Pica, Rumination Disorder, Laxative Abuse, and Compulsive Exercise

For our last blog post series on eating disorders, I will be discussing Pica, Rumination Disorder, Laxative Abuse, and Compulsive Exercise, which are all classified as eating disorders by the National Eating Disorder Association.

Pica

According to National Eating Disorder Association, Pica is an eating disorder that occurs when an individual eats items that are not thought of as food and contain no nutritional value. Examples of items that someone with Pica might ingest are hair, dirt, paint chips, clay, etc. Pica can occur with other mental health disorders, such as intellectual disability, autism, and schizophrenia. Those with iron-deficiency anemia, malnutrition, and pregnancy are the most common cause of Pica.

Diagnosis: To diagnosis Pica, there are no laboratory tests available. A clinical history of the patient will help determine the diagnosis. In addition to clinical history, it is also important to receive tests for anemia, intestinal blockages, and/or side effects from substances/items consumed, such as paint or bacteria/parasites from dirt.

Symptoms and Warning Signs: Symptoms are typically related to the non-food items that the individual has eaten. Below are a few warning signs.

• At least one month of consistently eating non-food items that do not contain any nutritional value
• Eating items that are not culturally supported
• Eating of items need to be developmentally inappropriate
• Bowel problems
• Injuries to teeth
• Lead poisoning
• Infections

How to help: If you or someone you know is displaying warning signs or symptoms of Pica, it is important to see a doctor as soon as possible. Pica can typically be treated with certain medications and/or vitamins. It is also important to address any illness or medical needs resulting from non-food items.

Rumination Disorder

According to National Eating Disorder Association, rumination disorder involves the regular regurgitation of food that occurs for at least one month. This may include food that is re-chewed, re-swallowed, or spit out. Rumination disorder can be confused with bulimia, GERD (gastroesophageal reflux disease) and gastroparesis.

Diagnosis: According to the DSM-5, the criteria for rumination disorder are:

• For at least one month, there needs to be repeated regurgitation of food.
• The regurgitation of food is not due to a medication condition, such as a gastrointestinal condition.
• It does not occur with anorexia, bulimia, binge eating disorder, or avoidant/restrictive food intake disorder.
• If another mental health disorder is also occurring, it is severe enough to get clinical attention.

Symptoms and Warning Signs: According to Mayo Clinic, symptoms of rumination disorder include:

• Effortless regurgitation, typically within 10 minutes of eating
• Pain or pressure relieved by regurgitation
• Unintentional weight loss
• Nausea
• Dental issues
• Social isolation
• Bad breath

How to help: As with all eating disorders, it is important to seek professional help if you feel that you or someone you know may be struggling with rumination disorder. According to Mayo Clinic, behavioral therapy or medications may be included in the treatment protocol. Behavioral therapy it can help teach people how to breathe from the diaphragm which can help with rumination disorder.

Laxative Abuse

According to National Eating Disorder Association, “laxative abuse occurs when a person attempts to eliminate unwanted calories, lose weight, feel thin, or feel empty through repeated, frequent use of laxatives.” It is noted that although people try to use laxative abuse for weight loss and control, it can be harmful as laxative abuse actually aids in the loss of water, minerals, and electrolytes important for body hydration.

Symptoms and warning signs:

• Severe dehydration
  • Weakness, fainting, blurry vision, kidney damage
• Internal organ damage
• Increase risk of colon cancer

How to help: Treatment for laxative abuse may include assistance from multiple health professionals, including a psychiatrist, psychologist, primary care provider, and dietician. It is important to have support from friends and family members or others also struggling with laxative abuse.

Compulsive Exercise

Although compulsive exercise is classified as an eating disorder by the National Eating Disorder Association, it is not a diagnosis with the DSM-5. Compulsive exercise can have many different definitions such as: secretive or hidden exercise, exercise as permission to eat, and exercise that interferes with important activities or continues to occur while injured or with medical complications. Compulsive exercise can be linked to many eating disorders.

Symptoms and Warning Signs: For a full list of symptoms and warning signs, visit: https://www.nationaleatingdisorders.org/learn/general-information/compulsive-exercise

• Overtraining
• Exercise taking place despite an injury
• Feeling guilty if not exercising
• Withdrawal from friends/family

How to help: If you or someone you know is showing symptoms and warning signs of compulsive exercise, it is important to seek professional help. Typically compulsive exercise can lead to serious eating disorders.

This blog post was written by Post Adopt Coordinator, Jaclyn Stroehl, LBSW

References:

National Eating Disorders Association. (2018, February 22). Rumination Disorder. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/rumination-disorder#:%7E:text=The%20DSM%2D5%20criteria%20for,(e.g.%2C%20gastrointestinal%20condition).

Rumination syndrome – Symptoms and causes. (2020, October 14). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rumination-syndrome/symptoms-causes/syc-20377330

National Eating Disorders Association. (2018a, February 22). Pica. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/pica

familydoctor.org editorial staff. (2021, January 28). What Is Pica? – Pica Eating Disorder. Familydoctor.Org. https://familydoctor.org/condition/pica/

National Eating Disorders Association. (2018a, February 22). Compulsive Exercise. https://www.nationaleatingdisorders.org/learn/general-information/compulsive-exercise

https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/CompulsiveExercise.pdf

National Eating Disorders Association. (2018b, February 22). Laxative Abuse. https://www.nationaleatingdisorders.org/learn/general-information/laxative-abuse