Emerging Trends in Eating Disorders by Dr. Kevin Wandler
Emerging trends in eating disorders are pretty complex, actually. The DSM-5 recently changed their EDNOS, which is Eating Disorders Not Otherwise Specified, to FEDNEC, which is Feeding and Eating Disorders Not Elsewhere Classified. I think with the result of this, that the DSM even recognizes that we have unique patients that we've all been treating for years that don't quite fit into categories, such as pure anorexia and pure bulimia, and I'm hoping that some of these will be able to fit into this grouping.
The first group I want to talk about is called diabulimia. Diabulimia is probably the scariest emerging trend that I'm seeing. The mortality rate from this can be as high as 25%. This is where an insulin-dependent diabetic doesn't use her insulin, as an effort to control her weight. The problem with that can be that her blood sugars are extremely high. It can lead to toxicity to the whole body, from high blood sugars. It can affect her brain, it can affect her nerves, it can affect her heart, her kidneys, and it needs to be addressed quickly. As I said earlier, 25% of these people can die untreated, which is a very high statistic, much higher than our regular eating disorder mortality rates.
Drunkorexia is probably the most common emerging trend that I see, and it has two problems inherent with this diagnosis. Drunkorexia commonly manifests by young women who, because they want to watch their weight, watch their caloric intake, really restrict their breakfast, maybe restrict their lunch by eating very few calories, and then they go out and can binge drink. Now, the problem with that is a couple consequences of binge drinking. First of all, women shouldn't really be drinking more than two or three alcoholic beverages in one setting, or it becomes a problem. Secondly, they can fall; they can become alcoholic. About 10% of alcohol abusers can become alcoholic. This is an emerging trend that warrants treating, both the anorexia problem or the eating disorder, and the alcohol abuse problem.
Pregorexia is an emerging trend that not only affects the patient, but also her unborn child. In simple terms, it's when a young woman does not want to gain the weight necessary to sustain her pregnancy. She feels she's fat, she doesn't want to change her shape. Naturally when someone's pregnant, they do gain a significant amount of weight. It's necessary for her as well as her unborn child. When a pregorexic patient comes in to treatment, she has not gained the weight necessary, she is way behind on the growth curves for herself, and oftentimes her unborn child. Problems with pregorexia can include the fact that the mother herself could have spontaneous miscarriage or premature birth. The child can be born with numerous deficiencies, from being premature as well as having neurologic development and being very small for gestational age, which can affect his or her development in life.
Orthorexia is a condition where individuals are uber-healthy, at least with the food intake that they have. Oftentimes these individuals will restrict all meat products, will be vegan, will restrict all products that have any additives or preservatives in them, they really only will eat organically grown foods. Nothing wrong with this on the surface. However, the orthorexic patient oftentimes gets so consumed with restricting their caloric intake that they become severely underweight. Now, different than a true anorexic patient, the orthorexic will usually admit that they're underweight, and they actually kind of pride themselves on that. Treatment takes an intervention possibly of working with the anxiety around eating foods that are not necessarily all organic, as well as nutrition intervention, to give these orthorexic patients alternatives that they may be able to use for their nutritional intake that will be more balanced.
These emerging trend often times need to be treated differently than a standard eating disorder. For example, the diabulimic, you need to involve an endocrinologist, you clearly need to work on the patient's concepts of food and nutrition. Usually with eating disorder patients, we do not have them calorie count or carb count, but a diabetic needs to do that her entire life, so she's going to need an extreme amount of monitoring, extreme amount of nutritional support from a nutrition therapist, as well as ongoing monitoring with an endocrinologist. The other person who needs to be involved is someone to see that she needs to accept her illness. You cannot wish diabetes away, so this will be a very collaborative effort among two, three different providers.
Diabulimia is a very challenging-to-treat emerging trend. You need not only and eating disorder specialist, a dietitian, you also need an endocrinologist to work with the diabetes, and a therapist to allow the patient to accept her illness. You can't wish away diabetes. Typically with eating disorder patients, we don't have them count their calories or count their carbs, but someone with diabetes needs to do that regularly to manage her insulin and to manage her blood sugars.
Treatment of the emerging trends is challenging. Each emerging trend has its own unique issues. For example, the drunkorexia, you need to be addressing not only the eating disorder, as well as the alcohol abuse or dependence. With pregorexia, you need to work in a team that includes not only a nutrition therapist, an eating disorder therapist, as well as an OB-GYN. For the treatment of orthorexia, I think if you're lucky enough to have an orthorexic patient come in for help, really nutrition therapy intervention is key. The orthorexic needs alternatives, needs to have the ability and acceptance of alternative food groups so he or she is able to maintain a normal weight. Treatment of diabulimia, which is the potentially most life-threatening of all of these eating disorder types, really requires a unique intervention with not only an endocrinologist, but a nutrition therapist as well as a regular therapist. Suzy is not able to stop counting calories or carbs, so she needs to be able to accept her illness and work with alternatives so that she's able to manage her weight in a healthy way.
As an expert in the field of eating disorders for the past 18 years, these emerging trends are actually very scary. I think that the more we hear about them is good. They're making the popular press. They are increasing awareness for everyone that someone can be pregnant and have an eating disorder, someone can be eating healthy and have an eating disorder. I think as public awareness comes out, it will also go to physician therapy, dietitian awareness, so we're able better to help these people and possibly identify them sooner. As I said, the diabulimic has a 25% mortality rate if untreated. What a great time to offer awareness so we can save all of these patients with these merging trends in eating disorders.