 Other "Eating Disorders"
As you will see from our Definitions section, technically speaking there exist only a small number of 'official' eating disorders (plus their atypical variants), Anorexia Nervosa, Bulimia Nervosa and Eating Disorders Not Otherwise Specified (EDNOS) as defined in the two diagnostic manuals DSM-IV and ICD-10. The latter category - EDNOS - provides a convenient, generic place to stow away a variety of eating disordered behaviour that does not conform to the diagnostic criteria for Anorexia and Bulimia Nervosa. Currently Binge Eating Disorder, although recognised as possibly being a distinct eating disorder in its own right, would constitute an Eating Disorder Not Otherwise Specified. There are a number of other conditions in which disordered eating or body image/weight play a significant part. A number of them may be considered by some to be eating disorders in their own right but which, by lacking a formal diagnosis and definition, are to be consigned to the Eating Disorders Not Otherwise Specified (EDNOS - DSM-IV) category, or Eating Disorders Unspecified (ICD-10). Others may be distinct disorders in themselves and have diagnostic criteria and classification in the diagnostic manuals but not being considered eating disorders (DSM-IV ~ 307, ICD ~ F50) despite having a disordered eating or distorted body image component. We have given some examples below along with a brief description. Please note that the groups that these conditions have been ordered in are for illustrative purposes only and may vary between different organisations. This information is by no means complete or authoritative and provided only to give an illustration of other conditions with food, eating or body image distortion elements.
'Unofficial'
Eating Disorders
Unofficial Eating Disorders is a 'homemade' catagory we have created in order to include 'disorders' created by third parties such as authors, the media etc. to describe certain patterns of eating or body image related behaviour. They are not 'official' in the sense that they do not appear in the diagnostic systems either as recognised disorders or, as in the case of Binge Eating Disorder, as research criteria. It should be noted that experts in the field of eating disorders may themselves label eating disordered behaviour which may then be adopted by some quarters of the medical profession. • Anorexia Athletica
The term Anorexia Athletica was first used in the 1980s by NJ Smith in the aritcle "Excessive weight loss and food aversion in athletes simulating anorexia nervosa" published in Pediatrics in July (1980 66(1) pages 139-142) and by Pugliese MT, Lifshitz F. Grad G. Fort P. Marks-Katz in their article "Fear of obesity. A cause of short staure and delayed puberty" published in The New England Journal of Medicine, September 1983 (volume 309 page 513-518). It has long been recognised that there is a higher than normal prevalence of eating disorders in athletes and indeed a great deal of research has been done in this field. Sundgot-Borgen used the term anorexia athletica to define a sub-group of athletes with eating disorder symptoms that do not permit a diagnosis of anorexia nervosa or bulimia nervosa to be made and would therefore fall within the boundries of Eating Disorder Not Otherwise Specified (EDNOS) (assuming DSM-IV is used to provide the diagnostic criteria). Whilst not a formal eating disorder it might be surmised that individuals to whom the term anorexia athletica could be (correctly) applied would have an eating disorder catagorised under EDNOS. Technically anorexia athletica should refer only to female athletes but tends to be applied to either gender. The term has since come to be used, rather loosely, in some quarters to simply refer to compulsive exercising. There is much information and research available on the internet for anyone wishing to look into anorexia athletica further, for example the 1994 paper by Sundgot-Borgen - "Risk and trigger factors for the development of eating disorders in female elite athletes" . • Bigorexia (Muscle Dysmporphia)
Bigorexia, sometimes called 'Reverse Anorexia' or 'muscle dysmorphia' is a term used to describe behaviour whereby the individual has a distorted view of themselves and belief that they are too small (in a muscuar sense) when they are not. Such behaviour is sometimes seen in bodybuilders and strength atheletes and can be severely socialy disabling with individuals afraid to be seen in public or wearing large clothes to disgues their bodies. Although unrecognised some members of the scientific community do consider it to be link to eating disorders (in particular anorexia nervosa) in that similar body image distortions and extreme preoccupations to remedy the situation occur (albeit in a reverse direction). The use of steriods and anabolic agents and the associated health risks to achieve the desired goal may be seen to be strikingly similar to the use of laxative, diueretics and slimming pill with anorexia nervosa and bulimia nervosa. They are also likely to have self-esteem and 'coping' issues in common. Bigorexia is considered to affect more men than women and there may be connections between Bigorexia and anorexia nervosa in terms of percieved gender ideals. • Ortharexia Nervosa
Ortharexia Nervosa is a term created by the author Dr. Steven Bratman in his book 'Health Food Junkies: Overcoming the Obsession with Healthful Eating' to describe individuals who take their concerns around eating 'healthy' foods to dangerous and/or obsessive extremes. Such individuals may see certain types of food as 'healthy', 'good', 'pure', 'proper' etc. Ortharexia Nervosa is not a recognised condition and lacks the 'clarity' of diagnostic criteria when it comes to defining whether an individual has Ortharexia Nervosa. Individuals with obsessive and/or dangerous behaviour around 'proper' food might be considered to fit Dr. Bratman's label but equally may not. Lacking diagnostic criteria and therefore differential diagnosis it is unclear whether individuals following extreme dietary practices for religous or moral reasons would be considered. Any connections with Obsessive Compulsive Disorder are also unclear. Most people would not consider Ortharexia Nervosa an eating disorder on the grounds that the emphasis and concern relates to the quality or purity of food rather than on a desire to be thin and/or any body distortion issues. However if one considers 'eating disorders' to be mechanisms of coping with underlying distress the definition 'may' fit. • Multi-Impulsive Bulimia
The term multi-impulsive bulimia was used by J. H. Lacey and C. Evans (1986). in their article "The impulsivist: a multi-impulsive personality disorder" published in the British Journal of Addiction. It propses a distinct subgroup of individuals with multiple self-harming behaviour in addition to their bulimic behaviour and suggests that the combined behaviours be treated as a single 'impulse control' issue. Multi-impulsive bulimia is not a formal diagnosis and has been challenged but is recognised by some agencies and clinics. It should be noted that both DSM-IV and ICD-10 consider eating disorders to be a catagory in their own right and not impulse control disorders. It may also be worth noting that it is not unkown for additional self-harming behaviours to be used by individuals suffering from bulimia nervosa as a way of copy with the distress of their bulimic condition. Multi-impulsive bulimia is a complex area and much information (for and against) can be found on the internet.
Eating Problems in Children There are a number of eating problems found in children which are not generally considered to be eating disorders and lack formal diagnostic criteria and classification. It is argued that these childhood eating problems are not eating disorders because it is felt that they have different causes and symptoms and require different treatment. This view is, however, not universally accepted and some do considered certain of them to be eating disorders in themselves. Things can be further complicated as, due to the lack of formal diagnostic criteria, different professionals may choose to apply different names to the same problem. In some instances some professionals may consider a pattern of disordered eating in a child to be simply an extreme manifestation of 'picky eating' behaviour which often occurs normally in children; it is not unheard of for childhood eating problems to be dismissed as faddy eating which the child will "grow out of". Which ever view is subscribed to these childhood disordered eating problems can be very distressing and, in some cases, have serious consequences. Below are some examples of childhood eating problems, this list is by no means complete nor does the inclusion of a condition necessarily mean that that condition is restricted on to children. • Food Avoidance Emotional Disorder
Food Avoidance Emotional Disorder is a condition (named by Great Ormond Street Hospital) in which emotional problems affect appetite and result in the avoidance of food. This can be mistaken for child onset anorexia nervosa but there are a number of differences. Notably it is considered that the avoidance of food results from symptoms of emotional difficulties (such as depression or worry) which affect appetite and is not an attempt to use food to suppress these difficulties. The sufferer will often be aware of their eating difficulties and thinness (unlike the distorted body image that can occur in anorexia) and express a desire to eat more. Food Avoidance Emotional Disorder sufferers are also not considered to have preoccupations with weight or aspirations to be thin. • Food Refusal
Food Refusal is a term given to a behaviour of refusing food as a way of the child getting their own way, in some situations this may simply be getting a more preferred food. The pattern of refusal is often erratic and inconsistent and generally is not thought to pose a risk to the child's [physical] health. Despite appearing to be manipulative it is often felt that some form of stress, sadness or upset may underlie the behaviour. • Restrictive Eating
In Restrictive Eating a child generally eats a broad and balanced range of foods but noticeably restricts the quantity of food eaten. The reasons for this are unclear and some contend that it may result from learnt/observed behaviour, such as parents dieting or where others in the household exhibit restrictive eating whilst some feel it may simply be that a child has a naturally small appetite.
A child with Restrictive Eating may be below normal height/weight
norms for their age but, due to their generally balanced diet, are often
considered to be healthy. As with Selective Eating there appears to be
no preoccupation with weight or aspirations to be thin.
• Selective Eating [Disorder]
Selective eating, sometimes called selective eating disorder, is characterised by a child have a very narrow range of' 'safe' or 'acceptable' foods. This may be limited not only to specific food types but, in extreme situations, specific brands. A child may become very distressed if attempts are made to encouraged (or force) them to eat foods outside of their range. A child may also avoid situations (parties etc.) where food will be present. There is not necessarily restriction in the amount of food eaten from within the acceptable range. There does not seem to be a group of foods common to selective eating and consequently the the consequences of the problem can be dependant on the type and range of foods taken but malnutrition must be considered. Body weight may be high, low or normal and as such is not a good indication of the condition. Dental problems may occur is the child's acceptable range of food contains sugary foods. Selective Eating does not seem to have the preoccupation with weight and desire to be thin components of anorexia nervosa.
Other [related?] Disorders There are a number of other disorders which are sometimes considered to be related in some way to 'eating disorders' in that they posses a symptomatic component which can be seen to be similar to symptoms existing with 'eating disorders'. These disorders are often conditions in their own right with their own diagnostic criteria. Some examples are shown below. • Body Dysmorphic Disorder
Body Dysmorphic Disorder (BDD) is a condition (a Somatization Disorder - DSM-IV) in which in which an excessive preoccupation with and imagined physical imperfection/anomaly is the most marked symptom. Other symptoms can include, amongst others, a fear of ridicule, an avoidance of mirrors, repeatedly seeking reassurance about the perceived defect, frequent measuring of the 'imperfection, and attempts to hide or camouflage the problem area. BDD can lead to a great deal of social isolation and distress. Body Dysmorphic Disorder is sometime considered to have associations with Social Phobia and Obsessive Compulsive Disorder. It is sometimes associated with eating disorders in that the 'body dysmorphia' can be seen to have similarities with the dissatisfaction with, and distorted view of, body shape and size seen in anorexia nervosa. Interestingly Body Dysmorphic Disorder cannot be diagnosed in the presence of a dissatisfaction with, or distorted image of, body size/shape cause by anorexia nervosa (differential diagnosis). • Food Phobia
Food phobia is often listed as an Eating Problem in Children. 'Specific Phobias' (previously called 'Simple Phobias') are recognised by both DSM-IV and ICD-10. The are conditions in which sufferers experience a strong, persistent fear in the presence of, or thought, specific items or situations. Exposure to phobic objects or situations results in a marked fear/anxiety response despite the response being recognised as unreasonable or irrational. Phobic stimuli are often avoided. A 'Specific Phobia' may be given a name identifying the type of phobic stimuli (for example arachnophobia - phobia of spiders). Where the phobia is related to food (Sitophobia) or the process of eating, the fear and avoidance of eating can show 'eating disorder' like symptoms. There are a number of Specific Phobias that can fall into this category. - Sitophobia or Cibophobia - Fear of Food.
- Phagophobia - Fear of Swallowing.
- Dipsophobia - Fear of Drinking.
- Geumatophobia - Fear of Taste.
• Night Eating
Syndrome
Night Eating Syndrome (NES) is another condition that
does not have diagnostic criteria and as such it's definition may vary
somewhat from place to place. It is a condition in which the sufferer
has little appettite in the morning or early in the day and may delay
eating for a considerable time. Individuals with NES generally eat considerably
during evening (some definitions require more than 50% to daily food intake
to be consumed after 8pm or the evening meal) and may get up during the
night to eat (sometime numerously). There is generally an associated feeling
of guilt/unhappiness during these times of eat an also disturbed sleeping
patterns.
It is unclear exactly what Night Eating Syndrome is, it is
variously considered to be a form of eating disorder, a dysfunction in
the body clock, that it may be stress induced, physiological rather than
psychological (possibly hormonal) and others.
• Obsessive-Compulsive
Disorder
Obsessive-Compulsive Disorder (OCD) is a complex anxiety disorder recognised
by both DSM-IV and ICD-10, the criteria for which are quite complex but
which can include, amongst others, a variety of distressing rituals, fears,
repetitive and intrusive thoughts and compulsive actions. There is much
available information on the internet for anyone wishing to find out more.
Obsessional behaviour around food/dieting may present 'eating disorder' like symptoms. It is also thought by some the OCD and eating disorders 'may' be related in some way. It is not uncommon for someone to suffer both an eating disorder and OCD. • Pica
The craving for and eating of non-food substances (dirt, clay, paper for example). It is often seen in situations where a diet is not providing sufficient vitamins and minerals (low calorie diets, in pregnancy). Pica is also common in children and sometimes listed as a childhood eating problem. Pica is not generally considered a serious condition, however depending on the substances consumed intestinal blockages can occur and the ingestion of toxic non-food substances is possible as is contracting parasitic or bacterial infections. There is an obvious 'food' connection between Pica and eating disorders and one of the reasons often cited for Pica, the eating of non-calorie non-food items to ease hunger (when dieting), is often mirrored in eating disorders. Pica in adults is included is ICD-10's 'Other Eating Disorders' (F50.8) catagory and as such is an eating disorder under this diagnostic system.
• Pervasive Refusal
Syndrome
We have chosen to list Pervasive Refusal Syndome here
although it is often considered to be an eating problem in children. The
reason we have done this is that although a child with Pervasive Refusal
Syndrome will present a refusal to eat, this is only on of a number of
'refusal' symptoms.
Pervasive Refusal Syndrome is a very serious, non-organic,
condition in which a child may present an overwhelming refusal to eat,
drink, engage in activities (e.g. walking) or generally care for themselves
in any way (including washing, toileting etc.). This is obviously a life
threatening condition and since the refusal to eat and drink is likely
to elicit concern first, it may be that the condition is seen to an eating
disorder.
In some quarters Pervasive Refusal Syndrome is considered
to be a child form of 'catatonia'. The condition is often linked to a
previous, severe trauma.
• Prader-Willi
Syndrome
Prader-Willi Syndrome is a congenital chromosome disorder (loss of genes
from chromosome 15) which results in a number of mental and physical disabilities.
One symptom of Prader-Willi Syndrome, thought to be caused by hypothalamic dysfunction, is appetite and satiation dysfunction in which there is an overwhelming physiological urge to eat and an obsession with food. This is compounded by the fact that individuals with Prader-Willi Syndrome have lower than normal calorie requirements. Whilst this is clearly not an 'eating disorder', Prader-Willi Syndrome does have a food/weight component. The Prader-Willi Syndrome Association UK can provide information and support.
• Sleep Eating
Disorder
Sleep eating disorder is a 'Sleep Disorder' in which individuals binge
during episodic sleep walking. Usually the individual is unaware of the
experience and only becomes aware on wakening when discovering that the
food is gone. Such a condition can be very distressing and can lead to
obesity and related health concerns.
These are just some of the conditions/disorders sometimes
associated with eating disorders, there are others . An internet search
will usually provide plenty of information these and the conditions listed
here.
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