Other Eating Disorders

Pica

Pica, a widely misunderstood phenomenon, is defined as a compulsive craving for eating, chewing or licking non-food items or foods containing no nutrition. These can include such things as dirt, clay, burnt match heads, chalk, plaster, paint chips, baking soda, starch, glue, rust, ice, coffee grounds, and cigarette ashes. It may sometimes be linked to certain mineral deficiencies (i.e., iron or zinc). Pica can be associated with, developmental delays, mental deficiencies and/or a family history of the disorder. There may be psychological disturbances that lead to Pica as well, such as conditions in which a child lives in a low-income or poor family, or who lives in an environment of little love and support. Because of the inherent danger in eating non-food items, it is extremely important that an individual suffering with Pica be evaluated by a doctor, given the correct diagnosis, and treated promptly. The treatment that will follow will depend on the causes of the behavior. If the compulsion is driven by a vitamin or mineral deficiency, supplements will be prescribed; Examination of the home environment, behavior-modification therapy and psychological treatment may also be needed. Pica is commonly found in: pregnant women; People whose diets are deficient in minerals contained in the consumed substances; People who have psychiatric disturbances such as hysteria; People with developmental disabilities or similar impairments; People whose family or ethnic customs include eating certain non-food substances; People who diet, become hungry, and then try to ease hunger and cravings with low-calorie, non-food substances.

Pica: facts and theories

The person must regularly eat these craved substances for a month or more before a diagnosis is given.
The name “pica” comes from the Latin word for magpie, a bird that is famous for eating anything and everything.
Perhaps ten to twenty percent of children have pica at some time before adulthood.
Depending on the population, zero percent to sixty-eight percent of pregnant women have pica. Those in lower socioeconomic groups seem to have more of these cravings.
In some cases, pica is related not to dietary deficiencies but to folk traditions passed on in families or ethnic groups.
Some people treat clay or dirt eating as a part of daily routine, somewhat like smoking.
Others believe that eating dirt will help them incorporate magical spirits from the Earth into their bodies.
Still others believe that certain kinds of clay will suppress morning sickness when eaten.
Some children with pica may be imitating a pet dog or cat.
Stress may be a precipitating factor, especially the stress of dieting when the person tries to relieve hunger and cravings with non-food substances.
There is evidence to support the hypothesis that at least some pica is a response to dietary deficiency. Pregnant women, for example, have given up pica after they were treated for iron-deficiency anemia.
But other cases of pica can cause dietary deficiencies because the consumed substances block absorption of essential nutrients in the intestines.
If pica is a lifestyle choice that does not harm the individual, and if it is not part of an underlying eating disorder, it can go untreated, but care should be taken to protect against toxic substances (such as lead in paint and plaster chips). The person must be alert for symptoms (pain, lack of bowel movements, abdominal bloat and distention) that suggest the substance has formed an indigestible mass that has blocked the intestines. If such is the case, immediate medical attention is necessary.

Complications of pica can include lead poisoning, malnutrition, abdominal problems, intestinal obstruction, hypokalemia, hyperkalemia, mercury poisoning, phosphorus intoxication, and dental injury.

It may be possible (but uncommon) for people with Anorexia and/or Bulimia to develop Pica because of the compulsive nature of these illnesses to binge, and/or the malnutrition that can set in. If the two disorders co-exist, it is important to tell your doctor of both.

Night Eating Syndrome

Here’s the Merck Manual definition and conclusion about treatment. (1982 ed.) p.917:
“Night Eating Syndrome consists of morning anorexia, evening hyperphagia (abnormally increased appetite for consumption of food frequently associated with injury to the hypothalamus) and insomnia. Attempts at weight reduction in these 2 conditions, (referring to bulimia as well), are usually unsuccessful and may cause the patient unnecessary distress.” The authors call both syndromes, “deviant eating patterns apparently based on stress and emotional disturbance…” Episodes of Anorexia and Insomnia can begin at an early age, usually in children who are overweight, and are sometimes accompanied by joint paint. It is interesting to note what the parent of a now 24 year old daughter had to say… People with Night-eating syndrome are characterized as people that put off eating until late in the day, who binge on food in the evenings and who experience problems with falling asleep and/or staying asleep.

Body Dysmorphic Disorder

BDD, or Body Dysmorphic Disorder is a preoccupation or obsession with a defect in visual appearance, whether that be an actual slight imperfection or an imagined one. Some example of this would be obsessing to the point of severe depression (sometimes including thoughts about or attempts at suicide) over physical attributes such as freckles; a large nose, blotchy skin, wrinkles, acne, scarring. Though the preoccupation can include any part of the body, areas of the face and head, specifically the skin, hair and nose, are most common.

People suffering with BDD may often have a low self-esteem and unreasonable fears of rejection from others due to their perceived ugliness. Some sufferers realize that their perception of the “defect” is distorted, but find the impulse to think about it uncontrollable.

There are two types of Body Dysmorphic Disorder — the non-delusional type — and the delusional type (where the person actually has hallucinations of a completely imagined defect, or an imagined gross exaggeration of a small defect). The delusional form is less common and more severe.

Men and women living with BDD may practice unusually compulsive rituals to look at, hide, cover and/or improve their defect(s). They may spend a great deal of time looking at themselves in anything mirror-like and trying to convince others of how ugly they are. They may be compulsive in searching our doctors to treat them with medications and/or plastic surgery. Patients may go to any lengths to improve their appearance, including using methods that are dangerous. Some may even attempt their own surgery, or commit suicide.

Mental Illnesses that sometimes co-exist with BDD are depression, Obsessive-Compulsive Disorder (OCD) and Social Phobia.

Treatment is often difficult, but there has been shown progress with medications such as Prozac, and cognitive-behavior therapy. Diagnosis can often be difficult because of the patients shame (causing them to keep their symptoms a secret).

Symptoms as per the DSM-IV (from Mental Health Net)

Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.
The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

Orthorexia Nervosa

It should be noted that Orthorexia Nervosa is not a condition that a physician will diagnose, as there is no clinical guideline for this disorder. It is a condition that has been observed as an extreme pattern of dietary purity and has not yet been defined under the clinical diagnostic manual (DSM-IV).

Orthorexia Nervosa is an obsession with a “pure” diet, where it interferes with a person’s life. It becomes a way of life filled with chronic concern for the quality of food being consumed. When the person suffering with Orthorexia Nervosa slips up from wavering from their “perfect” diet, they may resort to extreme acts of further self-discipline including even stricter regimens and fasting.

“This transference of all of life’s value into the act of eating makes orthorexia a true disorder. In this essential characteristic, orthorexia bears many similarities to the two well-known eating disorders anorexia and bulimia. Where the bulimic and anorexic focus on the quantity of food, the orthorexic fixates on its quality. All three give food an excessive place in the scheme of life.” (Steven Bratman, M.D., October 1997)

As noted by BeyondVeg.com, Orthorexia Nervosa should only be characterized when it is in the long-term (paying attention to healthy food for a few weeks where it becomes a normal and healthy routine not obsessed over, would not be considered a disorder), when it has a significant negative impact on an individual’s life (thinking about food to avoid the stresses of life, thinking about how food is prepared to avoid negative emotions, thinking about food the majority of each individual’s day), and where food rituals are not better explained by something like religious rites (such as in the Orthodox Jewish religion).