If you are concerned as to whether you or a loved one has an eating disorder, see the first article in this series, “How Do You Get An Eating Disorder: Defining Disordered Eating” to review the signs and symptoms suggestive of disordered eating. This present article will focus on the different types of eating disorders recognized by the psychological community as well as emerging types that are beginning to be considered as distinct forms of disordered eating.As of the writing of this article, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition with Text Revisions (DSM-IV-TR), only recognizes Anorexia Nervosa and Bulimia Nervosa, with all other forms of disordered eating falling under a catch-all diagnosis of Eating Disorders NOS (not otherwise specified). The DSM-V to be published in 2013 reportedly defines other types of disordered eating beyond Anorexia and Bulimia. What follows is a brief definition of both the recognized and emerging types of disordered eating.Anorexia is characterized by: 1) a refusal to maintain a minimal body weight (e.g., weight falls to 85% or less of expected weight for age and height), 2) intense fear of gaining weight or becoming fat, even though patient is underweight, 3) distorted perception of their bodies (weight or shape) with body image significantly impacting self-evaluation or a denial of the seriousness of their current low weight and 4) lack of a menstrual cycle for three consecutive months in menstruating girls/women.Bulimia is characterized by: 1) frequent binge eating in which large amounts of food are consumed in a discrete period of time and there is a sense of loss of control over eating during the binge, 2) recurrent use of behaviors to compensate for the binges such as self-induced vomiting or misuse of laxatives, medications or other diuretics, and 3) body weight or shape has a significant, negative impact on self-evaluation. One caveat, however, is that bulimic binges do not have to include eating a large amount of food. For example, a patient once described hiding in the bathroom to eat a donut in which she stuffed the whole donut in her mouth, choking it down while in a dazed state, followed by intense guilt and shame afterwards. This is the psychological state consistent with binging, even though a large amount of food was not consumed. Further, what constitutes a binging episode (i.e., amount of food consumed) will be defined differently from individual to individual, while the psychological consequences are quite similar.Despite these limitations in the DSM-IV-TR, other forms of disordered eating are being recognized among professionals and the public alike. For example, most professionals recognize Binge-Eating, also called Compulsive Overeating as another type of eating disorder. Unlike Bulimia, Compulsive Overeating does not include compensatory behaviors such that the patient gains an excessive amount of weight due to the uncontrolled binges. Exercise Bulimia entails excessive amounts of exercise, generally while eating a normal, healthy diet. The damage occurs from not allowing the body to adequately rest, which can result in injuries, and may involve inadequate nutrition if caloric intake is not increased to ensure proper nutrition while over-exercising. Orthorexia is also being recognized by professionals and is characterized by an obsession with avoiding foods perceived to be unhealthy. The obsession can effectively result in malnutrition from lack of proper nutritional and caloric intake.The catch-all category of Eating Disorder NOS may also include other forms of disordered eating such as Purging Disorder, in which individuals purge in the absence of binging in order to control weight. Diabulimia is a term used to describe the intentional manipulation of insulin levels by diabetic individuals to control or manipulate their weight. Drunkorexia is a term coined to describe individuals who intentionally restrict calories so that more alcohol can be consumed without creating weight gain. Finally, Pregorexia is a type of disordered eating in which extreme dieting and exercise are employed to prevent weight gain during pregnancy.What is confusing for most folks is that Anorexia can also include binging, purging or other compensatory behaviors (over-exercise, laxative use, diuretics) and Bulimia can also lack purging (self-induced vomiting) with a focus on other types of compensatory behavior. In addition, Exercise Bulimia can evolve into Anorexia, as can Orthorexia. The point is that while there are specific defining characteristics of the different types of eating disorders, there is also considerable overlap and many patients do not neatly fall into one category, suffer from both at the same time or may switch between the different types (Bulimarexia is a term coined to describe this). Regardless of the type of disordered eating, prompt intervention is required to ensure the best possible outcome, including full recovery from the disorder.
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