What are the different types of eating disorders?

Help and healing start with knowledge. Below is a list and brief description of some of the most widely recognized and common eating disorders.

Types of Eating Disorders in the DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition lists 8 distinct feeding and eating disorders. These include the following:

1. Anorexia nervosa
2. Bulimia nervosa
3. Binge-eating disorder
4. Avoidant/restrictive food intake disorder (ARFID)
5. Other specified feeding or eating disorder (OSFED)
6. Unspecified feeding or eating disorder (UFED)
7. Pica
8. Rumination

Additional information to note:

• ARFID is also referenced as Selective Eating Disorder (SED) in the DSM-5. The terms are often used interchangeably to describe an avoidance or restrictive pattern of eating.
• There are also subtypes or severity levels listed in the DSM-5 based on meeting certain diagnostic criteria.
• In addition to all the eating disorders listed in the DSM-5, there are other terms that are used commonly to describe feeding and eating-related issues.

Anorexia nervosa (AN)

Anorexia nervosa is an eating disorder defined by the restriction of nutrients and energy relative to the needs of an individual. Individuals who experience AN often present with intense fear or worry about gaining weight and will attempt to avoid it through not eating, exercising too much, and sometimes purging as well as the overuse of laxatives.³ This sometimes results in markedly low body weight, but most individuals struggling with AN are not at markedly low body weights.

While previous definitions of AN often included specific weight or weight loss criteria, it is now understood that people of all body sizes may struggle with this eating disorder. Due to genetic variation in how different people’s bodies respond to restriction, some people will lose weight while struggling with AN but not reach a “markedly low body weight” and other people will lose little to no weight but will experience other symptoms of malnutrition.

Atypical anorexia nervosa (AAN)

The eating disorder atypical anorexia nervosa has been used to diagnose this eating disorder in people who are not at an extremely low body weight. However this term is misleading because we now know that the majority of people with AN are not at “significantly” low weights. Due to stereotypes associating AN with a specific appearance and pervasive cultural and medical fatphobia, these individuals often experience delayed diagnosis or misdiagnosis of their anorexia nervosa, prolonging medical complications and making treatment more difficult to access. 

Similarly to anorexia nervosa, body image distortion is also common in people with atypical anorexia. Individuals may perceive their bodies in a way that varies significantly from their actual bodies. This may involve a consistently inaccurate perception of their body size and shape or an inconsistent perception that shifts dramatically even if no actual body changes have occurred. A preoccupation with food and calories resulting in rules that restrict intake is common as well. AN sufferers may also avoid eating in public. 

Avoidant restrictive food intake disorder (ARFID)

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ARFID is a disruption in eating or feeding due to a lack of interest in food, the sensory characteristics of food (i.e., textures, appearance, flavor), or a conditioned negative association with food intake caused by a traumatic experience such as vomiting or choking. This disruption is highlighted by a deficit in nutritional and energy needs and can result in one or more of the following:⁵

• Undernutrition which in some cases causes weight loss or lack of growth in children.
• Significant nutritional deficiency.
• Psychosocial functioning impairment.
• Dependency on tube feeding or supplements for nutrition. 

ARFID, while sharing similar characteristics to anorexia nervosa and bulimia nervosa, differs because the avoidance and restriction of food is not motivated by body image concerns. A person with ARFID will avoid eating due to an aversion to food, fears of immediate harm occurring from eating certain foods, or a general disinterest in food.⁶

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Binge eating disorder (BED)

Binge eating disorder is an eating disorder that is more prevalent in the United States than anorexia nervosa or bulimia nervosa.¹³ BED consists of episodes of eating large amounts of food in a short amount of time, typically under two hours. Unlike BN, BED is not followed by compensatory behaviors such as purging behaviors or laxative abuse. Binge eating is signified by at least three of the following:¹³

• Eating at a more rapid pace than normal.
• Eating beyond the feeling of satiety and into discomfort.
• Eating large quantities of food without being physically hungry.
• Guilt, shame, and depression brought on by overeating.
• Embarrassment in relation to the amount of food causes solitary eating.

In order to meet diagnostic criteria, episodes of these eating habits must occur at least once a week for three months.¹³ Many people with BED experience a binge-restrict cycle in their relationship to food, and some individuals who meet criteria for BED also have nutritional deficiencies.

Bulimia nervosa (BN)

Bulimia nervosa is an eating disorder characterized by episodes of binge eating followed by purging or compensating behaviors. The DSM-5 defines BN with the following criteria:¹¹

• Binge eating episodes:
  - Individuals eating portions significantly larger than most would consume in a similar amount of time and under commensurable circumstances.
  - Individuals feel out of control during these episodes and are unable to limit the servings consumed.
• Purging and compensating behaviors, such as:
  - Self-induced vomiting (to purge food eaten)
  - Diuretic and laxative abuse
  - Fasting
  - Extreme exercise behaviors

In order to establish a diagnosis, episodes occur at least once per week for three months.¹²

Atypical bulimia nervosa (ABN)

Atypical bulimia nervosa can have many of the symptoms of BN but does not meet all of the criteria for a BN diagnosis. An individual experiencing ABN might have recurrent bouts of laxative abuse or binging, but the frequency with which they occur is lower than meets the threshold for a diagnosis of BN. Additionally, ABN may present without the concern for body image that is exhibited in BN. 

Compulsive eating 

Compulsive or emotional eating describes the tendency to eat past the point of satiety in response to negative emotions. Major life events that elicit stress, anger, fear, sadness, or loneliness may trigger the use of eating as a way to self-soothe or suppress emotions even in the absence of hunger.¹⁴

Compulsive eating can occur in people who restrict their food intake at times and feel out of control around food at other times. This can lead to a binge-restrict cycle which may not meet the specific criteria BED or BN but can be very distressing and disruptive.¹⁴

Diabulimia

Diabulimia refers to individuals with type 1 diabetes mellitus who intentionally administer inadequate amounts of insulin with weight loss as the motivation. Although not recognized as a formal diagnosis according to the DSM-5, diabulimia is extremely dangerous and is garnering an increased presence amongst individuals experiencing type 1 diabetes.⁸

Prior to a diagnosis of type 1 diabetes, individuals may experience weight loss because of their deficiency in insulin. Once insulin treatments begin, rapid weight gain can be a common occurrence. Individuals with diabulimia may restrict or completely withhold insulin in an attempt to lose weight after they have been diagnosed.⁸

Severe adverse reactions to intentional insulin restriction are common and may include diabetic ketoacidosis, vision loss, and kidney damage. According to an eleven-year study, the restriction of insulin increased the risk of death by 3.2 times.⁹

Exercise addiction

Exercise addiction is marked by obsessive and immoderate exercise patterns that can lead to psychological and physical distress or harm.¹⁵ While some people, including professional athletes, may spend significant amounts of time exercising, those suffering from exercise addiction generally exhibit key differences in their motivation for exercise, response to fatigue and injury, and the amount of distress and disruption it causes in their lives.

Without the presence of exercise, someone with exercise addiction can experience a combination of withdrawal effects consisting of sleep disruption, anxiety, and restlessness. 

Night eating syndrome

Night eating syndrome (NES) is an eating disorder distinguished by a substantial amount of overall food intake occurring after dinner with two or more weekly nighttime sleep disruptions followed by food ingestion as a possible accompaniment. Causes of NES still require further research but point to a desynchronization between food intake patterns and sleep patterns.¹⁷

Orthorexia nervosa

An increasing cultural concern with “healthy” foods and diets has resulted in greater prevalence and recognition of an eating disorder known as orthorexia nervosa (ON). While being interested in nutrition and striving to eat nutritious foods is not inherently pathological , individuals experiencing ON obsess over achieving what they perceive to be a “healthy” manner of eating even to the detriment of their own physical and mental well-being.¹⁰

Some signs of orthorexia nervosa may include an increased focus on the health value of food, cutting out specific food groups, or feeling compelled to check nutrition labels, while practicing restrictive eating. People with orthorexia may also spend a great deal of time thinking about food, and how “healthy” or “unhealthy” certain food items are while experiencing an extreme fear of certain foods, or overall distress around eating.

Pregnancy-related eating disorders

Pregorexia is a term that refers to an eating disorder in which a great fear of pregnancy-related weight gain exists. An individual with pregorexia will take measures to avoid the changes that occur to the human body during pregnancy such as caloric intake restriction and excessive exercise.¹⁹

Pregorexia is a relatively new term and there is much to be learned. It is not formally recognized by the DSM-5, so diagnosis can be difficult, but if you or a loved one has concerns it is highly recommended to seek help from a medical professional for the health of baby and parent alike.

Getting help for an eating disorder 

There are many different types of eating disorders that all require thoughtful care and treatment in order to recover from them. At Within, our care team specializes in eating disorder treatment and recovery. We will meet you where you are in your healing, and create a unique plan to meet your specific needs.

Our treatment program is virtual, so you can receive care, and connect with your team from the comfort of your own home. If you or a loved one is experiencing any of the types of eating disorders listed above, please reach out to our team today for help.