Listed:
  Pica
  Prader-Willi Syndrome
  Night Eating Syndrome
  Sleep Eating Disorder (SED-NOS)
  Body Dysmorphic Disorder (BDD)
  Orthorexia Nervosa
  Bigorexia

Pica

Pica, a widely misunderstood phenomenon, is defined as a compulsive craving for eating, chewing or licking non-food items or foods containing no nutrition. These can include such things as chalk, plaster, paint chips, baking soda, starch, glue, rust, ice, coffee grounds, and cigarette ashes. It may sometimes be linked to certain mineral deficiencies (i.e., iron or zinc). Pica can be associated with, developmental delays, mental deficiencies and/or a family history of the disorder. There may be psychological disturbances that lead to Pica as well, such as conditions in which a child lives in a low-income or poor family, or who lives in an environment of little love and support.

Because of the inherent danger in eating non-food items, it is extremely important that an individual suffering with Pica be evaluated by a doctor, given the correct diagnosis, and treated promptly. The treatment that will follow will depend on the causes of the behavior. If the compulsion is driven by a vitamin or mineral deficiency, supplements will be prescribed; Examination of the home environment, behavior-modification therapy and psychological treatment may also be needed.

Pica is fairly common in pregnant women and symptoms usually disappear following the birth of the child.

Complications of pica can include lead poisoning, malnutrition, abdominal problems, intestinal obstruction, hypokalemia, hyperkalemia, mercury poisoning, phosphorus intoxication, and dental injury.

* It may be possible (but uncommon) for people with Anorexia and/or Bulimia to develop Pica because of the compulsive nature of these illnesses to binge, and/or the malnutrition that can set in. If the two disorders co-exist, it is important to tell your doctor of both.

Link: Pica Defined by ANRED

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Prader-Willi Syndrome

Prader-Willi Syndrome is a congenital condition (present at birth) and is believed to be caused by an abnormality in the genes that occurs (though statistically it does not seem to run in families). Children born with Prader-Willi Syndrome may have early feeding difficulties that lead to tube feeding, and often have a degree of behavioral and/or mental problems (some severe).

The person with Prader-Willi Syndrome has an insatiable appetite. This can lead to obesity, stealing, and eating pet foods and items that are spoiled. This continuous appetite is caused by a defect in the hypothalamus -- a part of the brain that regulates hunger -- that causes the person to never actually feel full. There may be sleep disorders and abnormalities, boughts of rage, a higher threshold for pain, compulsive behaviors such as picking at the skin, and even psychoses.

Physical problems associated with Prader-Willi Syndrome can be delayed motor development, abnormal growth, speech impairments, stunted sexual development, poor muscle tone, dental problems, obesity and diabetes type II. The life expectancy of a person with Prader-Willi Syndrome may be normal if weight is controlled.

Prader-Willi Syndrome is a rare condition that puts a great deal of stress on the families involved. It is important to get the proper diagnosis early and to find medical and emotional support.

Link: Prader-Willi Syndrome Association

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Night Eating Syndrome

Here's the Merck Manual definition and conclusion about treatment. (1982 ed.) p.917:

"Night Eating Syndrome consists of morning anorexia, evening hyperphagia (abnormally increased appetite for consumption of food frequently associated with injury to the hypothalamus) and insomnia. Attempts at weight reduction in these 2 conditions, (referring to bulimia as well), are usually unsuccessful and may cause the patient unnecessary distress."

The authors call both syndromes, "deviant eating patterns apparently based on stress and emotional disturbance..."

Episodes of Anorexia and Insomnia can begin at an early age, usually in children who are overweight, and are sometimes accompanied by joint paint. It is interesting to note what the parent of a now 24 year old daughter had to say...

"I've always had the feeling that much of the stress and emotional disturbances my daughter has suffered have been the result of social rejection and discrimination rather than the cause of her eating disorder ... more so as she got older. She started out as an intelligent, outgoing, cheerful human being. There is a line in our culture where a marginally acceptable "chubby" child becomes a miserable adolescent and then a depressed adult."

"People who exhibit NES don't eat a lot at one sitting, often skip breakfast, and don't start eating until noon," says psychiatrist Albert Stunkard, an obesity researcher at the University of Pennsylvania. "They will over eat the rest of the day, and eat frequently. They also have difficulty falling asleep or staying asleep."

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Sleep Eating Disorder (SED-NOS)

Sleep Eating Disorder typically fall into the category of Sleep Disorders, though it is a combined sleep-eating problem. Sufferers tend to be overweight and have episodes of recurrent sleep walking, during which time they binge on usually large quantities of food, often high in sugar or fat. Most often, sufferers do not remember these episodes, putting them at great risk of unintentional self-injury.

Because of the compulsive nature of this illness, sufferers are at the same physical health risks as those of Compulsive Overeaters with the added risks of sleep walking. It is not uncommon to find a person suffering to be anxious, tired, stressed and angry.

Link: More information at ANRED's website

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Eating and/or Sleeping Problems

It is important to be aware that throughout life, during positive and negative stress periods, people may experience eating and/or sleep pattern problems. If either or both of these conditions persist or interfere with daily life, then it is important to identify the underlying cause(s) of the problem. Problems with Eating and Sleeping are defined as usually over/under eating or too much or too little sleep. During the past decade, we have become aware of the detrimental effects of Anorexia, Bulimia and Compulsive Overeating and while these problems may warrant medical attention, the underlying causes need to be identified and appropriate coping skills developed.

Body Dysmorphic Disorder

BDD, or Body Dysmorphic Disorder is a preoccupation or obsession with a defect in visual appearance, whether that be an actual slight imperfection or an imagined one. Some example of this would be obsessing to the point of severe depression (sometimes including thoughts about or attempts at suicide) over physical attributes such as freckles; a large nose, blotchy skin, wrinkles, acne, scarring. Though the preoccupation can include any part of the body, areas of the face and head, specifically the skin, hair and nose, are most common.

People suffering with BDD may often have a low self-esteem and unreasonable fears of rejection from others due to their perceived ugliness. Some sufferers realize that their perception of the "defect" is distorted, but find the impulse to think about it uncontrollable.

There are two types of Body Dysmorphic Disorder -- the non-delusional type -- and the delusional type (where the person actually has hallucinations of a completely imagined defect, or an imagined gross exhageration of a small defect). The delusional form is less common and more severe.

Men and women living with BDD may practice unusually compulsive rituals to look at, hide, cover and/or improve their defect(s). They may spend a great deal of time looking at themselves in anything mirror-like and trying to convince others of how ugly they are. They may be compulsive in searching our doctors to treat them with medications and/or plastic surgery. Patients may go to any lengths to improve their appearance, including using methods that are dangerous. Some may even attempt their own surgery, or commit suicide.

Mental Illnesses that sometimes co-exist with BDD are depression, Obsessive-Compulsive Disorder (OCD) and Social Phobia.

Treatment is often difficult, but there has been shown progress with medications such as Prozac, and cognitive-behavior therapy. Diagnosis can often be difficult because of the patients shame (causing them to keep their symptoms a secret).

Symptoms as per the DSM-IV
(from Mental Health Net)

• Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.
• The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

Links:
They Think They're Ugly...
Body Image and Body Dysmorphic Disorder
Symptoms of Body Dysmorphic Disorder
BDD and the Body Image Program

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Orthorexia Nervosa

It should be noted that Orthorexia Nervosa is not a condition that a physician will diagnose, as there is no clinical guideline for this disorder. It is a condition that has been observed as an extreme pattern of dietary purity and has not yet been defined under the clinical diagnostic manual (DSM-IV).

Orthorexia Nervosa is an obsession with a "pure" diet, where it interferes with a person's life. It becomes a way of life filled with chronic concern for the quality of food being consumed. When the person suffering with Orthorexia Nervosa slips up from wavering from their "perfect" diet, they may resort to extreme acts of further self-disipline including even strictor regimens and fasting.

"This transference of all of life's value into the act of eating makes orthorexia a true disorder. In this essential characteristic, orthorexia bears many similarities to the two well-known eating disorders anorexia and bulimia. Where the bulimic and anorexic focus on the quantity of food, the orthorexic fixates on its quality. All three give food an excessive place in the scheme of life." (Steven Bratman, M.D., October 1997)

As noted by BeyondVeg.com, Orthorexia Nervosa should only be characterised when it is in the long-term (paying attention to healthy food for a few weeks where it becomes a normal and healthy routine not obsessed over, would not be considered a disorder), when it has a significant negative impact on an individual's life (thinking about food to avoid the stresses of life, thinking about how food is prepared to avoid negative emotions, thinking about food the majority of each individual's day), and where food rituals are not better explained by something like religious rites (such as in the Orthodox Jewish religion).

Please read the following links for more information:

Links:
Obsession with dietary perfection can sometimes do more harm than good, says one who has been there.
CLARIFYING ORTHOREXIA: Obsession with Dietary Purity as an Eating Disorder

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Bigorexia

It should be noted that Bigorexia is not a condition that a physician will diagnose, as there is currently no clinical guideline for this disorder. It is a condition that has recently been observed by several psychiatrists as the "opposite of Anorexia".

Found typically in body-building circles and known as muscle dysmorphia or reverse Anorexia, Bigorexia is a condition in which the sufferer is constantly worried that they are too small. This goes beyond the typical body-building gym-goer, and transcends into dangerous realms when men and women are willing to go to all lengths to increase muscle mass. Dr. Harrison Pope, of the McLean Hospital, says, "there's nothing inherently pathological about being an avid gym-goer, but it shouldn't take over your life." In likening Bigorexia to Anorexia he comments, "They are both disorders of body image, the preoccupations simply go in opposite directions."

Muscle dysmorphia isn't as acutely life-threatening as starving yourself, Pope says, but its sufferers are more likely to take other risks with their health, such as using steroids or other bodybuilding drugs. One muscle dysmorphic woman was hospitalized for kidney failure, brought on by her high-protein diet and steroid use. Within months of her release from the hospital, she was back on the drugs and unhealthy diet. (ABC News, Claudine Chamberlain)

Harrison Pope and several other researchers put together this set of criteria for diagnosing muscle dysmorphia:

1. The person is preoccupied with the idea that their body is not lean and muscular. They spend long hours lifting weights and pay excessive attention to diet.
2. This preoccupation causes major distress or impairs the person's social or professional life. The person may forego important social, work-related or recreational activities. They may avoid situations where their body will be exposed. The person continues to work out or diet even when they know it could hurt their health or well-being.
3. The focus of the person's concerns is on being too small or not muscular enough, as opposed to concerns about being fat.

Links:
Weightlifters' Woe: Bigorexia
Bigorexia Likened to Eating Disorders
ANRED - Muscle dysmorphia

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