What Kinds of Eating Disorders are there?

Anorexia Nervosa (AN) AN is perhaps the most severe of the eating disorders, as it is the most deadly and can lead to hospitalization if symptoms are severe enough. While we don’t know exactly what causes AN, it can sometimes start with or trying to eat more “healthy” foods. This often develops during childhood or the adolescent years (up to about age 24). Eventually, there is failure to gain weight or weight, which can be scary and dangerous, because kids and teens should be continuing to grow. In addition to weight loss or failure to make weight gains, AN may also cause malnourishment, cognitive symptoms (e.g., trouble eating foods perceived to be “bad” or “fattening”), or physical symptoms (e.g., dry skin, loss of periods, hair loss, dizziness, fatigue, etc). Children and adolescents do not need to lose a certain amount of weight in order to be diagnosed with AN; we also look at medical complications that result because of low weight or malnutrition (e.g., low heart rate, changes in blood pressure, changes in hormones and/or electrolytes). Some patients with AN also binge eat and/or make themselves throw up in order to “get rid of” the food they’ve eaten. They might also exercise excessively. One major challenge in treating AN is that patients who have it frequently do not recognize the seriousness of it and actually do not want treatment. This is because sufferers of AN are often scared to make behavioral changes and are very worried about “becoming fat”. In fact, people with AN tend not to view their bodies accurately (e.g., see themselves as “fat” or “overweight” even though they are normal weight). Treatment of AN often requires weight gain, normalizing eating patterns, and reversing the impact of malnourishment.

Bulimia Nervosa (BN) BN is more common than AN. People with BN often have normal or higher than normal weight, as well as consistent patterns of binge eating and purging behaviors. Binge eating means eating a large amount of food in a short period of time and having a loss of control over eating, where you cannot stop yourself from eating. This loss of control over eating is sometimes subjective- meaning no one else would think this is a huge amount but the person experiences a loss of control. Most often, however, it is an objective binge – an amount of food that anyone would find to be tremendous in a short period of time (e.g., eating 3500 calories in 20 minutes). After eating, in particular after a binge-eating episode, an individual feels a strong urge to “get rid of” the food they have eaten and will engage in behaviors to rid themselves of the food. Some of the ways people try to get rid of the food include making themselves throw up, using , , herbal supplements or engaging in excessive exercise. Some people will also go for periods of time without eating anything at all with a goal of avoiding weight gain. Use of diet pills, herbal supplements, diuretics and laxatives can cause acute medical symptoms. Purging (e.g., self-induced vomiting) can also lead to very serious medical complications. Unlike AN, most people with BN are deeply ashamed of and want to change these symptoms, but find this very difficult. BN often develops a bit later than AN, with onset during adolescence and young adulthood.

Binge (BED)

BED may be the most common eating disorder and can develop at any point in the lifespan. During binge eating episodes, people eat a large amount of food in a short period of time, while feeling out of control - like they can’t stop eating or prevent themselves from starting to eat in the first place. They may also eat when not hungry, eat until physically uncomfortably full, and/or eat continuously throughout the day. During binge eating episodes, people often eat faster than usual. They may also try to hide this behavior because they feel guilty and ashamed of how much or what they are eating. For some people, their binge eating occurs mostly at night, while for others it may occur in response to strong emotions or stress. The frequency of binges may increase and decrease over time. Unlike in BN, people with binge eating disorder do not purge after binge eating episodes. They may, however, try to diet and also may report concerns not unlike those reported by people with AN and BN. Some men with binge eating disorder may deny loss of control, saying that they were not thinking about what or how much they were eating but rather eating mindlessly.

Avoidant Restrictive Food Intake Disorder (ARFID) ARFID is sometimes described as “extreme picky eating” or “food neophobia”, which is a fear of new foods. ARFID often starts at very young ages, in early childhood or even the toddler years, but can also develop later, particularly after a scary experience such as choking and vomiting. Often parents describe their children as being very sensitive to the taste, texture, temperature, and appearance of foods. They may want to eat only certain foods and have a hard time eating out or trying new foods. Many young people with ARFID have a very strong preference for their favorite foods. Given their preference for only a limited number of foods, they may have a hard time gaining weight or may need to take vitamins, supplements or even be tube fed in order to keep from becoming malnourished. This is more than just ordinary pickiness – children with ARFID may requires their family to provide special meals, or they may have trouble eating out or in social situations, which causes challenges in the family, at school or socially.

Other Eating Disorders Some eating disorders do not fit into any of the categories above, but are seen frequently enough to qualify as: Not Otherwise Specified Feeding and Eating Disorders (OS-FED). There are several types of OS-FED that we frequently see in clinical practice and they often look like some of the following:

• Atypical Anorexia: Patients may have the same symptoms as AN, but their weight may not be as low. Many children and adolescents fall in this area because they might not have lost weight, but instead have failure to thrive or failure to make expected weight gains. In addition, some people who have lost weight but are not yet underweight may fall in this category. Sometimes this is thought of as the early stages of anorexia before it becomes full blown, but it is important to know that this disorder is just as severe and full of medical and psychiatric risks as full blown AN. Fortunately, we also know it is likely to get better with treatment because patients are younger and their disease is not as strong yet. • Atypical Bulimia: Patients with this often have the majority of symptoms of BN, but without the frequency of binge eating or purging necessary to reach full diagnosis. There may be only subjective binge eating episodes or purging may have only happened a few times. • Purging Disorder: Purging disorder is characterized by self-induced vomiting, , , ordiet pill use, or fasting to lose weight. People with purging disorder do not typically engage in binge eating and are not at a low weight. • Night Eating Syndrome: Patients with night eating syndrome tend to consume a majority of their calories at night. They may not necessarily be binge-eating. Individuals who eat at night because of religious or cultural reasons, or because they are shift workers who work nights, might not meet criteria for this diagnosis.

What Symptoms can I Watch out for at Home?

Sometimes eating disorders can be sneaky and unless you pay close attention, it can be easy to miss some of the signs that your child is engaging in risky eating disorder behaviors. Here is a list of some of those signs:

• No longer eating foods they used to enjoy (e.g., used to like pizza but will no longer eat it) • Cutting out foods or ingredients considered “bad” or “unhealthy” (e.g., doesn’t want you to cook with butter or oil, stopped eating sweets, is eating only certain foods now even though they used to eat a variety of foods) • Asking you to buy organic or “healthy” foods instead of foods you used to feed them or have around the house • Skipping meals (e.g., you might notice your child saying they are not hungry for dinner or breakfast, while other times they might secretly be skipping lunch at school). Also, your child might be telling you that they ate lunch at school even though they didn’t. • Heading straight to the bathroom after meals or snacks (e.g., if you notice your child doing this, it may be because they are making themselves throw up the food they’ve just eaten) • Making comments about their appearance or weight (or other statements/behaviors making you aware that they are really concerned about their bodies/weight) • Trying to lose weight, even though they don’t need to lose weight • Your child seems to be losing hair or their hair is changing texture (often thinning) • Your child may have developed a fine hair all over their bodies (called “lanugo”) • Exercising a lot more often or intensely than they used to • Difficulty sitting still, always shaking, moving, standing up, preferring to stand than sit • Looking very pale, drawn or having dark circles under their eyes • Eating very large amounts of food (you may notice that snack foods are going missing from the kitchen or need to be replaced more often, or, if your child is older, they may be buying large amounts of food at the grocery store or restaurants) • Using laxatives or other kinds of teas/vitamins meant to assist with digestion in some way