Have you lost weight and noticed yourself avoiding certain foods or setting inflexible rules about your eating? Do you lose control while you eat every once in a while or find yourself self-inducing vomiting to feel better on occasion? Are you obsessional about exercise to the point that it interferes with other day-to-day activities? Are you more likely to eat all night but not much during the day? Or do you chew and spit out food sometimes?
Although anorexia nervosa, bulimia nervosa, and binge eating disorder are the most well-known eating disorder diagnoses, many people struggle with eating problems that fall into an ‘other’ eating disorder category (referred to as OSFED, which stands for other specified feeding and eating disorder). In fact, historically, most people with eating disorders have fallen under this classification. To have an ‘other’ eating disorder does not mean that your symptoms are not significant, potentially dangerous, or worthy of clinical attention. It simply means that not quite as much is known about these conditions and that more research is needed.
There are 5 types of ‘other’ eating disorders described in DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a diagnostic guide released in its most up to date form by the American Psychiatric Association in 2013).
Here’s how you might recognize the spectrum of signs and symptoms:
Atypical Anorexia Nervosa
- You have experienced substantial weight loss recently, and have a strong desire to keep losing weight.
- Your weight is still technically in a “normal” range for the general population (unlike in classic anorexia nervosa), but it’s not in a normal or healthy spot for you.
- The signs that your weight is in an unhealthy spot may be physiological (for example, losing regular menstrual function, thinning hair, and low heart rate) or psychological (for example, obsessing over exercise or experiencing rigid thinking about good/bad foods).
- You are afraid of gaining weight and feel dissatisfied with your body shape, no matter your size.
Bulimia Nervosa (Low Frequency/Limited Duration)
- You experience similar binge episodes as those with bulimia nervosa, but they happen less frequently than once a week in the past three months. The binge eating episodes involve eating a very large amount of food while feeling out of control.
- You try to “undo” these binge episodes in some fashion. You might feel compelled to purge, exercise, or fast in response to binge episodes to try to get rid of calories even though this is often unsuccessful and usually backfires. [For more on the ineffectiveness of compensatory behaviors, check out the informative self-help resource, Overcoming Binge Eating, by Dr. Christopher Fairburn.]
Binge Eating Disorder (Low Frequency/Limited Duration)
- Like people with classic binge eating disorder, you have recurring and distressing binge eating episodes (as described above), but they occur less regularly (less than once weekly in the past three months)
- You don’t try to compensate for your binge behavior. You are not purging, exercising, or fasting in the hours or days after a binge.
- You do not binge eat, but you tend to compensate for or “undo” your eating if you feel too full, if you have eaten a food that you usually deem “off limits,” or you are worried about your weight or body shape.
- Your attempts to control your weight or body shape might include self-induced vomiting, excessively exercising, fasting, or taking laxatives. These compensatory behaviors are extremely concerning, even in the absence of binge eating.
Night Eating Syndrome
- You tend to more than half of your daily calories at dinner or later in the evening.
- You might wake up from sleep in the middle of the night to consume food.
- When this pattern becomes entrenched, it becomes harder for you to eat during earlier parts of the day because of fullness. This cycle becomes quite distressing and interferes with day-to-day functioning.
Unspecified Feeding or Eating Disorder
Because expert clinicians know that we still don’t know all there is to know about eating problems, this ‘unspecified’ category is for the remaining types of problems that don’t neatly fit into any of the categories above but nonetheless stand out as problems worthy of clinical attention.
If these symptom clusters might apply for you, or for someone you know, it’s important to seek out an evaluation by a clinician. This could be a primary care physician or an eating disorder specialist (a psychiatrist, psychologists, or social worker perhaps). Psychotherapy or medication may be appropriate modes of treatment to try, and depending on the persistence of your symptoms, you might consider one of a number of different treatment settings.
To learn more about whether or not your relationship with food, eating and body image is a problem, check out the informative guidebook, Almost Anorexic, by psychologist Jennifer Thomas, PhD and author, Jenni Schaefer.