The Hidden Eating Disorders We Don’t Talk About

There are six official eating disorders, the ones that doctors can diagnose, plus three unofficial eating disorders. While most people are familiar with anorexia, bulimia and binge eating disorder, I want to go over the ones we don’t talk about, the “hidden” eating disorders.   

The Clinical Eating Disorders: 

Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder 

Avoidant and Restrictive Food Intake Disorder (ARFID) 

Different from anorexia, bulimia and binge eating disorder, ARFID doesn’t include negative thoughts and feelings about weight. Although this can develop if left untreated, those who have ARFID refuse or avoid certain foods or are fearful of eating, but not because they want to lose weight.  

What makes someone refuse food? It’s usually because of a certain texture, colour or smell. Parents often notice this in childhood, when it goes beyond “picky eating” and they see their child having extreme reactions to some foods (for example, meltdowns when offered carrots or outbursts when asked to eat something crunchy). For some, a past experience being sick after eating a certain food can trigger a fear of that food afterwards. 

For autistic individuals, it can be difficult to separate their food rituals and a lack of diverse food preferences, with ARFID. To help parents understand if their child might have ARFID, a few signs and symptoms are: 

• No weight gain appropriate to a child’s age (or weight loss) 

• Nutritional deficiencies or anaemia 

• Anxiety or refusal to eat certain foods or unfamiliar foods 

• Food rituals    

• Gastrointestinal complaints that have no cause 

Other Specified Feeding or Eating Disorders 

This diagnosis is for those who don’t quite fit into the diagnoses of anorexia, bulimia and binge eating disorder, but are still considered to have an eating disorder. Some examples include: 

• Anorexia type: like anorexia but not below the weight for their age 

• Bulimia type: like bulimia but binging and purging occurs less than once per week and/or for fewer than 3 months 

• Binge type: like binge eating disorder but binging occurs less than once per week and/or for fewer than 3 months   

• Night eating syndrome: when a person consumes an excessive amount of food during the night (e.g. even after eating dinner or waking up in the middle of the night to eat), causing distress and interfering with daily functioning 

• Purging type:  without binging, a person who persistently purges after eating 

Unspecified Feeding and Eating Disorders 

These diagnoses don’t match the above criteria but still cause significant distress or impairment to daily life. They include: 

• Pica: persistently eating non-food items for longer than a month, which may include soap, gum, soil, chalk, hair, ice, clay, cloth, ash, paper, string, metal, wool, pebbles, starch, coal, charcoal or talcum powder (this does not include children between 18 months and 2 years old who mouth non-food items as part of natural development) 

• Rumination disorder: consistent regurgitation of food without effort (no gagging or nausea) over a period of at least a month – this can be seen in infants but should be outgrown 

• Unspecified feeding or eating disorder: any other feeding or eating behaviour that doesn’t fit the above criteria but causes distress and impairment in daily functioning 

The Unofficial Eating Disorders: 

Compulsive exercising (sometimes called “anorexia athletica”) 

Related to anorexia but not directly related to food, compulsive exercising is when exercise is used to control weight and body shape, while providing a sense of control, power and self-respect. A person’s exercise regime becomes more important than almost anything else in their life (e.g. they’re unwilling to miss a workout, will take time off work/school or not see friends in order to exercise). 

When exercising, there is little or no pleasure taken, only a focus on the pose/activity/fitness goal. People who compulsively exercise are also rarely satisfied with their achievements and believe that their self-worth depends on their performance.  

Nocturnal sleep-related eating disorder 

This is when a person eats or binges, or consumes food that’s raw or even non-food items, while they are sleeping. It happens during an unconscious state between sleeping and waking and they don’t usually remember it happened after they wake up. While eating is involved, it is thought to be a sleep disorder instead of an eating disorder. 

Orthorexia 

A person is focused only on eating food that they deem “healthy,” often using “natural” products to treat illnesses. They have strict rules about what is “healthy” and “unhealthy,” usually depending on how “natural” they deem something.  

Eating becomes about eating the “correct” foods rather than eating for pleasure or enjoyment. This leads to an obsessive focus on food, often with weight as a measure of their “success.” This behaviour can often lead to an eating disorder. 

While all these diagnoses might sound intimidating, remember that you don’t have to have a diagnosis or fit into any of the criteria above to seek help. If you struggle with food and want to feel better, I encourage you to reach out. I’m here to help. 💜  

Reach out to Shelley Jensen at +1 (604) 670-1721 or by email to set up your free, half-hour consultation. Sessions are always confidential.