Shaun Hautly of St. Louis, Mo., has struggled with anxiety and eating problems since he was in the fourth grade. “Whenever my anxiety would get bad, my appetite would disappear,” he remembers. “The thought of eating would make me sick.”

In fact, this anxiety became so bad when he began college that he went for three weeks without eating anything. At that time his life consisted of drinking water, going to class, and sleeping. Fortunately, with the help of a counselor he got through it.

Several years later when he had another episode, he remembered what he’d learned and forced himself to eat at least once every other day. “All I could stand was a Jimmy John’s sandwich,” says Hautly, referring to the submarine sandwich specialty restaurant. “Although dramatic, it’s not untrue to say that the sandwich literally kept me alive. A few years later, I got that sandwich order tattooed on my arm.”

Hautly is far from alone. While most people think of anorexia (starving oneself to be thin) and bulimia (eating large amounts of food and then purging) when they hear the term eating disorders, a much wider variety of eating problems exists, ranging from eating while asleep to eating glass, hair, and just about everything in between.

Eating Disorders: A Broad Spectrum

The extent of eating problems and their eating disorder symptoms is extremely varied:

  • Nocturnal sleep-related eating disorder (NSRED). Individuals with NSRED can actually prepare and consume an entire meal and go back to bed, all while totally asleep, and have no memory of it the next day.
  • Binge eating. “Think bulimia without the purging,” says David Edelson, MD, assistant clinical professor of medicine at Albert Einstein College of Medicine in New York City and founder and medical director of HealthBridge, a weight loss facility. “The subject eats an unusually large amount of food at one time, even when not actually hungry,” explains Dr. Edelson. Often he or she eats until physically uncomfortable or nauseous and then feels disgusted and depressed afterward.
  • Pica. People with pica ingest non-food items including clay, soil, coal, soap, chalk, and metal.
  • Night-eating syndrome. Individuals with this eating disorder consume 25 percent of their daily calories after 9 p.m.
  • Prader-Willi syndrome. People with this syndrome are not able to recognize the feeling of fullness and eat uncontrollably, gaining a massive amount of weight in the process.
  • Trichophagia. People who have this disorder actually eat hair, often while it’s still attached to their heads.
  • Hyalophagia. This eating problem involves eating glass.
  • Various ritualized eating habits. These can range from insisting on eating foods in a certain order to having the table set a particular way to chewing food to get the flavor of it, but then spitting it out instead of swallowing it.

Eating Disorders: Causes and Complications

Just as there is a wide range of eating problems, there are a variety of causes — and issues — that can result. “Nocturnal sleep related eating disorder can be triggered by sleeping pills or can be a form of parasomnia (like sleepwalking),” says Edelson.

Prader-Willi Syndrome is genetic, and pica can be due to pregnancy, autism, schizophrenia, or obsessive-compulsive disorder, among other causes. Depression or chronic anxiety can cause binge eating and nocturnal eating syndrome, while trichophagia and other issues can come from obsessive-compulsive disorder, a social disorder, schizophrenia, or just odd behavior.

Numerous complications can arise depending on the disorder. While anorexia and bulimia can lead to malnutrition and dehydration, pica and hyalophagia may result in intestinal perforations, and trichophagia can cause intestinal blockages. Obesity, diabetes, high blood pressure, heart attack, stroke, and sleep apnea are all dangers with nocturnal sleep related eating disorder, night eating syndrome, and Prader-Willi syndrome.

Eating Disorders: Treatment

While the exact treatment will depend on the type of eating problem and its cause, getting help is key. “Seek medical assistance from a physician experienced in dealing with eating disorders,” recommends Edelson. “Start with your internist or primary care provider and, if you’re not getting answers, look for a specialist in obesity or a psychiatrist with a specialty in eating disorders.”

If a loved one is battling an eating disorder, know that they need your support. “Don’t corner them,” says Ramani Durvasula, PhD, professor of psychology at California State University in Los Angeles. “If you back them against a wall, they will ‘defend’ their position. Use reflection and compassion. Let them know you are there for them, even if just to listen.”