It’s no longer just bulimia and anoxeria when it comes to eating disorders. The American Psychiatric Association introduced a new category of eating disorders in the 1990s — aptly named the Eating disorders not otherwise specified (EDNOS). Some of the disorders under this umbrella include orthorexia, pregorexia, binge eating, anorexia athletica and drunkorexia. In fact, EDNOS are now the most commonly diagnosed eating disorders, accounting for almost 60 percent of cases in a study conducted by Behaviour Research and Therapy.

Orthorexia

Often referred to as a fixation with healthy and/or righteous eating, orthorexia includes an obsessiveness about not eating particular types of foods, specifically fats, preservatives and food with added salts or sugars. "It’s an unhealthy obsession with eating healthy foods," says Dr. Christopher Adams, a psychologist at Wheaton Franciscan Behavioral Health in Milwaukee. "There’s a compulsion involved with it — they have to do this, it’s not something they can control or will consider controlling." The determining factor in diagnosing the disorder occurs when a patient’s behavioral pattern becomes harmful to them. "At that point, it becomes problematic. They’re severely malnourished or emaciated," says Adams.

Pregorexia

Women who suffer from pregorexia carry out extreme diet or exercise patterns while pregnant. Though extremely rare, individuals endanger not only their personal health, but the health of their fetus. "Women engage in restrictive eating during that time because they are fearful of weight gain," says Dr. Tracey Lee Cornella-Carlson, a psychiatrist at Rogers Memorial Hospital in Milwaukee. Women may also use pregnancy as a justification for eating, adds Cornella-Carlson, leading to excessive weight gain while pregnant.

Binge Eating

As one of the most common disorders in the EDNOS group, binge eating involves compulsive overeating, typically to deal with negative emotions or stress. "Patients can’t resist the urge," says Adams. "They’re not hungry. They only stop when they become uncomfortable." The addictive quality of the disorder leads to frequent consumption of unusually large amounts of food, and these episodes are often followed by significant guilt or remorse, adds Cornella-Carlson. Because of its increased prevalance in both men and women, binge eating may be included as it’s own separate disorder in next spring’s DSM-V, the official manual used by psychologists and psychiatrists in diagnosing diseases and disorders.

Anorexia Athletica

Also known as hypergymnasia, anorexia athletica is an addiction to exercise. Those who suffer from the disorder fear weight gain and compulsively exercise to ease said fear. "Patients have a distorted or inappropriate view of what you should do to maintain their health," explains Adams. "They feel compelled to overexercise." More often than not, the addiction interferes with an individual’s professional and personal life, and they voluntarily choose exercise over work commitments or social gatherings.

Drunkorexia

Most apparent in college-aged females, individuals who suffer from drunkorexia restrict their food intake to reserve calories for alcohol and binge drinking. "It’s an obsessive intention to not put on weight," says Adams. "They will skip meals to save calories for anticipated drinking." The disorder may lead to serious consequences, notes Adams, including alcohol poisoning and uninhibited sexual behavior.

Despite the rise in eating disorder diagnoses in the U.S., a high percentage of individuals fail to seek treatment until the disorder has significant physical or social impact on their lives. Many feel helpless; that their actions are beyond their control. "There is a clear defense system built around the behavior," says Adams. "They do not see it as a problem until someone else confronts them." Cornella-Carlson stresses the importance of positive reinforcement when treating her patients. "I tell them they are blessed to be in treatment, getting the help they need," she explains. "There is a stigma associated with it (eating disorders) because it is a mental illness. It takes a lot for people to realize they need help, and that if they continue, they will have serious medical and psychological complications."

Adams encourages his patients to expand their social network or have a greater involvement in things that define who they are, such as a charity, recreational sports team or group organization. "I tend to look at these disorders as stress-related or self-perception disorders in many ways," says Adams. "People who are substituting a sense of well-being with compulsive behaviors around exercise and the kinds of foods they eat often lack a compelling external reason or sense of meaning or purpose that is sufficient for them."

A decline in eating disorder diagnoses in the foreseeable future is not likely, says Cornella-Carlson. When asked about ways to curb this trend, Cornella-Carlson is quick to respond. "Education is key," she says. "We need to educate people more about eating disorders, so teachers are more aware with students, parents are more aware with teenagers, etc."

It is the hope that, with an increase in education, eating disorder diagnoses will not only decrease, but that individuals who do suffer from an eating disorder will choose to seek treatment sooner. M