Atypical anorexia – what is it?

Atypical anorexia is a commonly used diagnosis, in fact often more common than anorexia nervosa. However the wording atypical is not helpful. It can lead to people with atypical anorexia nervosa feeling they do not fit the criteria for a “proper” diagnosis and that they are not sick enough. I hope through the content of this blog post you will be able to see that atypical anorexia is very much anorexia. It means someone is just as sick and needs help.

What is atypical anorexia

The American Psychiatric Association defines atypical anorexia as “all of the criteria for anorexia nervosa…except that despite significant weight loss, the individual’s weight is within or above the normal range”. Whilst that may sound like common sense, it can be confusing to someone who receives this diagnosis. Does this mean I don’t have normal anorexia? So am I abnormal? Do I not need to follow the normal treatment plans?

Describing what atypical anorexia is and how it should be treated as anorexia.

Much like most areas of life, it is hard to eating disorders into neat boxes. They don’t always fit into a specific criteria and there are always “tomatoes”. What do I mean by a tomato? Well, we class a tomato as a vegetable most of the time but it can also be classed as a fruit. Imagine being the tomato, it could be pretty confusing and cause you to have an identity crisis. At the end of the day, the tomato is still valid as a fruit or a vegetable, it is all in the same food group.

Atypical anorexia symptoms

As atypical anorexia is still anorexia, and so you may recognise these symptoms as being the same. Some of the behavioural symptoms include:

  • Being hyperfocused on body weight, size, and shape.
  • Having a low self-worth or distorted body image.
  • An intense fear of being overweight or gaining body fat and weight.
  • Obsessed with tracking, learning about food and nutrition.
  • Refusing to eat with or be seen eating by others.
  • Increased emotional dysregulation (irritability, mood swings, etc).
  • Difficulty thinking and focusing as well as rigid thinking, sometimes called black and white thinking.
  • Meal skipping or cutting out whole food groups and anxiety eating certain foods.
  • Frequent weighing and body checking in the mirror/feeling a body area.
  • Low self esteem and body image issues.

Physical Health Risks of atypical anorexia:

Alterations in heart rate (usually bradycardia – low heart rate).

Low blood pressure

Lack of hormones being made, affecting menstruation, thyroid and more.

Stress fractures and poor wound healing.

Low bone mineral density, osteopenia and osteoporosis.

Gastrointestinal and digestive issues, including bloating, food intolerances and wind.

These all improve as you eat regularly and nourish your body.

How does this differ from anorexia

The main difference between anorexia and atypical anorexia is the weight. Which is where it can feel confusing. If the hallmark of anorexia nervosa is to be a low weight, then this can lead to the perception that atypical anorexia isn’t an important condition. Which is far from the truth. Anyone can be sick with an anorexia at any size and shape. You can be undernourished at any weight, yes even if overweight or obese. Malnutrition does not have to be related to your body weight but to your nutritional status. It is not about weight but about the psychological impact the disease is having on you and the physcial consequences. Anorexia at any weight can lead to conditions including organ damage, loss of bone mass, and cardiovascular complications.

Anorexia has the highest mortality of any eating disorder, and the atypical form is not exempt from this risk. This shows just how serious a condition it really is.

Things to remember about anorexia:

  • It is very common
  • You don’t need a label to get treatment
  • Atypical does not mean you have not met the full diagnosis.

Atypical Anorexia treatment

Treatment for anyone with any form of anorexia is essential. This is not something to be getting better from on your own and everyone deserve help from a specialist team. One of the largest barriers to accessing support is that certain providers will only provide care where a low weight is recorded. Totally unhelpful and unvalidating. This may mean that some people with atypical anorexia have to seek private treatment or wait longer for help. Again this is not how it should be and I am sorry if this has happened to you or a loved one.

You are deserving of support. If you do need private support or want to go this route for speed of treatment then look for a team you feel supported by, able to talk to and who are there for the long term.

Eating disorder dietitian role

A dietitian can support your recovery but will not be the only member of your care team. Your GP or doctor will need to monitor your physical health, an eating disorder therapist or psychologist is also a vital part of your care team. A dietitian may help with nutrition education, a food plan, guidance on portions and help monitoring your intake. I personally like to see what people are eating for a period of time and hear the thoughts and feelings around this. Whilst dietitians are not therapists, if they work in eating disorders they usually have upskilled to some level and so can also support you to recover from eating disorder thoughts and behaviours. This work is crucial and can support the therapy you are having.

You can book for help with our eating disorder dietitian here and sign up to our specialist email series of recovery tips here.

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Masheb RM, Ramsey CM, Marsh AG, Snow JL, Brandt CA, Haskell SG. Atypical Anorexia Nervosa, not so atypical after all: Prevalence, correlates, and clinical severity among United States military Veterans. Eat Behav. 2021 Apr;41:101496. doi: 10.1016/j.eatbeh.2021.101496. Epub 2021 Mar 2. PMID: 33711788.

Wells JC, Sawaya AL, Wibaek R, Mwangome M, Poullas MS, Yajnik CS, Demaio A. The double burden of malnutrition: aetiological pathways and consequences for health. Lancet. 2020 Jan 4;395(10217):75-88. doi: 10.1016/S0140-6736(19)32472-9. Epub 2019 Dec 15. PMID: 31852605; PMCID: PMC7613491.

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