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  • Programs for Eating Disorders

    Other Types of Eating Disorders

    Mother and Teenage Daughter Reading Book Together

    St Louis Behavioral Medicine Institute does not only treat Bulimia and Anorexia. Our facility treats many different eating disorders that occur in individuals of all ages and gender.

    In order to receive help for your eating disorder, the first step is to contact our Intake Coordinator at 636-532-9188. Our Intake Coordinator will match you to one of our clinicians who will evaluate your concerns and make recommendations to you.  Your insurance coverage will also be reviewed by the intake coordinator.

     The first step is an important one and only you can place the call. We look forward to speaking with you.

    Other types of Eating Disorders we treat include:


    Eating Disorder Not Otherwise Specified (EDNOS):

    Some individuals struggle with many aspects of Anorexia or Bulimia but may not meet full criteria for either diagnosis in particular. It is important to note EDNOS can be just a serious an eating disorder, and EDNOS has historically been the most common eating disorder diagnosis among people who seek treatment.

    Diabulimia:

    Diabulimia is a form of a very serious eating disorder where individuals with Type I Diabetes skip or reduce insulin as a way to lose weight.  Failing to take the necessary amounts of insulin cause increased blood sugar that results in rapid weight loss, and thus, this manipulation of insulin levels is likened to purging seen in Bulimia Nervosa. It appears that there is an alarming trend in increased prevalence of this disorder, especially among adolescents with Diabetes.  Recovery requires conjoint treatment by physicians who specialize with diabetes treatment and eating disorder specialists.  Often intensive treatment and diabetes management is required to help interrupt these life threatening behaviors.  Within the structure of daily treatment, as in Intensive outpatient programs (IOP), blood sugar and insulin treatment can be closely monitored along with a comprehensive treatment approach that  provides psycho-education about eating disorders and replacement coping skills for purging behaviors, family therapy, Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), nutrition counseling, and interventions aimed at increasing self-acceptance and self-responsibility.

    Orthorexia:

    This is a recent term coined by Steven Bratman, M.D. in 1997 and means “correct appetite”.  Orthorexia occurs when individuals become obsessed with health related eating practices.  Furthermore, the effects of semi-starvation also mimic Obsessive-Compulsive Disorder (OCD) which, as is seen in Anorexia Nervosa (link), further complicate and worsen the condition. Also, similar to individuals with Anorexia Nervosa who desire to be thin, these individuals become obsessed with what is considered to be “healthy eating.” Fiercely held internal rules and convictions can result in extreme and dangerous restricting behaviors and elimination of certain foods. Treatment is very similar as in OCD and Anorexia Nervosa with an emphasis on behavioral exposure with response prevention (ERP) and cognitive behavioral strategies (CBT).

    Avoidant Restrictive Food Intake Disorder (ARFID):

    This category refers to eating disturbances that include seemingly decreased interest in eating or food; avoidance of food due to sensory characteristics of food; and increased concerns about consequences or perceived disadvantages of eating, such as fear of choking or becoming ill.  ARFID is more persistent and is associated with significant health concerns in comparison to food refusal due to food preferences.  ARFID is only diagnosed when food is available and eating problems are clinically significant and associated with consequences such as low weight or weight loss, poor nutrition that may be associated with inadequate growth or significant impairment in psychosocial functioning. Although ARFID most often develops in early childhood, as when associated with sensory disturbances, it could present or continue into adulthood.  Extreme food refusal, rigid, limited and perseverative eating behaviors may be associated with developmental disabilities, such as Autism Spectrum Disorder. Children may eat a very limited range of foods that may share similar characteristics such as texture, color, smell or temperature.  This behavior is commonly associated with sensory integration issues or associations that are linked to sensory aspects of food. In older children and adolescents, food avoidance or refusal may be associated with medical conditions such as gastroesophageal reflux or psychological conditions such as trauma, mood disorders, and anxiety disorders.  In these conditions food may be refused or avoided due to previously resolved or current medical complications associated with eating, such as IBS, or social fears, such as being teased for using the bathroom at school.  ARFID is only diagnosed and treated separately when the eating disturbance requires treatment beyond the scope of the intervention for the associated disorder or medical condition. 

    There is often significant marital strain and family stress associated with having a child or sibling with ARFID. Significant behavioral limitations may be placed on families due to a child’s aversion to trying new foods. Disruptive behaviors, such as difficulty swallowing or gagging, and behavioral tantrums contribute to a high degree of conflict around meals. Often intervention is multidisciplinary approach of occupational, speech, behavioral, and family therapists who work together to establish structured eating patterns and gradually increase food variety. Re-feeding in a hospital setting may be a necessary first step in treatment. Anxiety management strategies, cognitive restructuring and systematic behavioral exposure are possible interventions for these complex conditions.

    Phobias:

    Phobias may result in avoidance of food and related weight loss and are typically seen in children either as an isolated condition or part of more Generalized Anxiety Disorder (GAD). In children fear of being fat is rare and the more common phobias include fear of vomiting, fear of contamination or poisoning, fear of carcinogens, functional dysphagia- fear of swallowing, and fear of eating lumpy or solid foods). Such fears may be the result of prior health trauma or just represent an idiosyncratic thought.

    As seen in adolescents and adults, Obsessive-Compulsive Disorder (OCD) may cause food restriction and avoidance.  In such cases food related obsessions and unusual related behaviors may involve fear of spreading germs from food or idiosyncratic fears related to or interchanged with other OCD symptoms. Rigid and ritualistic patterns of behavior may ultimately result in poor nutrition or weight loss. 

    Anxiety symptoms associated with conflict in the home or separation anxiety may result in stomach pain, food restriction, and sometimes rapid weight loss that becomes a health risk.  Sometimes mothers with eating disorders inadvertently convey fear of foods and model abnormal eating behaviors.