The different types of eating disorder diagnoses include:
Anorexia nervosa, often simply called anorexia, is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight, and a distorted perception of one’s body weight. A diagnosis of anorexia is based on the following:
The diagnosis of anorexia has two subtypes that may be specified. These include:
The most common ages of onset of anorexia are the mid-teens, between 14 and 18 years. However, up to 5 percent of patients have the onset of the disorder in their early 20s. Anorexia is estimated to occur in about 0.5 to 1 percent of adolescent girls. It occurs 10 to 20 times more often in females than in males.
Anorexia appears to be a way for adolescents to express a form of autonomy. Many adolescents with anorexia experience their bodies as somehow under the control of their parents, so that self-starvation may be an effort to gain validation as a unique and independent person. Only through acts of extraordinary self-discipline can an anorectic patient develop a sense of autonomy and selfhood. Psychotherapists who treat patients with anorexia generally agree that these young patients have been unable to separate psychologically from their mothers. The body may be perceived as though it were controlled by an intrusive and unempathetic mother. Starvation may unconsciously mean rebelling from this controlling presence.
Individuals with anorexia have high rates of major depressive disorders. The suicide rate is higher in patients with the binge eating-purging type of anorexia than in the restricting type. Patients with anorexia are often secretive, deny their symptoms, and resist treatment. In almost all cases, relatives or intimate friends must confirm a patient’s history.
Because of the complicated psychological and medical implications of anorexia, a comprehensive treatment plan, including hospitalization when necessary, is recommended. Both individual and family therapy are recommended. Cognitive-behavioral therapy has proved effective for inducing weight gain. In many cases, medication may be needed. Participation in support groups, such as those provided by the National Association of Anorexia Nervosa and Associated Disorders, may also be helpful.
Bulimia nervosa, often simply called bulimia, is an eating disorder characterized by a cycle of binge eating and purging. A diagnosis of bulimia is based on:
Cognitive-behavioral therapy (CBT) is considered the first-line treatment for bulimia. Effective treatment is based on strict adherence to detailed guided treatments that include 18-20 sessions over 5 to 6 months. CBT aims to interrupt the patient’s behavioral cycle of binging and dieting, and correct dysfunctional thoughts about food, weight, body image, and overall self-concept.
Antidepressant medications have also proven helpful in treating bulimia to reduce binge eating and purging.
Bulimia is more prevalent than anorexia. Estimates of bulimia range from 1 to 4 percent in young women. As with anorexia, bulimia is more common in women than in men, but its onset is often later in adolescent than that of anorexia. The onset may also occur in early adulthood. Approximately 20 percent of college women experience transient bulimic symptoms at some point during their college years. In the United States, bulimia may be more prevalent among Hispanics and blacks than non-Hispanic whites.
Individuals with bulimia, as with those with anorexia, tend to be high achievers and to respond to societal pressures to be slender. As with anorexia patients, many patients with bulimia are depressed and have increased familial depression. The families of patients with bulimia, however, are generally less close with more conflict than the families of those with anorexia. Patients with bulimia describe their parents as neglectful and rejecting.
Binge eating disorderis characterized by recurrent episodes of earing large quantities of food. A diagnosis of binge eating disorder is based on:
The cause of binge eating disorder is unknown. Impulsive and extroverted personality styles are linked to the disorder, as are individuals who place themselves on a very low-calorie diet. Binge eating may also occur during periods of stress to reduce anxiety or to alleviate depressive moods.
Binge eating disorder is the most common eating disorder. It occurs in approximately 25 percent of patients who seek medical care for obesity and in 50 to 75 percent of those with severe obesity. It is twice as common in females (4 percent) than in males (2 percent).
The most effective treatment for binge eating disorder is usually a combination of psychotherapy and antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs). Cognitive behavioral therapy (CBT) is the most effective type of psychotherapy for treating binge eating disorder. Exercise has also shown a reduction in binge eating when combined with CBT. Two other types of effective treatment include interpersonal psychotherapy (therapy focused on interpersonal problems) and participation in self-help groups such as Overeaters Anonymous.
Avoidant restrictive food intake disorder (ARFID), previously known as “selective eating disorder,” is characterized by highly selective eating habits, disturbed feeding patterns, or both. It often results in significant nutrition and energy deficiencies, and for children, failure to gain weight.
A diagnosis of avoidant restrictive food intake disorder is given when a person has one or more of the following symptoms:
ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness.The disorder is not better explained by lack of available food or by an associated culturally sanctioned practice. A diagnosis of ARFID also requires that the eating problem is not attributable to a concurrent medical condition or other mental disorder.
Pica is a compulsive eating disorder in which people eat nonfood items, such as dirt, hair, and pant chips. A diagnosis of pica disorder is based on:
Rumination disorder involves the regular regurgitation of food that may be re-chewed, re-swallowed, or spit out. A diagnosis of rumination disorder is based on:
Other specified eating disorder diagnoses are used when an individual’s behavior does not meet the criteria for any specific eating disorder. Examples include:
A diagnosis of “unspecified eating disorder” is given when an individual has eating disorder symptoms that cause significant distress or impairment in social, occupational, or other important areas of functioning but the behavior does not meet the full criteria for any specific eating disorder. This diagnostic category is used in situations when there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).