Eating Disorders- You are what you eat

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 Nervosa2,3

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: -

  • Extremely underweight
  • Intense fear of gaining weight
  • Denial of being seriously underweight
  • Persistent compensatory behaviors to avoid gaining weight, despite being underweight
  • Preoccupation with food and weight

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 Nervosa2,4

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:

  • Self-induced vomiting
  • Laxatives abuse
  • Diuretic use
  • Extreme physical activity
  • Fasting

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: -

  • Recurrent episodes of binge eating that is eating episodes that occur in a discrete period [≤2 hours] and involve the consumption of an amount of food that is larger than most people would consume under similar circumstances,
  • Loss of control during binge eating,
  • Feeling guilt about binge eating,
  • No compensatory or purging behaviors.

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 Disorder1,2,9

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.
Publisher’s name- Dr. Dangs Lab

References :
  2. Balasundaram P, Santhanam P. Eating Disorders. [Updated 2021 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  3. Morris, J., & Twaddle, S. (2007). Anorexia nervosa. BMJ (Clinical research ed.), 334(7599), 894–898.
  4. Jain A, Yilanli M. Bulimia Nervosa. [Updated 2021 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  5. Iqbal A, Rehman A. Binge Eating Disorder. [Updated 2021 Nov 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  6. Berkman ND, Brownley KA, Peat CM, et al. Management and Outcomes of Binge-Eating Disorder [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Dec. (Comparative Effectiveness Reviews, No. 160.) Introduction. Available from:
  7. Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Curr Psychiatry Rep. 2017;19(8):54. doi:10.1007/s11920-017-0795-5
  8. Advani S, Kochhar G, Chachra S, Dhawan P. Eating everything except food (PICA): A rare case report and review. J Int Soc Prev Community Dent. 2014;4(1):1-4. doi:10.4103/2231-0762.127851
  9. Murray HB, Juarascio AS, Di Lorenzo C, Drossman DA, Thomas JJ. Diagnosis and Treatment of Rumination Syndrome: A Critical Review. Am J Gastroenterol. 2019;114(4):562-578. doi:10.14309/ajg.0000000000000060

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  2. Gorwood P, Blanchet-Collet C, Chartrel N, Duclos J, Dechelotte P, Hanachi M, Fetissov S, Godart N, Melchior JC, Ramoz N, Rovere-Jovene C, Tolle V, Viltart O, Epelbaum J. New Insights in Anorexia Nervosa. Front Neurosci. 2016 Jun 29;10:256. doi: 10.3389/fnins.2016.00256. PMID: 27445651; PMCID: PMC4925664.
  3. Harrington BC, Jimerson M, Haxton C, Jimerson DC. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. 2015 Jan 01;91(1):46-52.
  4. Forney KJ, Bodell LP, Haedt-Matt AA, Keel PK. Incremental validity of the episode size criterion in binge-eating definitions: An examination in women with purging syndromes. Int J Eat Disord. 2016 Jul;49(7):651-62.
  5. Himmerich H, Bentley J, Kan C, Treasure J. Genetic risk factors for eating disorders: an update and insights into pathophysiology. Ther Adv Psychopharmacol. 2019;9:2045125318814734. [PMC free article] [PubMed]
  6. De Toro V, Aedo K, Urrejola P. Trastorno de Evitación y Restricción de la Ingesta de Alimentos (ARFID): Lo que el pediatra debe saber [Avoidant/Restrictive Food Intake Disorder (ARFID): What the pediatrician should know]. Andes Pediatr. 2021 Apr;92(2):298-307. Spanish. doi: 10.32641/andespediatr.v92i2.2794. PMID: 34106171.
  7. Mahmoudieh M, Keleidari B, Nasr Esfahani F, Zolfaghari B, Melali H, Davarpanah Jazi AH, Mehdinezhad N, Mokhtari M. The effect of Punica granatum L. flower extract on post-surgical peritoneal adhesions in a rat model. Eur J Obstet Gynecol Reprod Biol. 2020 Mar;246:113-116. doi: 10.1016/j.ejogrb.2019.12.034. Epub 2019 Dec 24. PMID: 32004879.