The different types of eating disorders

Anorexia

Sometimes referred to as anorexia nervosa, people with this type of eating disorder often go to significant lengths to keep their weight as low as possible by not eating enough food, exercising too much, or both. Over time, anorexia causes physical damage such as muscle weakness, disrupted menstrual cycles, dry, yellow coloured skin and in extreme cases can be fatal. So, it’s extremely important to get professional support as soon as possible.

Anorexia is most common in young women and typically starts in the mid-teens, although it can affect men and women of all ages.

Signs and symptoms of anorexia

  • A very low body mass index (BMI).
  • Skipping meals, eating very little or avoiding eating any foods you see as fattening (even if they’re not in reality).
  • Seeing yourself as overweight even when you are a healthy weight or even underweight.
  • Avoiding events where food is involved.
  • Taking medicine such as appetite suppressants to reduce hunger, relying on laxatives to lose weight, taking diuretics to get rid of fluid, or using emetics to make yourself vomit what you’ve eaten.
  • In women, your periods might stop completely. In adolescent girls, your first period may not start at the expected time
  • Physical problems such as absent hair growth, hair loss, very dry or flaky skin, heart palpitations or stomach pains.
  • An overwhelming day-to-day focus on food which impairs your social, family, working or school life.

What help is available if you have anorexia?

Recovery from anorexia is very achievable with the right kind of help and support. Your GP is the first person to contact. They will ask you questions about your eating habits and check your weight and overall health. They might also run some blood tests to make sure that your weight loss isn’t being caused by something else. Malnutrition isn’t always obvious, so your GP may order some tests to determine if you’re suffering from any deficiencies. You may also be referred to a specialist for treatment.

Treatments may include:

  • Talking therapy
  • Cognitive behavioural therapy (CBT)
  • Family therapy
  • Dietary counselling with a dietician
  • Support groups
  • Medication to help with any underlying mental health condition such as depression or anxiety
  • Help as an inpatient or outpatient at hospital.

Bulimia

Sometimes referred to as bulimia nervosa, or ‘binge and purge eating’, bulimia involves eating a large amount of food over a very short time (binge eating) and then ridding your body of the extra food (purging) by making yourself vomit, taking laxatives, exercising excessively, or a combination of these.

Many people with bulimia report feeling very guilty and ashamed after bingeing and may also worry that they have lost control over their relationship with food. Purging helps them to feel better and more in control until the cycle begins again.

Signs and symptoms of bulimia

  • An overwhelming fear of putting on weight.
  • Being very self-critical about your weight and body shape.
  • A preoccupation with food to the detriment of your day-to-day life.
  • Hiding or hoarding food, and eating in secret.
  • In some cases, you may be obsessively exercising.
  • Eating very quickly and then going to the bathroom shortly afterwards.
  • Running into financial problems because of the amount of food you’re purchasing.
  • Physical health problems such as a chronically sore throat or dental problems from being sick.

What help is available if you have bulimia?

Your GP is the first person to speak to. They will ask you questions about your eating habits and check your weight and overall health. Malnutrition isn’t always obvious, so your GP may order some tests to determine if you’re suffering from any deficiencies. If they think that you have bulimia, you may also be referred to a specialist for treatment.

Treatments may include:

  • Talking therapy
  • CBT
  • Family therapy
  • Dietary counselling with a dietician
  • Support groups
  • Medication to help with any underlying mental health condition such as depression or anxiety
  • Help as an inpatient or outpatient at hospital.

Binge eating disorder

This eating disorder involves regularly eating large portions of food all at once until you feel uncomfortably full or even at the point of being sick. You might also feel ashamed, guilty or low afterwards. Unlike bulimia, binge eating is not followed by purging. Binges may follow a pattern such as during times of stress, or they can occur much more frequently. They are often planned in advance and people with binge eating disorder may buy very specific binge foods.

Signs and symptoms of binge eating disorder

  • Eating very quickly during a binge.
  • Not noticing what you’re eating until after you’ve finished.
  • Eating until you feel uncomfortably full or sick to your stomach.
  • Eating when you’re not hungry.
  • Hiding food or eating in secret.
  • Feeling depressed, guilty, ashamed or disgusted after a binge eating episode.
  • Weight gain (although it’s important to note that this doesn’t happen to everyone with binge eating disorder).

What help is available if you have binge eating disorder?

Recovery from binge eating requires the help and support of specialists so seeing your GP is the best first step. Don’t feel shame in opening up – eating disorders are more common than many people think and your doctor will not judge you. Your GP will ask you questions about your eating habits and check your weight and overall health. If they think that you have binge eating disorder, you may also be referred to a specialist for treatment.

Treatments may include:

  • Talking therapy
  • CBT
  • Family therapy
  • Dietary counselling with a dietician
  • Support groups
  • Medication to help with any underlying mental health condition such as depression or anxiety
  • Help as an inpatient or outpatient at hospital.

Orthorexia

A relatively newly identified eating disorder, the term orthorexia was first coined in 1997. This is a disorder that involves an unhealthy obsession with healthy eating. Unlike other eating disorders, orthorexia mostly revolves around food quality, not quantity. Those who live with orthorexia tend not to focus on losing weight, but instead, have an extreme fixation on the health benefits and ‘purity’ of what they eat. They may also be very vocal about the benefits of healthy eating to the exclusion of other topics.

The onset of orthorexia can be gradual; what started as ‘clean eating’ can become a preoccupation until the person begins to actively fear eating anything that they feel is unsafe. It’s estimated that of all eating disorders, orthorexia accounts for about 1%, but more research is needed to confirm this.

Signs and symptoms of orthorexia

  • Avoiding friends or family for fear of not being able to access foods that you consider to be ‘clean’ or ‘pure’.
  • Intense emotional distress when your chosen foods aren’t available.
  • Following ultra-strict dietary rules even if these cause you financial hardship or physical health problems related to malnutrition such as heart problems, osteoporosis or digestion problems.
  • Having rigid routines around when, where and with whom you can eat or drink.
  • Severe anxiety, guilt or fear if you feel forced to break a dietary rule.
  • Disruption to your daily routine such as travelling hours out of your way to access certain foods.
  • An inordinate amount of time spent researching nutrition, and weighing, measuring and cataloguing food to the point where your work and home life is negatively affected.

What help is available if you have orthorexia?

Research suggests that the majority of people living with orthorexia first become aware of their disordered eating only through the expressions of concern from friends and family members. Although it can be difficult for the person living with orthorexia to appreciate the difference between eating healthily and eating obsessively, those close to them are more likely to notice that their loved one has an unhealthy relationship with food. And because orthorexia can be dangerous, causing multiple physical and emotional health problems over time, getting support is really important.

Your GP is the first person to speak with. They will ask you about your eating habits and review your overall health. Malnutrition isn’t always obvious, so your GP may order some tests to determine if you’re suffering from any deficiencies. They will also ask you about your overall mental health. If your GP thinks that you have orthorexia or another eating disorder, you may be referred to a specialist for treatment.

Treatments may include:

  • Talking therapy
  • CBT
  • Exposure and response prevention therapy (ERP)
  • Family therapy
  • Dietary counselling with a dietician
  • Medication to help with any underlying mental health condition such as depression or anxiety
  • Help as an inpatient or outpatient at hospital.

Avoidant or restrictive food intake disorder (ARFID)

Avoidant restrictive food intake disorder, more commonly known as ARFID, occurs when a person avoids certain foods or types of food, having restricted intake in terms of overall amount eaten, or both.

ARFID differs from orthorexia in that people living with the disorder don’t focus wholly on ‘clean’ or ‘pure’ foods. According to Beat, a charity which supports people with eating disorders, there are many reasons for developing ARFID including:

  • A sensitivity to the taste, texture, smell or appearance of certain types of food, and/or the ability to eat foods only at a certain temperature.
  • A distressing experience with food in the past such as choking or vomiting. This can cause the person to develop feelings of fear and anxiety around food or eating, and lead to them to avoid certain foods or textures.
  • Generalised worries about food which they find difficult to articulate leading them to restrict their intake to what they regard as ‘safe’ foods.
  • In some cases, and for whatever reason, a person may not feel hunger in the way others do or they may generally have a poor appetite. For them, eating might seem unimportant, purely functional, and unenjoyable, resulting in them struggling to eat enough.

A person can have one or more of these reasons behind their avoidance or restriction of food and eating so the reasons for, and symptoms of, ARFID can differ between people. It’s for this reason that ARFID is sometimes described as being an umbrella or blanket term and is not used in reference to a specific disorder.

Despite being a general term, ARFID is serious and can have a significant impact on both physical health and emotional wellbeing. Children and young people may fail to gain weight as expected and their growth can be affected (including poor bone development), while adults and children alike can become deficient in certain vitamins and minerals. A person’s social life may also be severely impacted and performance at work and at home can suffer.

What help is available if you have ARFID?

Because people can restrict or even avoid food for many different reasons, including those physical in nature, your GP will ask you about your eating habits and review your overall health to rule out any possible causes such as IBS or food allergies. Malnutrition isn’t always obvious, so your GP may order some tests to determine if you’re suffering from any deficiencies. He or she will also ask you about your overall mental health. If your GP thinks that you have ARFID, you will be offered a referral to a specialist for treatment.

Treatments may include:

  • Talking therapy
  • CBT
  • ERP
  • Family therapy
  • Dietary counselling with a dietician
  • Medication to help with any underlying mental health condition such as depression or anxiety
  • Help as an inpatient or outpatient at hospital.

Other specified feeding or eating disorder (OSFED)

OSFED is the term used for any eating disorder which is not as serious as anorexia, bulimia, binge eating disorder or ARFID. People suffering from OSFED are nonetheless every bit as deserving of understanding, treatment and support. OSFED accounts for a large percentage of eating disorders and examples include:

  • Atypical anorexia: when someone has all the symptoms required for a diagnosis of anorexia but their weight consistently remains within the normal range.
  • Bulimia nervosa of low frequency and/or limited duration: when someone has all of the symptoms of bulimia but the binge or purge cycles occur more rarely or over a shorter period of time than a health professional would expect.
  • Binge eating disorder low frequency and/or limited duration: when someone has all of the symptoms of binge eating disorder, except the binges don’t happen as often or over a shorter period of time than a health professional would expect.
  • Purging disorder: when someone purges by being sick or using laxatives in an attempt to lose weight or change their body shape but isn’t doing this as part of a binge or purge cycle.
  • Night eating syndrome: when someone repeatedly eats at night, either after waking up from sleep, or by eating a lot of food after their evening meal.

People with OSFED may go to extremes to hide their eating and may not present with physical symptoms for some time, if at all.

What help is available if you have OSFED?

Any type of eating disorder can be treated effectively with professional help and support, but in the case of OFSED, the exact nature of the disorder needs to be identified and seeing your GP is the first person to speak to.

Your GP will ask you about your eating habits and review your overall health. Malnutrition isn’t always obvious, so your GP may order some tests to determine if you’re suffering from any deficiencies. They will also ask you about your overall mental health. If your GP thinks that you have OSFED, you will be offered a referral to a specialist for treatment.

Treatments may include:

  • Talking therapy
  • CBT
  • Family therapy
  • Dietary counselling with a dietician
  • Medication to help with any underlying mental health condition such as depression or anxiety
  • Help as an inpatient or outpatient at hospital.

Further resources you might find helpful

For adults over the age of 18

Beat Eating Disorders 

 

beateatingdisorders.org.uk 

 

0808 801 0677

  • A confidential helpline for anyone who has been directly or indirectly affected by an eating disorder of any kind.
  • Online information, advice and guidance.
  • Peer coaching programme.
  • Online support groups.
  • Local services finder.

For young people under the age of 25

Young Minds

 

youngminds.org.uk

 

0808 802 5544

 

 

  • A confidential helpline for anyone who has been directly or indirectly affected by an eating disorder of any kind.
  • Online information, advice and guidance.
  • Peer support programme.
  • Online support groups.
  • Local services finder.

For adults and young people living with anorexia or bulimia

Anorexia & Bulimia Care (ABC)

 

anorexiabulimiacare.org.uk

 

03000 11 12 13

 

  • A confidential helpline for anyone who has been directly or indirectly affected by anorexia or bulimia.
  • Online information, advice and guidance.
  • Befriending programme.
  • Online support groups.
  • Local services finder.