Eating disorders include more body-image conditions than anorexia and bulimia. Learn the warning signs of orthorexia, pregorexia, drunkorexia, and diabulimia, and why treatment is important.
While anorexia and bulimia are the most commonly known eating disorders, they are not the only ones that have been identified. For example, orthorexia, pregorexia, drunkorexia, and diabulimia are just a few of the conditions in the news lately.
Though not as well known, these eating disorders are not actually new. In fact, they’ve been widely recognized by doctors for years. Because of their new, trendier names and surrounding publicity, many people are hearing about them for the first time.
Like other eating disorders, they involve issues related to body image and usually need intervention to get under control. The first step is knowledge so people struggling with them — and their family and friends — can recognize the warning signs and know when to get help.
Orthorexia: An Obsession With Healthy Food
“Orthorexia is an obsession with eating healthy food — to such an extent that the person may restrict their diet very severely and limit their functioning, such as not socializing in situations where there is ‘unhealthy’ food,” says Sheela Raja, PhD, an assistant professor and clinical psychologist in the Colleges of Medicine and Dentistry at the University of Illinois at Chicago. There has been no research into eating disorder statistics to know how widespread orthorexia is, but in general the idea of “good” and “bad” foods is relatively common in people with eating disorders.
The advent of so many fad diets hasn’t helped matters either. No carbs, only raw food, macrobiotics — diets with such strict food rules can certainly lead to confusion about what really is healthy and what isn’t, and in turn can contribute to orthorexia.
Warning signs can range from negative feelings about “impure” foods to trouble dealing with stress. Avoiding social situations or bringing your own food to restaurants or get-togethers can be another red flag, as can insisting that good health is totally dependent on the quality of the food you eat. It can also be more common in people who have obsessive or black-and-white thinking that a food is either all good or all bad.
Orthorexia is not an official psychiatric diagnosis, given that the symptoms overlap significantly with diagnoses of other eating disorders. “No classic treatment plan is available, but I work with people to normalize food and take away magical thinking about the ‘right/perfect’ foods,” says Esther Kane, MSW, a registered clinical counselor in private practice in Courtenay, British Columbia, Canada, and author of It’s Not About the Food: A Woman’s Guide to Making Peace with Food and Our Bodies.
Nutritional education and finding other ways to deal with stress and negative moods are important steps. Raja, for example, suggests participating in an activity unrelated to eating, such as going for a walk or taking a bath, when feeling stressed. Focusing on moderation is also key, as is emphasizing the idea that no food should be excluded from the diet.
Pregorexia: An Eating Disorder During Pregnancy
Pregorexia, or experiencing an eating disorder while pregnant, can affect up to 30 percent of pregnant women who have a history of an eating disorder. Even women who survive pregnancy without an eating disorder episode are at a high risk for relapse after childbirth.
Physical symptoms include vomiting, laxative use, excessive exercise, and a large weight loss. Women with pregorexia can also worry excessively about losing control of their bodies, being fat even when others tell them they’re not, and eating too much.
Women with eating disorders are often very secretive, so ideally a doctor would ask a pregnant woman if she has concerns about eating or weight gain while pregnant, in order to help identify the problem. Once the eating disorder has been identified, a woman should work with a nutritionist and her doctor to learn about her nutritional needs, calorie intake, and more. Alternate ways of dealing with stress and negative emotions should also be explored. Women with pregorexia may benefit from talking with other women about how their bodies changed during pregnancy to help anticipate these changes. Finally, even steps as simple as avoiding buffet restaurants and keeping only a limited quantity of favorite binge foods in the house can be helpful.
Here are two more eating disorders you may not have heard of.
Drunkorexia: Cutting Food in Favor of Alcohol
Most common among college students, drunkorexia is the concept of restricting calories before drinking alcohol. One study found as many as 14 percent of freshmen limited food before alcohol consumption, with 6 percent admitting it was done to avoid weight gain.
While not a specific psychiatric diagnosis, drunkorexia warning signs include impairment in school, work, and relationships, and alcohol problems in general. “There is a strong association between eating disorders and alcohol abuse,” says Raja. “A large population study reported that 30 to 50 percent of individuals with bulimia and 12 to 18 percent of individuals with anorexia have abused alcohol.”
Education is key and college campuses need to focus on the overlap between eating disorders and substance abuse. People with drunkorexia need to understand the dangers of this behavior and how it can interfere with long-term goals and success. Learning stress management techniques is important, too. In severe situations, usually alcohol addiction is treated first and then the eating disorder is addressed.
Diabulimia: Cutting Out Insulin to Be Thin
Diabulimia is an eating disorder that occurs when people with type 1 diabetes don’t take their insulin for the specific purpose of being thin. While there are few studies on this specific area, research suggests the numbers could be as high as 10 to 40 percent of type 1 diabetes patients engaging in this behavior, particularly young people.
Symptoms can include consistently high glucose levels and a distorted body image, as well as numerous ER visits. Depending on the severity, treatment can be in-patient or out-patient, but both approaches focus on education about nutrition, the importance of taking insulin as directed, and changing thoughts when it comes to body image.
How Unhealthy Eating Behaviors Spread
Ultimately researchers are not certain whether these eating disorders are on the rise, but if they are, it is likely to be because the behaviors are being passed from one person to another. “For example, it is not uncommon for girls to ‘teach’ each other ‘tricks’ for weight control (such as using laxatives, or vomiting) in various settings that emphasize thinness,” says Raja. “If more women are seeing these types of disorders (like not using insulin in order to lose weight) in other women, the overall prevalence of behaviors may be increasing.”