, but it can also persist into adulthood. The etiology varies, it can occur due to loss of interest in eating, intense dislike for specific tastes, smells, texture, or colors. It can also impair social function and inhibits the individual from eating with others.
PICA is an act or habit of eating non-food items such as stone, bricks, chalk, soap, paper, soil, etc., It commonly occurs in children who start seeing the world through the oral cavity. Pica poses a risk for parasitic infections, micronutrient deficiency, intestinal obstruction, and heavy metal poisoning.
The treatment strategy for pica includes decreasing the exposure to the craved items, micronutrient supplementation, and behavioral/aversive treatment, particularly among mentally disabled individuals.
Rumination syndrome (RS) is characterized by the repeated regurgitation of material during or soon after eating with the subsequent rechewing, re-swallowing, or spitting out of the regurgitated material.
Rumination is a voluntary action that usually happens within 30 minutes after having the food. Rumination developed in infancy usually resolves by 12 months. Rumination disorder in children and adults can lead to weight loss or malnutrition.2 Biofeedback techniques like re-education of abdominal contractions and diaphragmatic breathing are commonly used to reduce the effects of rumination disorders & to decrease the episodes of rumination disorders.
Other Specified Feeding and Eating Disorder (OSFED)2,8,9
The terminology eating disorder - not otherwise specified (EDNOS) in DSM IV is changed to the Other Specified Feeding and Eating Disorder (OSFED) in DSM V. OSFED includes purging disorder, night eating syndrome, atypical anorexia nervosa, and subclinical bulimia nervosa / binge eating disorder. OSFED exhibits the same concern about eating, body shape, weight, and disordered eating behavior. However, disorders like Avoidant restrictive food intake disorder, pica disorder, and rumination disorder are not included in this subsection, because these disorders don’t share the same weight and shape concerns.
Some of OSFEDs are: -
Purging disorder : Characterized by the purging behaviors like vomiting, excessive exercising, using laxatives or diuretics to control weight. But it does not have binge eating. Individuals with purging disorders depict complications like Bulimia nervosa such as metabolic disturbances, electrolyte imbalances, dental issues, oral bleeding due to esophageal tears, and swollen parotid glands. Management of purging disorder and bulimia nervosa is somewhat similar.
Night eating syndrome : Characterized by overeating, often after awakening from sleep. It also depicts a strong association with sleep disturbance.
Atypical anorexia nervosa : It has similar features to anorexia nervosa except for BMI in the ‘adequate’ range of 20–25 kg/m2 or higher. Management is similar to anorexia nervosa.
Subthreshold bulimia nervosa and binge eating disorder do not meet the ideal definition criteria of bulimia nervosa and binge eating disorder.
Orthorexia : It is recognized as a separate eating disorder in DSM V. Patients with orthorexia have an obsessive focus on healthy eating. Individuals with orthorexia may drop entire food groups, fearing they are unhealthy.
Eating disorders are behavioral conditions. These are characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. Common types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, pica, rumination disorders & other specified feeding and eating disorder.
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