Beyond Anorexia Nervosa; Exploring Lesser-Known Eating Disorders

The most well-known eating disorders in women are anorexia nervosa, bulimia nervosa, and binge-eating disorder. In popular perception, indeed, anorexia nervosa might be considered the only eating disorder. Because of the extreme weight loss caused by anorexia nervosa, and the portrayal it’s received in several media outlets, it’s perhaps more recognizable than other disorders to a layperson. However, any form of disordered eating can be quite dangerous for the sufferer’s health and must be taken seriously.

Other eating disorders such as nighttime eating disorder and avoidant/restrictive food intake disorder also affect people of all ages and genders but do not gain the attention that the more well-known ones do. Some people may feel these disorders aren’t as serious as anorexia nervosa, and these eating disorders might be treatable with a few sessions with a therapist, or even through “willpower.”This couldn’t be further from the truth.

With more research into less-familiar eating disorders like orthorexia nervosa, pica, ARFID, and Chewing and Spitting Disorder,the need for treatment to prevent serious physical and mental health consequences has become eminently clear.Here, we’ll discuss some of thelesser-known eating disorders and hopefully shed light on how they can be treated.

Orthorexia Nervosa

About ten years ago the psychiatric community finally recognized this less-common but still-dangerous eating disorder. Orthorexia is an eating disorder where a person compulsively restricts the consumption of food based on their perception of the food’s “cleanliness, wholesomeness, and healthiness.”

Like many eating disorders, the development of orthorexia nervosa is often associated with dieting and attempts to “eat healthily.” People with orthorexia nervosa, becoming obsessed with improving their health, often increase their exercise regimens and also make drastic changes to what kind of foods they eat. Over time, their focus on eating low-fat, low-calorie, fresher foods becomes a compulsion that begins to negatively affect their health.

Compulsively avoiding food groups, and preparations and eating at a particular time of daybecomes part of the routine and then gradually a habit that can’t be broken. For people at risk of developing compulsive behaviors, dieting and “healthy eating” can become more than a simple diet or lifestyle change.

For example, a person with orthorexia nervosa may decide to remove any food with gluten out of their diet in their attempt to avoid “unhealthy foods,” not counting Celiac disease or a legitimate gluten allergy. Eating this way can lead to nutritional imbalances.Like many disordered eating behaviors, it also releases dopamine, a “feel-good chemical” into the brain. To spur more of this chemical release, the person might go to more extreme diets and food avoidance. Like the binging and purging cycle related to bulimia nervosa, this is often a coping mechanism related to negative emotions or PTSD.

A diet without sufficient nutrition will eventually take a toll on overall health as the body begins shutting down.Eating disorder treatment centers evaluating someone with severe orthorexia nervosa may recommend the individual be hospitalized for malnutrition and weight restoration before they begin psychotherapy.

Of course, not everyone who diets or doesn’t eat certain types of food develops an eating disorder. Risk factors for this eating disorder include having perfectionistic tendencies, obsessive/compulsive habits, rigid (black or white) thinking, and anxiety disorders.


Unlike most eating disorders, which involve disordered actions concerning food and body image, pica is not usually related to a desire to lose weight or a disordered body image. Instead, a person suffering from pica eats things that aren’t considered food and provide no nutritional value. Pica is often associated with neurological and psychiatric disorders that affect cognition, such as schizophrenia. It’s unknown how many people suffer from pica, although experts think that it might be more common in developing countries and areas with food insecurity than in the United States.

Examples of things that are eaten in a case of pica might consist of rocks, dirt, hair, or paint chips. Because of this, in addition to psychiatric treatment, people admitted to facilities for pica often need examinations for the gastrointestinal tract for blockages, as well as damage to the stomach, throat, and intestines. It’s also associated with hair-pulling and skin-picking disorders, which are treatable through extensive behavioral training programs. There are no specific medications for pica.

There are no medical or laboratory tests for pica, so the diagnosis must be made by analyzing behaviors, namely, persistently eating “non-foods” over at least a month. It can affect people of any age, but it’s most common in smaller children. In some cases, nutritional deficiencies or pregnancy may trigger cravings for minerals, which is considered a temporary case and is related to the nutritional needs of the mother and fetus.

Chewing and Spitting Disorder

People with Chewing and Spitting Disorder experience urges to chew food but refuse to swallow it. They intend to get the taste of the food without taking un any calories or gaining weight. Chewing and spitting is similar in some ways to other eating disorder like bulimia nervosa because chewing and spitting involve eating large amounts of high-fat, high-calorie foods but not consuming the food. This behavior is often observed in people with anorexia nervosa as well.

People who are experiencing the symptoms of Chewing and Spitting Disorder will often go to great lengths to find ways to chew their food and spit it out without being noticed. In some cases, this can cause great distress when eating with other people, causing social isolation and an inability to spend time with others in situations where food is involved.

Chewing and Spitting Disorder is associated with suicidal ideation and body image concerns, depression, preoccupation with weight and appearance, and anxiety. These associations are common to most eating disorders, and they normally must be addressed during treatment. Many treatment methodologies can be applied to multiple disorders, such as Cognitive Behavioral Therapy and Dialectic Behavioral Therapy.

Physical consequences of a chewing and spitting disorder include stomach ulcers, hormonal imbalances, weight loss, swollen salivary glands, and tooth decay. IF the individual has lost a significant amount of weight or is displaying signs of malnutrition, complete or partial hospitalization might be required. Chewing and Spitting Disorder treatment also often includes exposure therapy, in which the individual gradually tries to chew and swallow their food in increasing amounts. “Facing their fears” in this way can be difficult for the individual, but it is an effective way to normalize more typical eating behaviors.

ARFID (Avoidant Restrictive Food Intake Disorder)

Another eating disorder that doesn’t necessarily include behaviors caused by body dysmorphic disorder or other issues with body image, ARFID has been officially designated a psychiatric disorder in the most recent diagnostic manual, the DSM-V. With this disorder, a person will strictly avoid certain foods to the point that their health is impacted, usually in the form of severe weight loss.

Unlike orthorexia nervosa, however, the person doesn’t avoid certain foods because they are “unhealthy” in the sense of being fatty or otherwise bad for the health, but rather by a severe aversion to the food’s flavor, texture, or odor. This often extends to undue concerns that the food has spoiled or is poison. People with ARFID often have phobias about choking on certain foods or getting food poisoning or vomiting if they eat that food. This is often triggered by a negative experience with that food during childhood. Over time, more and more types of food become undesirable, until the individual is unable to eat more than a few specific foods.

In the past, it was known as selective eating disorder, but recently it’s been renamed ARFD to separate it from orthorexia nervosa and simple picky eating. ARFID often begins in childhood and progressively worsens over time. It’s relatively common for children to be “picky eaters” and everyone has preferences for what they eat, but when it becomes either compulsive behavior or has negative effects on the individual’s heath, ARFID requires specialized eating disorder treatment.

Like orthorexia, untreated ARFID can cause psychosocial complications, and also severe nutritional imbalances. Also like orthorexia, a negative or distorted body image is not necessarily a cause of the disorder. ARFID is normally treated using talk therapy and cognitive retraining such as Cognitive Behavioral Therapy (CBT).

Treatment Is Available for Every Kind of Eating Disorders

Less well-known eating disorders are becoming less obscure as awareness d disordered eating in general increases. Some high-profile films, documentaries, and celebrities being open about their struggles have raised knowledge of the more common disorders like anorexia nervosa. Although that may put more focus on the well-known disorders, it’s tangentially raised awareness of lesser-known ones as well.

The even better news is that as awareness improves, more people can seek out help for their disordered eating.Residential and outpatient eating disorder treatment programs remain the most effective methods, anyonewith an eating disorder can depend on to achieve recovery from an eating disorder. Virtually any treatment program can address the psychological aspects of these eating disorders and residential programs especially can deal with the medical complications as well.

If you or a loved one is experiencing an eating disorder of any kind, don’t lose hope. Treatment is available. Reach out to your therapist or an eating disorder treatment facility as soon as you can. It’s the first step to achieving a fully recovered life.

With 20 years of behavioral health business development experience, Carrie combines world-class marketing, media, public relations, outreach and business development with a deep understanding of client care and treatment. Her contributions to the world of behavioral health business development – and particularly eating disorder treatment – go beyond simple marketing; she has actively developed leaders for her organizations and for the industry at large.