An overview of all types of eating disorders: symptoms, causes and treatments
Samantha recently shared her story about living with misophonia, and earlier Esther spoke candidly about what it’s like to live with ARFID. Both are extremely limiting when it comes to eating, and the latter has even been officially diagnosed as an eating disorder. I had already heard of anorexia, bulimia and ARFID several times—especially the first two are well known—but pica and rumination disorder? I didn’t know these existed, and the same goes for the other eating disorders in this article. Time for an overview of the most common types of eating disorders, their main symptoms, causes and treatments.
It is estimated that approximately 200,000 people in the Netherlands suffer from an eating disorder each year. Eating disorders can develop at any age, but anorexia and bulimia in particular often begin during puberty. Eating disorders are complex conditions, and not all of the disorders mentioned below are included in the DSM (Diagnostic and Statistical Manual of Mental Disorders—the diagnostic and statistical manual of mental disorders). Although too little is still known about these eating disorders, they should certainly be taken seriously. Especially because early intervention can lead to better outcomes.
1. Anorexia nervosa
This is one of the best-known and most serious eating disorders. People with anorexia have an intense fear of gaining weight, even when they are underweight. They eat little or nothing, which leads to severe weight loss and sometimes even death. It is, incidentally, a misconception that this only affects (young) women. Boys can also have anorexia.
- Symptoms:
- Extreme weight loss
- Intense fear of gaining weight
- A distorted body image
- Excessive exercise
- Disrupted menstrual cycle in women
- Causes:
- Often a combination of genetic, biological, psychological and environmental factors.
- Treatment:
- A combination of psychotherapy (such as cognitive behavioural therapy), nutritional advice and sometimes medication.
2. Bulimia nervosa
Bulimia is characterised by recurring episodes of binge eating, followed by vomiting, fasting or excessive exercise to prevent weight gain.
- Symptoms:
- Regular episodes of extreme binge eating
- A feeling of loss of control during binges
- Repeated vomiting and/or use of laxatives
- Fear of gaining weight
- Fluctuations in body weight
- Causes:
- Often a mix of psychological factors such as low self-esteem and social pressure to be slim.
- Treatment:
- Psychotherapy (especially cognitive behavioural therapy), nutritional advice and sometimes antidepressants.
3. Binge Eating Disorder (BED)
In Dutch: eetbuistoornis. This is the most common eating disorder and is characterised by recurring binge-eating episodes, but without subsequently vomiting. People with BED often eat large amounts quickly, even when they are not hungry, and then feel guilty or ashamed.
- Symptoms:
- Binge-eating episodes at least once a week for three months or longer
- Eating until uncomfortably full
- Eating in secret out of shame
- Feelings of guilt or disgust after eating
- Causes:
- Often a combination of genetic factors, psychological problems such as depression and anxiety, and negative emotions such as stress.
- Treatment:
- Cognitive behavioural therapy and sometimes medication such as antidepressants or anti-obesity drugs.
4. Orthorexia nervosa (not included in the DSM)
People with orthorexia are obsessively focused on healthy eating. Unlike anorexia, it is initially not about wanting to lose weight, but about wanting to live an extremely healthy lifestyle. Although everyone emphasises the importance of healthy eating, people with orthorexia become so obsessed with it that it can lead to malnutrition and worse. Eating only fruit and raw vegetables marked the end of Zhanna’s life: she starved to death.
- Symptoms:
- Obsessive focus on healthy eating and nutrition
- Avoiding foods that are not considered pure
- Fear or guilt when eating unhealthy foods (even if they are not necessarily unhealthy)
- Causes:
- Often related to perfectionism, anxiety disorders and a desire for control.
- Treatment:
- Psychotherapy, with an emphasis on letting go of rigid eating patterns and developing a healthier relationship with food.
5. ARFID (Avoidant/Restrictive Food Intake Disorder)
This is an eating disorder in which someone restricts their eating due to a lack of interest in food, fear of the consequences of eating (such as choking), or an aversion to certain tastes, smells, textures or even colours.
- Symptoms:
- Avoiding certain foods or food groups
- Insufficient intake of nutrients
- Weight loss or insufficient weight gain in children
- Lack of interest in food or extreme pickiness
- Causes:
- Can develop as a result of negative experiences with food, such as choking, or because of sensory sensitivities.
- Treatment:
- Behavioural therapy, nutritional advice and, if necessary, medication to address underlying fears or sensory issues.
6. Pica
With this eating disorder, people eat things that are not edible, such as soil, chalk, clay or paper. Pica is genuinely considered strange and can be dangerous to health.
- Symptoms:
- Repeatedly eating non-food substances for a period of at least one month
- Risk of poisoning, infections or intestinal problems
- Causes:
- Often related to malnutrition, deficiencies in minerals such as iron or zinc, or psychological disorders.
- Treatment:
- Medical intervention to replenish nutritional deficiencies, and psychotherapy to address underlying causes.
7. Rumination disorder
This eating disorder is characterised by repeatedly regurgitating food, which is then chewed again, swallowed or spat out. This involuntary behaviour can lead to malnutrition and weight loss.
- Symptoms:
- Repeated regurgitation of food without an underlying medical cause
- Unintentional weight loss
- Possible damage to tooth enamel or the oral cavity
- Causes:
- Often associated with developmental disorders, stress or trauma.
- Treatment:
- Behavioural therapy and nutritional advice to reduce rumination and promote healthy eating patterns.
8. OSFED (Other Specified Feeding or Eating Disorder)
With this eating disorder—in Dutch: NAO (Niet Anders Omschreven)—someone has symptoms of anorexia, bulimia and/or binge-eating disorder, but does not fully meet the criteria for any of these three eating disorders. The causes and treatment will also be a combination of those associated with anorexia, bulimia and/or binge-eating disorder.
9. Bigorexia nervosa (not included in the DSM)
This eating disorder is also known as muscle dysmorphia or reverse anorexia. Someone with bigorexia feels that they have too little muscle mass (and too much fat) and therefore focuses obsessively on exercise. Even though they are often already muscular, people with bigorexia see themselves as too thin or not muscular enough. This condition falls under the broader category of Body Dysorphic Disorders (BDD), arising from a distorted body image, and occurs mainly in men. This eating disorder is related to anorexia athletica; people with anorexia athletica exercise excessively, panic if they miss a workout and constantly count how many calories they burn while exercising.
- Symptoms:
- Obsessive focus on muscle growth
- Dissatisfaction with one’s own body image
- Excessive use of supplements and steroids
- Causes:
- Often associated with perfectionist tendencies and low self-esteem
- Traumatic experiences (for example, being bullied)
- Societal pressure to look perfect
- Treatment:
- Behavioural therapy and psychotherapy to address underlying causes.
10. Night Eating Syndrome (NES) (not included in the DSM)
With this eating disorder, most eating takes place in the evening or during the night. There are no binge-eating episodes; food is eaten at a normal pace. This is often accompanied by sleep problems.
- Symptoms:
- Excessive eating at night
- Sleep problems
- Weight gain
- Causes:
- Possible abnormalities in the biological clock that regulates appetite and sleep patterns, and disrupted hormone balance
- Stress, anxiety and depression
- Irregular working hours, such as night shifts, can also contribute to a disrupted eating pattern and the development of NES.
- Treatment:
- Behavioural therapy, nutritional advice and psychotherapy to address underlying causes.
Read also:
Sources: my.clevelandclinic.org, Voedingscentrum, naeweb.nl stichtingkiem.nl, eetstoornissen.nl
