Not an eating disorder but just as serious: orthorexia, bigorexia and others

On the previous page I described the diagnosable eating disorders. Here are some related conditions that can be just as serious.

Diabulimia

Diabulimia is not an official diagnosis but seems to be common among people with Type 1 diabetes (who need to inject insulin). They regularly restrict their insulin dose to lose weight or to compensate for bingeing. They suffer from the physical and mental risks associated with an eating disorder, plus those associated with untreated diabetes. There are many highly dangerous health effects including organ damage and a shortened life.

Someone with diabulimia may meet the criteria for purging disorder, one of the eating disorders categories under 'Other Specified Feeding or Eating Disorder' (OSFED).

Orthorexia

Orthorexia is not an official diagnosis but can be as crippling as any eating disorder. It may be a covert form of anorexia. Often it is a precursor to anorexia. In some individuals, the behaviours of orthorexia are part of the 'avoidant/restrictive food intake disorder' (ARFID) eating disorder diagnosis.

Those affected have taken ‘healthy’ or ‘clean’ or ‘orthodox’ eating to heart to such an extent that there are very few foods they eat. They suffer from malnutrition and perhaps also weight loss. Medical risks are high. Their mental state is affected, so it can be hard to get them to re-introduce balanced eating.

* Is it OK for my child to be vegan during eating disorder treatment? *

Drunkorexia

Again, not a diagnosis, but a behaviour often linked to eating disorders. This is where people restrict food intake so that they can drink without consuming extra calories. They also do this to become drunk more quickly.

Muscle dysmorphia / Bigorexia / Reverse anorexia: a drive to muscularity

These terms describe a compulsion to build muscle. Life becomes all about hours at the gym, and disordered, unbalanced eating for the sake of bulk. Originally this was an issue among body-builders. Now we see a fair number of boys, and some girls, somewhere on a spectrum of miserable or dangerous behaviours. A large study found that 22 percent of young men engaged in these disordered eating behaviours.

Even though they may consume plenty of calories and be working at weight gain, those affected can be at high medical risk — often poorly diagnosed because their weight is often higher than average.

The health dangers come from their low level of body fat, the malnutrition from their specialised, highly unbalanced diet, and for some, from the supplements and anabolic steroids used.

The person spends many hours in the gym at the expense of other activities. Their body image may be distorted – they may be ashamed of their 'puny' looks and are obsessed about the need for ever-bigger muscles. Some people say they’ve beaten anorexia by getting into body-building, but bigorexia is just as much of a trap.

Some of the young people affected have a horror of body fat and want only muscle. Some will consume protein to excess and be deficient in other nutrients. Some put their bodies through cycles of ‘bulking’ and ‘cutting’. Even when they use a personal trainer, they may be getting nutritional and weight advice which is dangerous to a growing youngster. Additionally, they are restricting their horizons by attaching self-worth to body shape.

* How do eating disorders present in males? by Mark Warren *

* Should you be concerned about your son? by Scott Griffiths *

* Bodybuilding, gyms, and eating disorders: a guy's perspective: Tabitha Farrar's podcast with Ari Snaervarsson *

Bigorexia can be a type of body dysmorphic disorder or (depending on what eating behaviours are involved) may be an atypical eating disorder, an eating disorder classified as ‘Other Specified Feeding or Eating Disorder’ (OSFED).

* Onwards: Frequently Asked Questions *

* Onwards: The main eating disorders: binge eating, bulimia, anorexia, ARFID and OSFED *