Lesser-known eating disorders: What you should know
When most people think about eating disorders, diagnoses like anorexia nervosa, bulimia nervosa, and binge eating disorder come to mind. These are serious and life-threatening illnesses, and they’re also among the most widely recognized and studied. However, these are not the only eating disorders that impact people’s lives.
Some eating disorders are less commonly known or diagnosed, but they can still lead to serious distress and medical complications. It is important to recognize and validate all eating disorder diagnoses so that individuals can get the support they need. Below, we take a closer look at a few of these lesser-known eating disorders, including what their symptoms look like, who they affect, and how treatment can help.
Pica
Pica is an eating disorder that involves consuming non-nutritive, non-food substances in a way that is developmentally inappropriate for at least one month. Common items ingested may include:
- Dirt or clay (geophagia)
- Ice (pagophagia)
- Hair (trichophagia)
- Paper, chalk, soap, or paint
While pica is most commonly diagnosed in children, it also appears in individuals with intellectual or developmental disabilities and sometimes during pregnancy. In adults, it may be associated with trauma, iron deficiency, or obsessive-compulsive behaviors.
Pica can lead to serious medical complications, such as malnutrition, gastrointestinal blockages, poisoning, and dental damage. Treatment often involves addressing underlying nutritional deficiencies and using behavioral modification, education, and possible psychiatric medication to treat compulsive behaviors or co-occurring mental health concerns.
Rumination Syndrome
Rumination syndrome involves the repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out. Unlike bulimia, this behavior is not driven by body image concerns or intentional purging. Rumination can be:
- Reflexive, or, in some cases, voluntary as it becomes a learned pattern
- Occur within minutes of eating or up to two hours after meals
- Happen during both stress and calm
Though often diagnosed in infants and people with developmental delays, rumination disorder can also affect adolescents and adults. It’s frequently misdiagnosed as a gastrointestinal issue or mistaken for bulimia nervosa.
Treatment may include cognitive behavioral therapy, diaphragmatic breathing, nutritional counseling, and addressing underlying anxiety or trauma. Early intervention is important to prevent malnutrition and social withdrawal.
Exercise Addiction
While regular physical activity has many health benefits, exercise addiction (sometimes referred to as compulsive exercise) becomes a problem when it leads to physical harm, psychological distress, or interference with daily life.
Signs of exercise addiction include:
- Exercising despite injury or illness
- Inability to reduce exercise or a loss of control around exercise habits
- Feeling extreme guilt or anxiety when missing a workout
- Prioritizing exercise over social, work, or school responsibilities
- Using exercise as a primary way to manage emotions
Exercise addiction is often intertwined with other eating disorder diagnoses, especially anorexia and orthorexia, as a method of controlling weight or coping with body image concerns. In these cases, the behavior may be seen as healthy or disciplined, even as it causes harm.
Treatment includes helping clients develop a healthier relationship with movement, guided by trauma-informed practices and body-trust principles. The goal isn’t to eliminate exercise entirely, but to rebuild it as a form of self-care rather than self-punishment.
“Drunkorexia”
“Drunkorexia” is a non-clinical term used to describe a pattern of disordered eating where individuals restrict calories, purge, or over-exercise to “make room” for alcohol consumption. This may involve:
- Skipping meals before drinking
- Using alcohol to replace food
- Purging after eating or drinking
- Exercising excessively to “compensate”
Though not a formal diagnosis in the DSM-5, “drunkorexia” behaviors are concerning and can lead to both eating disorder symptoms and substance use disorders. This pattern is especially common in college settings, where social pressure and body image ideals collide with drinking culture.
“Drunkorexia” can increase the risk of alcohol poisoning, malnutrition, and long-term organ damage. An integrated approach to treatment helps address the complex overlap between disordered eating and substance use is beneficial, offering tools for emotional regulation and self-worth that don’t rely on harmful behaviors.
Eating Disorders in Diabetes Mellitus (EDDM)
Eating Disorders in Diabetes Mellitus (EDDM) refers to a range of disordered eating behaviors that affect individuals with any type of diabetes. Often incorrectly called “diabulimia,” EDDM includes the intentional misuse of insulin or diabetes medications, extreme food restriction (especially of carbohydrates), and other traditional eating disorder behaviors like bingeing, purging, or compulsive exercise. These behaviors are often used to lose weight or control body shape but can lead to severe medical complications, including diabetic ketoacidosis and long-term organ damage.
EDDM can occur in both Type 1 (EDDMT1) and Type 2 diabetes (EDDMT2). For example, individuals with Type 1 diabetes may skip or reduce insulin doses as a form of weight control, while those with Type 2 may engage in restrictive eating or misuse medication. EDDM is especially dangerous because managing diabetes already requires daily attention to food, numbers, and body cues—making it easy for disordered behaviors to go unnoticed or be mistakenly reinforced.
Risk factors include a history of eating disorders, body dissatisfaction, mental health challenges like depression or anxiety, and the psychological burden of diabetes management.
Treatment for EDDM requires a specialized, integrated approach that addresses both the eating disorder and the complexities of diabetes management. Medical oversight is critical to stabilize blood glucose levels, prevent diabetic ketoacidosis, and monitor complications related to insulin misuse.
Why these lesser-known disorders matter
Eating disorders are often surrounded by stereotypes about who gets them, what they look like, and how serious they are. These assumptions can delay diagnosis and keep people from accessing care until they’re in crisis. For those living with lesser-known eating disorders, the challenge is often twofold: struggling with painful behaviors and feeling like no one understands.
It is necessary to affirm that all disordered eating deserves attention, compassion, and specialized support. Whether someone is struggling with pica, compulsive exercise, or OSFED, they deserve the same level of care and validation as someone with anorexia or bulimia.
