Anorexia and bulimia are the most well-known eating disorders, but there are a variety of less common eating disorders. All are considered mental illnesses, and all can affect your overall health. At the Center of Excellence in Eating and Weight Disorders at Mount Sinai, we have experts who can diagnose and treat any of these conditions.

Avoidant Restrictive Food Intake Disorder

If you have avoidant restrictive food intake disorder (ARFID), you fail to eat enough. The condition cannot be explained by lack of available food or by cultural practices. It is not associated with body image issues such as fear of becoming overweight. But, it can lead to significant weight loss and nutritional deficiencies.

ARFID can occur at any age and affects both men and women. Researchers do not know what causes ARFID. It is more likely to affect people who are on the autism spectrum, have attention deficit disorders, or display intellectual disabilities. Children who are extremely picky eaters, or who do not outgrow their picky eating, are more likely to develop ARFID. Many people with ARFID have anxiety and other psychiatric disorders.

Nutritional deficiencies can lead to other conditions. These include:

• Developmental delays
• Dizziness, fainting, and weakness
• Dry skin, brittle nails, and thinning hair
• Gastrointestinal issues, such as bloating that contributes to a lack of appetite
• Impaired immune functioning

Children with ARFID may have developmental issues as well as stalled weight gain and growth. Adults may experience weight loss and the inability to maintain basic body function.

You may need intensive interventions to regain your health. We use a variety of forms of psychotherapy to treat ARFID. Family-based therapy and cognitive behavioral therapy can be effective treatments. We may also combine medication and intensive interventions.

Pica

If you or a loved one has pica, you often eat substances that lack nutritional value. The substances vary by patient age and availability. But the most common substances are dirt, clay, and paint. Doctors also consider the age and developmental level of the patient as well as cultural norms for diagnosis. For example, children under two years of age often put small objects in their mouth as they explore their senses. This is considered typical development. Similarly, some African American women in Georgia have a cultural custom of eating white clay. This, also, is not considered pica. Most people with pica also eat food.  

Researchers do not know what causes pica. We suspect that it affects people who are not getting sufficient nutrition from their regular diet. For instance, many people who eat dirt have anemia.

People who have another mental health disorder may be more likely to develop pica. Examples of these disorders include schizophrenia, autism, or an intellectual disorder. If pica is severe or occurs along with another mental disorder, you need to see a doctor. We do not know how common pica is, though researchers think is it more common in developing countries than in the United States.

There are no lab tests to diagnose pica. Instead, our doctors take a medical history and perform a medical exam to make the diagnosis. You must eat non-food substances for more than a month to be diagnosed with pica.

Pica can be associated with or cause other health issues, such as:

• Anemia and other nutritional deficiencies
• Blockage in the digestive tract
• Poisoning, such as lead poisoning that can lead to brain damage

To treat pica, we use close observation and medical monitoring along with psychological therapies. We often use behavioral therapies.

Rumination Disorder

If someone—usually an infant or child up to 12 months—has rumination disorder, that person brings back up and re-chews partially digested food. Usually, the child does not appear to be upset or disgusted by this behavior. The behavior must happen for at least a month to be diagnosed as rumination disorder. 

Rumination can cause health-related symptoms such as:

• Bad breath or tooth decay
• Choking
• Dehydration
• Indigestion
• Malnutrition
• Raw, chapped lips
• Tooth decay
• Weight loss

Infants may strain or arch their back as they try to bring the food back up.

Doctors do not know what causes rumination disorder, though we suspect these factors may contribute:

• An effort to gain attention
• Mental illness, such as anxiety or depression
• Parental neglect (chewing can be a comforting behavior)
• Physical illness

Doctors make this diagnosis based on psychological rather than digestive issues. At Mount Sinai, we diagnose the test by conducting a medical history and physical exam. The first step is to rule out physical causes for vomiting. We also check for signs of dehydration or malnutrition. To help make the diagnosis, doctors must watch the infant or child during and after feeding.

Careful attention to eating habits and treatment interventions are required in severe cases to avoid serious medical issues.

Other Specified Feeding or Eating Disorder

There are many types of eating disorders. Not all of them fit into the categories outlined by the American Psychiatric Association (APA). If your eating disorder does not, doctors say you have other specified feeding or eating disorder (OSFED), a term used in the APA’s DSM-5. These disorders can cause numerous emotional and medical issues.

If you or a loved one has OSFED, you have a distorted body image and a strong fear of gaining weight. Physical symptoms include fluctuating body weight or significant weight loss; absence of menstrual periods; loss of sex drive (libido); swelling around the cheeks and jaw, damaged teeth, bad breath from frequent vomiting; and fainting or dizziness. Psychological effects include low self-esteem, depression, anxiety, self-loathing, and irritability.

Possible long-term health effects include:

• Constipation and diarrhea
• Infertility
• Irregular heartbeat or slow heart rate
• Kidney failure
• Slowed growth (in young people)
• Tearing of the throat and stomach (from repeated vomiting)
• Weak bones or osteoporosis

Most types of OSFED involve someone who meets all the requirements of one of the more common eating disorders—with slight variations. For instance, symptoms might not last as long. Here are some examples of OSFED:

• Atypical anorexia nervosa: You have all the characteristics of anorexia nervosa, but your body weight is normal or slightly higher.
• Limited binge-eating disorder: You show all the traits of binge-eating disorder, except you binge less often or for less than three months.
• Low frequency bulimia nervosa: You meet all requirements of bulimia nervosa, but your behaviors happen less frequently than most bulimia patients, or last for less than three months.
• Purging disorder: You purge to control your body weight or shape, though you do not binge eat.
• Night eating syndrome: You often wake in the middle of the night to eat, or you eat excessively after the evening meal. The behavior causes significant distress. It cannot be explained by another mental health disorder.

Our experienced clinicians can diagnose a range of feeding and eating disorders. We offer personalized treatment to meet your individual needs.