Fundamentals of Human Nutrition/Non-categorized Eating Disorder

Many times when someone has an eating disorder, it is categorized into Anorexia or Bulimia. The problem with this is that every person is different and experiences a variety of symptoms that may not fit perfectly into the known major eating disorders. In 1987, under the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R, 1987), Eating Disorder Not Otherwise Specified (EDNOS) was introduced to specify a group of eating disorders that were not previously recognized. According to The Center for Eating Disorders, EDNOS accounted for about 40-60% of eating disorder cases in treatment centers. In 2013, the DSM-V was published with a new change in regards to EDNOS. More eating disorders were individually recognized like Binge Eating Disorder as well as Purging Disorder and Night Eating Syndrome being classified disordered eating behaviors. The biggest change was the switch from EDNOS to Other Specified Feeding or Eating Disorder (OSFED). This change was made to be able to include the growing variety of disordered eating and feeding behaviors. OSFED now includes 5 main subtypes:

1.	Atypical Anorexia Nervosa

2.	Bulimia Nervosa

3.	Binge Eating Disorder

4.	Purging Disorder

5.	Night Eating Syndrome

6. Nocturnal Eating Disorders

Even though these categories have potential to become narrow like the original eating disorders, DSM-V added in a category called Unspecified Feeding or Eating Disorder (UFED). The main goal of all the changes made over the years is to open up the field of disorders and the minds of people to understand that individuals suffering from a disorder not well known or specifically defined, are acknowledged and then given the opportunity to seek appropriate medical help. Cases that may fall into one of the above categories include all of the symptoms for anorexia being met except for presence of a regular menstrual cycle or the individual weight is within normal ranges. Another case of OSFED could be someone who meets all of the general criteria for bulimia but doesn’t engage in binging or purging behaviors as often to be classified as a bulimic. There are also individuals known to purge after only eating small or normal amounts of food instead of fully binging then purging, as well as staying within normal weight ranges. In addition, some individuals will chew and spit out large amounts of their food without swallowing it. All of these are a little more commonly exhibited and recorded in the eating disorder world but do not include the every possible case or situation that may occur among an individual fighting a disorder.

Orthorexia

Orthorexia Defined

Although orthorexia is not considered a legitimate eating disorder, there are many people who overanalyze the foods they eat and do not consume anything that is unhealthy or impure. This includes any kind of food that has been processed, such as whole grain bread. Some orthorexics may even stray away from eating certain food groups, which can lead to the chain reaction of continuously removing more and more types of food. Just as anorexics have a strong desire to be thin, orthorexics have a strong desire to be healthy. People suffering from anorexia worry about the quantity of the foods they consume whereas orthorexics are concerned about the quality. Individuals with orthorexia start off simply trying to eat healthier but it progresses and they become so fixated on ‘I must eat healthily or nothing at all’. Orthorexics are so obsessed with eating healthy that, ironically, it actually causes their health to decline.

Symptoms
 * Spending a great deal of time thinking about the food quality of the next meal
 * Being so fixated on eating only healthy foods that are organic or whole that it interferes with daily activities.
 * Refusing to eat foods not prepared by oneself due to the possibility that the ingredients are unhealthy.
 * Not wanting to eat in social settings (thus causing one to be antisocial) because the food isn’t healthy.
 * Placing oneself on a pedestal and looking down on others for not having a “healthy” diet like them.
 * Feeling remorseful when not following a healthy diet, but feeling in control when they do.

Treatment
 * 1) Acceptance: The first step in treating individuals with orthorexia is for the orthorexics themselves to accept the fact that their compulsive urge to eat healthy is a threat to their health.
 * 2) Origin: Once the patients acknowledge that it is a problem, they must figure out what it was that caused them to develop their unhealthy obsession.
 * 3) Therapy: Orthorexics should be open to seeing a nutritionist or dietician, psychologist, or even a therapist. Because disorders are not something one can control, seeking assistance to guide these patients in the right direction is very beneficial. Orthorexics already feel isolated to begin with and requesting help from experts is a large step for them. For those reasons, it is crucial that the patient’s family members and the professional treating the patient speak to the patient with composure and understanding rather than an accusatory tone.
 * 4) Recovery: A recovered orthorexic will still have the impulse to eat healthily, but it will not be so severe that it will conflict with their day-to-day living.

Drunkorexia

Drunkorexia Defined

Although drunkorexia is also not considered a legitimate eating disorder, it has been given this official name by researches after many studies were done and many results showed a connection between binge drinking and either self-starvation or purging. Many people, especially college-aged students, engage in this type of behavior and drunkorexia can be seen as an uncategorized eating disorder. Drunkorexia has been more specifically characterized by

1.	Skipping meals so that the calories of from drinking will be compensated for.

2.	Over-exercising so that the calories from drinking do not cause weight gain.

3.	Drink massive amounts of alcohol, causing ones-self to become sick and purge food that was eaten previously.

It has also been stated in a study done on binge drinking that there are a few covariates for this study such as gender, age, race, year in college, place of residence, and greek membership.

So, there are many different variables that come into play when looking at this correlation. It is clear that there is a connection between disordered eating, or physical activity, to “offset calories consumed from drinking”. This eating disorder can closely resemble anorexia nervosa, with the relationship of excessive exercise or restriction of foods, because of the fear of gaining weight and body image (Barry).

Non-categorized eating disorders, also known as Eating Disorders Not Otherwise Specified, are made for those who have a lot of the symptoms of specific eating disorders but do not meet all of the criteria to be diagnosed in one section. A lot of times people with non-categorized eating disorders even meet the criteria for multiple eating disorders at the same time. It is also one of the largest groups of eating disorders because the criterion is not as specific as the ones for anorexia or bulimia. Actually, “about 40%-60% of cases in eating disorder treatment centers fell into the Eating Disorders Not Otherwise Specified Category” (A closer look). The significance or gravity of the cases can be decided through the patters of behaviors and symptoms. →Much like other diseases there are “various physical, psychological, and behavioral warning signs that can signal the onset” (Understanding the warning signs, 2015) and help should be sought as soon as possible. Significant weigh loss, loss of energy and behavioral warnings like rituals or evidence of binge eating, excessive dieting, or vomiting should not be taken lightly. The most notable characteristics of non-categorized eating disorders are distorted body image, being afraid of gaining weight, and disordered eating. n Although there are plenty of physical signs of eating disorders, there are significant behavioral patterns that would point to the eating disorder. A lot of times, people with eating disorders will eat meals alone, frequently use the bathroom right after meals, abuse laxatives, and change their appearance. More importantly there are also psychological signals like being preoccupied about their body image, feelings of distress and anxiety when it comes to food, and constantly fueling the idea of self-punishment. →Like other mental disorders, eating disorders not otherwise specified also come with major risks that could eventually lead to death. The risks that come with eating disorders not otherwise specified are not that much different from the complications and results that come with anorexia or bulimia. Some of the physical risks are the rupturing of the esophagus, kidney failure, osteoporosis, and ever infertility in both men and women. Eating disorders are usually tied to other mental issues like low self-esteem, depression, and anxiety. They can also cause significant stress on families, relationships and friendships. The person becomes so preoccupied with food, its almost like the eating disorder has taken control. It starts to leave no room for hobbies, hanging out, or even happiness. Even with all of the risks and warning behaviors, there is hope for treatment. It just takes the right support, base, and knowledge. “Having awareness about eating disorders and the warning signs can make a marked difference to the severity and duration of the illness” (Eating disorders explained, 2014). →Although we know a lot about most eating disorders, eating disorders not specified are more vaguely defined and discussed. It is much more difficult to find much data on non-categorized eating disorders because they usually are not included in studies like those done on anorexia or bulimia.

Athletes With Eating Disorders text

A lot of athletes are looked at for potentially dangerous eating behaviors. They are participating in regularly scheduled exercise and high intensity work outs. They require lots of physical activity to play at their best. A lot of athletes proceed to want to be the best at what they do which requires to be as fit as possible. Due to the nature of the athlete, excessive exercise and restrictive eating are often viewed as acceptable in athletic training. Athletes with eating disorders sometimes get overlooked due to the nature of their sport. Some people think that they are training harder because they want to be able to get a scholarship or to win a game or other factors that are in play. Personality traits among athletes are high achievement motivation, perfectionism, obsessive compulsive tendencies, and persistence toward goals despite pain or discomfort. They are willing to take risks in order to win. There is a general population of 3% of exercise addiction. There are also different populations where it is seen more than others, such as ultra- marathon runners and sports science students. Exercise additions appears to be related to food disorders, overuse of caffeine, work addiction and shopping addiction. Due to the nature of the addiction, exercise addiction co- occurs with eating disorder which is extremely dangerous. There is also a challenge for professionals to treat both additions. Making sure they take care of both disorders is a challenge that professionals have to face while dealing with athletes from suffering this disorder. A lot of coaches could also influence the chance of an athlete contracting this type of eating disorder. They are on top of athletes to make sure they are in shape and eating right in order to fit a certain body image. A sport that is high in eating disorders is dancers. A lot of dancers rely on their body image to be light enough and small enough to do certain moves and carries. Dancers have been found to have one of the highest amount of eating disorders of any sport. There are a lot of other sports that body weight is a major contributor to performance. Weight lifting requires both male and females to be classified into a specific weight class. This requires the athletes to keep close watch on their weight. There are sports that their performance is subjectively scored for their appearance, such as figure skating. Jockeying requires the athlete to be smaller in size due to the horse not being able to run as fast with someone heavier.

Night Eating Syndrome

Night eating syndrome(NES) is not like a binge eating disorder, however, the two may cross within certain individuals. The amount of food consumed does not necessarily have to be large, it can be of any quantity. A loss of control as with binge eating is also not required. Most individuals with this syndrome are often binge eaters, and can have a loss of control over food intake as well.

NES was originally described in 1955 by Dr. Albert Stunkard. NES affects around 1.5 percent of the population, and is equally common in both men and women. It is currently included in the “Other Specified Feeding or Eating Disorder” category. Most individuals with night eating syndrome may feel as though they have little to no control over their irregular eating patterns, and can feel humiliation and discomfort over their condition.

Individuals with NES can be overweight, feel ashamed, and eat in secret or when they are not hungry. These individuals will eat the majority of their food in the evening and at night as the name of the syndrome suggests. They will consume almost nothing in the daylight hours, and will wake-up in the middle of the night to pursue high calorie snacks.

The causes of NES vary, but as with other eating disorders, may arise as a result of shame and discomfort. It can also arise from bad habits, such as eating late at night, or working through lunches and dinners. It may even be a response to stress or hormones causing these individuals to not eat when they should, and to eat when they normally should not. It may also be caused in response to bad dieting techniques, restricting oneself on calories signals the brain later in the evening that the body is still hungry, resulting in consumption during a time when the body should be at rest. It may also result from late-night cravings.

The treatment of NES typically requires many therapies as with any other eating disorder. First the individual affected must be educated about their condition so that they may become more aware that their eating patterns are not normal. They must also be made aware that they are not at fault, and be given support as they take steps towards recovery. Treatment includes nutrition assessment, exercise therapy, behavioral therapy, and along with therapy, stress management. The individual must also be willing to change their beliefs and behavior associated with NES if they truly hope to be able to change.

Works Cited:

-American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Publishing. 2013.

-Gluck, Geleibter, and Satov. Night eating syndrome is associated with depression, low self-esteem, reduced daytime hunger, and less weight loss in obese outpatients. PubMed. 2001.

-Walden Eating Disorders. In: Night Eating Syndrome. Waltham, MA. 2015.

Nocturnal Eating Disorders

Nocturnal eating disorders are classified as abnormal eating patterns during the night and consist of two categories, Sleep-Related Eating Disorder and Nocturnal Eating Syndrome. Nocturnal Eating Disorders were discovered in 1955 in 25 patients with obesity. Nocturnal Eating Disorders are considered both eating disorders and sleeping disorders and may be amplified by other eating disorders of sleep disorders.

Sleep Related Eating Disorder: Classified as preparing and eating food while unconscious and unaware. Will wake up the next morning with no memory of eating or preparing food and may be confused as to why there is food out of the refrigerator. •	Signs of Sleep Related Eating Disorder o	Seeing food left out on counter upon waking o	Little or no appetite in the morning o	Weight gain

Nocturnal Eating Syndrome: This differs from Sleep Related Eating Disorder in that these patients are fully aware that they are eating. They may be woken up in the middle of the night and find themselves unable to fall asleep unless they eat. Usually the foods consumed are large amounts of unhealthy foods •	Signs of Nocturnal Eating Syndrome o	Frequently waking at night and must eat in order to sleep o	Eat more food after dinner than during dinner o	Little or no appetite for breakfast

Causes and Effects: may cause weight gain, depression, hypertension, and increase the risk of Type 2 Diabetes •	Found in 5% of the population •	More common in women •	More common in women under 50 •	More common in obese population •	Risk increased to 17% if tied to other eating disorders •	Risk increased to 27% in the severely obese community •	Dieting during the day may lead to hunger at night •	May be caused by alcoholism, drug abuse and other sleeping disorders •	May be a precursor to a larger medical problem such as stomach ulcers, sleep apnea, depression, bulimia, sleep walking, or a traumatic event •	Zolpidem (Ambien) can also cause nighttime eating

Treatment: If you think you may have a nocturnal eating disorder contact your doctor or health provider. Initial steps will be an interview to determine your symptoms which maybe be followed by an overnight stay in a sleep lab. •	Sleeping pills should be avoided and can cause confusion •	Stress management classes may be advised •	Counseling •	Limiting intake of alcohol or caffeine •	Popiramate (an anti seizure medicine) can treat both syndromes o	Works on dulling the appetite center of the brain •	If the cause of the disorder is depression, an anti depressant may be used

Works Cited

Auger, R. (n.d.). Sleep-Related Eating Disorders. Retrieved December 3, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945843/

Barry AE, Piazza-Gardner AK. Drunkorexia: Understanding the Co-occurrence of Alcohol Consumption and Eating/Exercise Weight Management Behaviors. Journal of American College Health 2012;60(3):236–243. doi:10.1080/07448481.2011.587487.

Sleep-Related Eating Disorders: Causes, Treatments, and More. (n.d.). Retrieved December 3, 2015, from http://www.webmd.com/sleep-disorders/guide/sleep-related-eating-disorders <%22htt>

Snacking While Asleep? The Truth About Nocturnal Eating Disorders. (n.d.). Retrieved December 3, 2015, from http://www.everydayhealth.com/sleep/other-disorders/nocturnal-eating-disorders.aspx <%22>