CAWs are very diverse and their manifestations are extremely varied. What they have in common: they are characterized by disturbed eating behavior and relationship to food, and have a potentially serious negative impact on human health.

Anorexia nervosa (restrictive type or associated with overeating)

Anorexia is the first TCA to be described and recognized. We speak of anorexia nervosa, or nervous. It is characterized by an intense fear of being or becoming fat, and therefore a strong desire to lose weight, excessive dietary restriction (going as far as a refusal to eat), and a deformity of the body. body image. It is a psychiatric disorder which mainly affects women (90%) and which generally appears during adolescence. Anorexia is thought to affect 0,3% to 1% of young women.

The characteristic features of anorexia are as follows:

1. Voluntary restriction of food and energy intake (or even refusal to eat) leading to excessive weight loss and resulting in a body mass index that is too low in relation to age and sex.
2. Intense fear of gaining weight or becoming obese, even when thin.
3. Distortion of body image (seeing yourself fat or fat when you are not), denial of the real weight and gravity of the situation.

In some cases, anorexia is associated with episodes of binge eating (binge-eating), i.e. disproportionate ingestion of food. The person then “purges” themselves to eliminate excess calories, such as vomiting or using laxatives or diuretics.

Malnutrition caused by anorexia can be responsible for many symptoms. In young women, periods usually go away below a certain weight (amenorrhea). Digestive disturbances (constipation), lethargy, fatigue or chilliness, cardiac arrhythmias, cognitive deficits and kidney dysfunction may occur. Left untreated, anorexia can lead to death.

Bulimia nervosa

Bulimia is a TCA characterized by excessive or compulsive consumption of food (binge eating) associated with purging behaviors (attempt to eliminate ingested food, most often by induced vomiting).

Bulimia mainly affects women (around 90% of cases). It is estimated that 1% to 3% of women suffer from bulimia in their lifetime (it can be isolated episodes).

It is characterized by:

• recurring episodes of binge eating (swallowing large amounts of food in less than 2 hours, with the feeling of losing control)
• recurring “compensatory” episodes, intended to prevent weight gain (purging)
• these episodes occur at least once a week for 3 months.

Most of the time, people with bulimia are at normal weight and hide their “fits”, which makes diagnosis difficult.

Binge eating disorder

Binge eating or “compulsive” binge eating is similar to bulimia (a disproportionate absorption of food and a feeling of loss of control), but it is not accompanied by compensatory behaviors, such as vomiting or taking laxatives.

Overeating is generally associated with several of these factors:

• eat too fast;
• eat until you feel “too full”;
• eat large amounts of food even when you are not hungry;
• eating alone because of a feeling of shame about the amount of food eaten;
• feeling of disgust, depression or guilt after the episode of binge eating.

Overeating is associated with obesity in the vast majority of cases. The feeling of satiety is impaired or even nonexistent.

It is estimated that overeating (binge-eating disorders, in English) is the most common TCA. During their lifetime, 3,5% of women and 2% of men would be affected¹.

Selective feeding

This new category of DSM-5, which is quite broad, includes selective eating and / or avoidance disorders (ARFID, for Avoidant/Restrictive Food Intake Disorder), which mainly concern children and adolescents. These disorders are characterized in particular by a very strong selectivity towards foods: the child eats only certain foods, refuses them a lot (because of their texture, their color or their smell, for example). This selectivity has negative repercussions: weight loss, malnutrition, deficiencies. In childhood or adolescence, these eating disorders can interfere with development and growth.

These disorders are different from anorexia in that they are not associated with a desire to lose weight or a distorted body image.².

Few data have been published on the subject and therefore little is known about the prevalence of these disorders. Although they start in childhood, they can sometimes persist into adulthood.

In addition, disgust or pathological aversion to food, after a choking episode for example, can occur at any age, and would be classified in this category.

Pica (ingestion of inedible substances)

The pica is a disorder characterized by the compulsive (or recurrent) ingestion of substances that are not food, such as soil (geophagy), stones, soap, chalk, paper, etc.

If all babies go through a normal phase during which they put whatever they find in their mouths, this habit becomes pathological when it persists or reappears in older children (after 2 years).

It is most often found in children who otherwise have autism or intellectual disability. It can also occur in children in extreme poverty, who suffer from malnutrition or whose emotional stimulation is insufficient.

The prevalence is not known because the phenomenon is not systematically reported.

In some cases, pica would be associated with iron deficiency: the person would unconsciously seek to ingest non-food substances rich in iron, but this explanation remains controversial. Cases of pica during pregnancy (ingestion of earth or chalk) are also reported³, and the practice is even part of the traditions of some African and South American countries (belief in the “nutritious” virtues of the earth)^4,5.

Merycism (phenomenon of “rumination”, that is to say regurgitation and remastication)

Merycism is a rare eating disorder that results in the regurgitation and “rumination” (chewing) of previously ingested food.

This is not vomiting or gastroesophageal reflux but rather a voluntary regurgitation of partially digested food. Regurgitation is done effortlessly, without gastric cramps, unlike vomiting.

This syndrome occurs mostly in infants and young children, and sometimes in people with intellectual disabilities.

Some cases of rumination in adults without intellectual disability have been described, but the overall prevalence of this disorder is unknown.⁶.

Other disorders

Other eating disorders exist, even if they do not clearly meet the diagnostic criteria of the categories mentioned above. As soon as eating behavior generates psychological distress or physiological problems, it must be the subject of consultation and treatment.

For example, it may be an obsession with certain types of food (for example orthorexia, which is an obsession with “healthy” foods, without anorexia), or atypical behaviors such as nocturnal overeating, between others.