Atypical Eating Disorders Explained By A Dietitian

/ Eating Disorders / By

Sharing is caring!

When you think about eating disorders, you might think about behaviors and body emaciation  that match what you learned in health class. But what about those atypical eating disorders? Eating disorders that don’t quite check off all the boxes in the DSM-V?

In reality, atypical eating disorders are actually the norm.  It’s very rare that someone fits all the boxes outlined in the DSM-V and/or has no other associated behaviors of an eating disorder. Eating disorders are incredibly complex and far more diverse than you might think.

In this blog, we’ll explore a range of atypical or lesser-known eating disorders—from orthorexia and ARFID to purging disorder and diabulimia. These conditions may not always be visible on the outside, but they are real, valid, and just as dangerous as eating disorders clearly outlined in the DSM-V.

Let’s shed some light on the eating disorders we don’t talk enough about. 

infographic with pink lettering of common types of atypical eating disorders

What Are Atypical Eating Disorders

Atypical eating disorders refer to disordered eating patterns that don’t meet the full criteria for anorexia, bulimia, or binge eating disorder, but still involve significant physical and emotional distress. These disorders can cause serious medical complications, impair daily functioning, and take a major toll on mental health.

Risks of atypical EDs include: 

  • Malnutrition
  • Anxiety
  • Depression 
  • Social isolation 
  • Abnormal lab values
  • Organ and tissue failure
  • Death

While the DSM-V has distinct criteria for each eating disorder described, I invite you to look at eating disorders in a different way.  Eating disorders are either intentionally restrictive (food, excessive exercise, purging laxative abuse) or non restrictive. 

Treatment for each restrictive eating disorders will be very similar across the board and different from eating disorders that are not restrictive in nature. 

Want A Free PDF of This Blog? 
Enter Your Email and I’ll Send It Right Along!
Thank you for subscribing!

Common Types of Atypical Eating Disorders

Atypical Anorexia Nervosa

What you might not know about atypical anorexia is that it is actually the “typical” anorexia. Only about 6% of people with anorexia are clinically underweight. The requirement that someone be underweight to have an eating disorder is a myth that is killing people. 

  • Meets all criteria for anorexia except the individual is not underweight according to bmi
  • Can involve dramatic weight loss 
  • Can lead to organ failure and cardiac arrest

Avoidant Restrictive Food Intake Disorder (ARFID)

ARFID is often referred to as extreme picky eating. We see many incidences of AFRID with people with sensory processing disorder or on the autism spectrum. People with ARFID do not have an intense desire to change their body

However, people with ARFID can quickly develop tendencies of food restriction if they start to see unwanted changes in their body or become influenced by diet culture. 

Some common characteristics of ARFID include:

  • Extreme food avoidance without body image concerns.
  • Sensory sensitivity, fear of choking, or lack of appetite causing reduced food intake
  • Fear of getting sick from food/vomiting
  • OCD behaviors such as hand washing that interrupt eating 

Orthorexia Nervosa

is an unhealthy obsession with eating only foods perceived as “clean,” “pure,” or “healthy.” While it’s not officially recognized in the DSM-5, it is widely acknowledged by clinicians as a serious and impairing eating disorder.

Some characteristics of orthorexia include:

  • Obsession with “clean” or “pure” eating
  • Avoiding “toxic” food choices such as non-organic foods or foods with sugar
  • Can lead to malnutrition and intense anxiety around food choices
  • Omitting entire food groups

Night Eating Syndrome (NES)

Night eating syndrome involves frequent night time eating or binge eating at night

Common traits of night eating . 

  • Recurrent episodes of eating at night (after dinner or upon waking from sleep).
  • Distress and sleep disruption, and can be tied to mood disorders
  • Binge eating at night 
  • Binge restrict cycles 

Rumination Disorder 

Rumination disorder is a condition in which a person repeatedly regurgitates food shortly after eating. The regurgitated food is often re-chewed, re-swallowed, or spit out. This behavior is involuntary for some, while others may learn to control it over time.

  • Repeated regurgitation and re-chewing of food without nausea or a medical cause.
  • The behavior is not due to nausea, vomiting, or a medical condition (such as GERD, acid reflux)
  • Regurgitated food may taste normal (not acidic or sour, unlike vomit)
  • No retching or gagging occurs—regurgitation is often effortless
  • Individuals may seem calm or unaware that it’s happening
Dangers of atypical eating disorders infographic

PICA

PICA can occur in children, adults and during pregnancy. There are many physical and emotional consequences of pica

Someone with PICA consumes non-nutriative substances such as hair, chalk, paint, dirt, laundry soap and many more.  

PICA is characterized by: 

  • Persistent eating of non-food substances (e.g., dirt, chalk, paper).
  • Often associated with nutritional deficiencies or developmental disorders
  • Can lead to bowel obstruction or other organ and tissue impairment

Chewing and Spitting Disorder

Chewing and Spitting (CHSP) is a disordered eating behavior where someone chews and spits out food. Many people who engage in chewing and spitting are doing so in efforts to lose weight or avoid certain types of foods or nutrients. 

A person with an eating disorder may more commonly chew and spit fear foods. Some common characteristics of chewing and spitting disorder include:

  • Chewing food and spitting it out to avoid swallowing
  • Often done to experience the taste while avoiding calories
  • Socially isolating when eating meals
  • Avoiding social gatherings where food is present

Diabulimia

The term diabulimia combines both “diabetes” and “bulimia” together. It involves misusing insulin in attempts to lose weight.  Misusing insulin can be seen as a form of purging even though technically a person isn’t getting rid of food from the body. 

Some common characteristics of diabulimia are: 

  • A person with type 1 diabetes intentionally reduce or skip insulin to lose weight
  • Widely recognized in medical communities even though not technically an eating disorder in the DSM-V
  • Dangerously high blood sugars or ketoacidosis

Treatment for Atypical Eating Disorders

Atypical eating disorders are not rare—they’re just rarely talked about. By broadening our understanding of what eating disorders can look like, we make space for more people to feel seen, heard, and supported on their path to healing.

Treatment for these lesser known eating disorders will include:

While weight restoration and correcting any type of malnutrition will be critical for any type of eating disorder, the behaviors associated with the eating disorder (purging, laxative abuse, rumination) will often need to be addressed simultaneously but with a different approach. 

Often treatment for eating disorder specific behaviors can include finding other outlets to reduce stress or cope with difficult emotions, reducing behaviors prior to full elimination, and urge surfing when the desire to engage in eating disorder behaviors becomes intense. 

Additional Eating Disorder Resources

Recovering from an eating disorder is not just about restoring weight and correcting malnourishment. There are many emotional barriers to recover. 

I often say “eat all the meals, feel all the feels” meaning that emotions will typically feel very intense in your eating disorder recovery journey. 

Here are some tools to help you with your recovery: 

Read about my eating disorder journey to help you understand that you are not alone, and that eating disorders can happen to anyone. While everyone’s journey is different, a long and lasting ED recovery is possible for everyone.

Shena Jaramillo. Registered Dietitian
Latest posts by Shena Jaramillo. Registered Dietitian (see all)