There are many stigmas and misunderstandings surrounding anorexia nervosa. Many people associate anorexia with an exceptionally low body weight or dramatic weight loss. However, individuals at a “normal” or higher weight can also struggle with the same restrictive and abnormal eating behaviors associated with anorexia nervosa. Atypical anorexia nervosa is nearly identical to typical anorexia nervosa without the low weight criteria.

by: Sadie Grant

“You don’t look like you have an eating disorder!”
“I wouldn’t be too worried. I mean, your weight looks fine.”
“You look so good! Whatever you’re doing is clearly working.”

If you live in a bigger body and have ever struggled with disordered eating, you have likely heard some version of one (or some) of the phrases listed above. Perhaps you just disclosed that you have an unhealthy relationship with food to a physician, or shared some persistent negative thoughts that you have been having about your appearance to friends and family. Unfortunately, in our weight-biased culture, we tend to praise weight loss. Furthermore, we often think that restrictive eating disorders such as anorexia nervosa are related to extreme weight loss or a very low body weight.

What if you struggle with restrictive eating patterns and behaviors but your body is at or above clinically “normal” weight?

Today we are going to talk about atypical anorexia, an eating disorder that shares all features of full-threshold anorexia nervosa but presents in people who do not meet the low weight criteria for an anorexia diagnosis. We will break down diagnostic criteria, prevalence, and challenges related to the diagnosis.

What is Atypical Anorexia?

Individuals with atypical anorexia exhibit the same symptoms as those with full-threshold anorexia nervosa but may be within or above a normal weight range for their height, age, and sex. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), atypical anorexia is classified under the category of Other Specified Feeding and Eating Disorders (OSFED), and is characterized by anorexic features without low weight. Common features include:

Restriction of food intake relative to one’s caloric requirements
Intense fear of gaining weight/becoming fat
Distress or disturbance related to body image

How Common is Atypical Anorexia?

Atypical anorexia is actually more “typical” than you might think. According to a study conducted by Vo et al., around 20% of youth with eating disorders may have atypical anorexia (2016). In fact, in their study on 651 young people ages 7-18 in out-patient programs who had met criteria for a DSM-4 eating disorder diagnosis, the research team found that atypical anorexia was the third most common eating disorder after anorexia nervosa and bulimia nervosa (Vo et al., 2016). Furthermore, research supports that atypical anorexia is also quite common among adults.

Due to the weight stigma that exists around eating disorders, individuals with atypical anorexia may not receive a correct diagnosis. Therefore, it can be difficult to determine exactly how common atypical anorexia is in the United States population.

Why should you seek help even if it is difficult to receive a diagnosis?

Due to the weight stigma that surrounds restrictive eating disorders, many people who have atypical anorexia may never realize that they are struggling with a severely dangerous eating disorder.

A person who is within or above a “normal” weight range may experience dangerously restrictive behaviors and intrusive thoughts, but still think, “am I sick enough?”.

The tendency for individuals with atypical anorexia to question or overlook the severity of the eating disorder reflects its widespread misdiagnosis. Many doctors view eating disorders among those at higher weights as less serious. In many cases, those with atypical anorexia do not receive the treatment that they need until their eating disorder progresses to the point that they are considered medically “underweight”. Such a late diagnosis is extremely medically and psychologically dangerous.

For one, individuals with atypical anorexia experience similar or worse complications compared to those with full-threshold anorexia. For example, in a study conducted by Sawyer et al. on atypical anorexia in adolescents, individuals with atypical anorexia were more likely to experience lower self-esteem and greater weight loss over a longer period of time than were those with full-threshold anorexia nervosa (2016). Furthermore, there was no difference in medical complications; even though they were not considered to be “underweight”, 25% of those with atypical anorexia had bradycardia (slowed heart rate), 33% had amenorrhea (loss of menses), and over 40% needed hospitalization (Sawyer et al., 2016). The study concluded that those with atypical anorexia nervosa experience similar medical complications but more severe disturbances in eating behavior and body image compared to those with full-threshold anorexia nervosa.

Furthermore, delaying the treatment of atypical anorexia can be detrimental to the possibility of recovery. In a society that valorizes thinness, those with atypical anorexia may actually receive positive reinforcement for restrictive eating patterns.

Clearly, it is critical that individuals with atypical anorexia nervosa receive treatment as soon as possible. We must look beyond weight and instead consider the various psychological, emotional, and behavioral symptoms that constitute an eating disorder.

Do you think you or a loved one might be living with atypical anorexia nervosa?

At BALANCE eating disorder treatment center, our compassionate, highly skilled team of clinicians is trained in diagnosing and treating the whole spectrum of eating disorders, including atypical anorexia and other less recognized disordered eating behaviors and body image issues.

Our admissions team would be happy to answer any questions you may have about our programs and services. Book a free consultation call with our admissions team below or read more about our philosophy here.

This post was written by BALANCE Blog Intern, Sadie Grant.

Sadie is a recent graduate of Oberlin College with a B.A. in psychology. After recovering from disordered eating, Sadie became passionate about eating disorder awareness, body neutrality, and destabilizing beauty standards that are established by social and cultural norms. While earning her Bachelor’s degree, Sadie conducted quantitative research, worked with populations experiencing barriers to essential services, and studied Spanish. Sadie hopes to use her developing research and interpersonal skills to work in the field of eating disorders and address the way in which expectations around eating and beauty vary across different populations.

References

Conason, A. (2018, February 09). What Is Atypical Anorexia Nervosa? Retrieved July 28, 2020, from https://www.psychologytoday.com/us/blog/eating-mindfully/201802/what-is-atypical-anorexia-nervosa

Cruickshank, H. (2032, September 18). What It's Like to Live with Atypical Anorexia. Retrieved July 28, 2020, from https://www.healthline.com/health/what-its-like-to-live-with-atypical-anorexia

Ekern, B., & Karges, C. (2020, January 23). Atypical Anorexia Nervosa: What Are The Signs and Symptoms. Retrieved July 28, 2020, from https://www.eatingdisorderhope.com/blog/atypical-anorexia-signs-symptoms

Vo, M., Accurso, E. C., Goldschmidt, A. B., & Grange, D. L. (2016). The Impact of DSM-5 on Eating Disorder Diagnoses. International Journal of Eating Disorders, 50(5), 578-581. doi:10.1002/eat.22628