American culture seems obsessed with dieting. According to the Centers for Disease Control, almost 70% of Americans over the age of 20 are overweight, including 35% that are considered obese. In kids and teens, it’s 17%. Meanwhile, the cultural ideal is to be fit, thin, and trim. The quest for body perfection has created a U.S. weight loss industry that was estimated to be worth $68.2 billion in 2017. In 2018, the fitness industry topped $30 billion.
While 45 million Americans go on a diet every year and 54 million Americans paid for gym memberships last year, the sad reality is that most diets fail and most people quit their gym within months. For those who want to be slimmer and more fit, it is very discouraging. It’s not surprising that according to the National Eating Disorder Association, in the USA up to 30 million people of all genders develop eating disorders.
Social media and news articles have brought eating disorders, and specifically anorexia, bulimia, and binge eating, into public and professional awareness. But there are many ways that people engage in disordered eating. You may not be aware that your own eating habits and behaviors or those of someone you love fall into one of the following classifications. Do realize that, as is true of many classification systems, people don’t necessarily fit neatly into one disorder. Often symptoms of more than one overlap. Brief case examples are provided as illustrations.
Eating Disorders You May Never Have Heard Of:
Avoidant Restrictive Food Intake Disorder (ARFID): This is characterized by difficulty tolerating foods due to sensory issues (texture or smell or appearance) or past negative experiences with it.
Lidia was referred to me for her OCD, not for an eating disorder. But when asked specifically about symptoms, she admitted she would only eat seeds and raw fruits and vegetables. She said she couldn’t stand the texture of anything that is cooked.
Night Eating Syndrome is characterized by eating 25% or more of calories after the usual dinner time. According to the National Institute of Mental Health (NIMH), Night Eating Syndrome affects an estimated 1.5% of the population, It is unlike Binge Eating because the amount of food eaten may not be excessive and the person doesn’t necessarily feel out of control. Often there is shame and embarrassment that any progress made through self-denial during the day is undone at night.
Moderately overweight, Char says she has found that she can control her weight by not eating during the day. After a breakfast of coffee, she allows herself only a salad for dinner. But often she wakes up ravenous during the night and heads to the fridge. She says that this started when her parents were overconcerned about what she ate. She learned that she could look like she was following a diet but then eat secretly at night.
Orthorexia: People with orthorexia are intensely focused on eating only “pure” — or what they consider to be healthy — food. Often they would prefer to go without eating at all rather than eat anything they consider to be too processed, grown incorrectly, or dangerous to their health. They have come to the erroneous conclusion that their body is somehow “toxic.” They resist accepting the fact that the human body is designed to detoxify itself. They therefore go to extreme measures to get rid of perceived poisons in their systems.
Hal, age 40, said he had been dealing with being overweight his entire life. According to him, no diet works. Lately, he has settled on the idea that his problem is that his body is “toxic” and he therefore has to purify it. He is now “detoxing” with special shakes and only eating food he has decided is “pure”. He is perpetually hungry which gives him a sense of satisfaction.
Fussy eating: Yes, many kids go through a stage of being picky. But picky eating as an adult can become an obsession. Often foods of a particular flavor (salty, sweet) or texture are avoided. Sometimes there are rituals around the presentation or pace of eating.
Shirl is difficult to have as a lunch companion. Although she does eat a balanced diet, she has a long list of food items she won’t eat. She takes twice as long to eat because she pokes and prods the food to make sure it’s “okay” before taking a bite. She came to treatment because it was having a negative effect on her social life and she can’t take prospective clients out for lunch.
Muscle Dysmorphia: Although it is a subtype of body dysmorphic disorder, this is often described as an eating disorder due to the impact on diet and exercise. It is more usual in men who have an exaggerated belief that their body is too skinny or too lacking in muscle definition, even though in most cases it is well within the normal range. To fix his body, the person gets involved with a strict diet, nutritional supplements, and excessive and obsessive exercise routines. This is often difficult to diagnose because the individual may look fit, healthy, and buff. They generally come to treatment because their routines are interfering with social or occupational functioning and they are incurring debt due to the costs of supporting their supplements, gym memberships and coaching.
Mauri has a long history of being bullied throughout his teens for being skinny and weak. Body building is his answer. He eats concoctions his coach tells him will pack on muscles and will win him medals in competitions. He buys hundreds of dollars of supplements every month. Eating has become as much a “discipline” as going to the gym. He hates both but loves the results.
Food Aversion: When a person has a psychological intolerance to certain foods or ingredients that results in gagging or vomiting. (The same negative reaction doesn’t occur if the food is disguised.) In women, this sometimes starts during pregnancy. Morning sickness gets associated with certain foods. Food aversion may also start when a food(s) is associated with vomiting due to an illness or a medical procedure or due to an experience of choking. Sometimes food aversion is rooted in a food’s connection to a traumatic event.
Jack starts to gag if he smells baking chocolate chip cookies. He knows it started when he went to visit his mother and found her collapsed on the floor with cookies baking in the oven.
Eating disorders can be treated.
With treatment, 50 – 60% of people with eating disorders recover. Those numbers significantly improve (up to 80% depending on the disorder) if treatment starts within the first few 3 years of onset. It does take time, especially if the disorder has been long term. But recovery is possible.