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What is Atypical Anorexia?

Atypical anorexia is an eating disorder that is nearly identical to anorexia. The difference? While people with anorexia are at significantly low body weights, people with atypical anorexia weigh in the “normal” range or live in larger bodies. Classified as an Other Specified Feeding or Eating Disorder (OSFED), atypical anorexia is also known as subthreshold anorexia. People of all genders, shapes and sizes can suffer serious, and even fatal, complications from atypical anorexia. And the number of people diagnosed with atypical anorexia is growing. A recent study found that between 25-40% of patients in inpatient eating disorder treatment centers have atypical anorexia. [1,2]

Is Atypical Anorexia Similar to Anorexia?

There are few differences in how anorexia and atypical anorexia affect people. The primary difference is that people with anorexia have a lower body weight to height ratio than people with atypical anorexia. While the two eating disorders are similar, since people with atypical anorexia do not appear underweight, they are less likely to receive eating disorder treatment compared to individuals with anorexia who look underweight. [3]

Causes of Atypical Anorexia

Atypical anorexia can have multiple causes, including genetic, biological, psychological, social and cultural factors.
girl in tree

Psychological Risk Factors

Individuals may be more likely to develop an eating disorder like atypical anorexia if they are already struggling with mental health issues like anxiety, depression, bipolar disorder, or substance use. Other traits highly associated with atypical anorexia and other eating disorders include: 

  • Perfectionism
  • Rigidity in thinking or behavior
  • Low self-esteem
  • Interpersonal problems
  • A history of trauma
  • Trouble with emotional regulation
  • Body image issues

If you recognize yourself in some of these personality traits, you may be at a greater risk for developing an eating disorder.  

Genetic and Biological Causes

All mental health conditions are biological in nature, and eating disorders are no different. Atypical anorexia, like other eating disorders, is known to have a strong genetic link. If someone in your family has had an eating disorder, you may be more likely to develop an eating disorder. This does not mean that parents are to blame for a child’s eating disorder. In fact, family support is instrumental at helping people overcome eating disorders.

Social and Cultural Causes

Another risk factor for eating disorders is being exposed to social and cultural messages proclaiming that a certain type of body is “better” than others. If you hear repeated messages about what your body “should” look like, you may take drastic measures to change your body to look more like that “ideal” body type. This may lead you to engage in behaviors aimed at losing weight or preventing weight gain, including dieting, purging or exercising excessively — all signs of atypical anorexia. At-risk individuals can be exposed to these social and cultural messages in many ways:

  • Friends, family members, coaches, dance teachers or others
  • The internet, magazines, TV and movies
  • Social media apps, where Photoshop, filters and photo editing are common
  • Celebrities and fitness influencers
  • Messaging from diet and weight-loss companies (a multi-billion-dollar industry)

People of all ages and all genders can be exposed to these messages, increasing the risk for eating disorders.

Sports and Athletics

Sports are a great way for young people to get exercise, socialize and build self-esteem. However, all sports can potentially increase the risk for developing eating disorders — and this is true for people of all genders. Trying to achieve the ideal athletic body or attempting to improve performance through increased training and diet changes can lead to eating disorder thoughts and behaviors like:

  • Restricting food to lower calorie intake
  • Bingeing and/or purging (through vomiting, laxatives, or other means)
  • Exercising excessively (running miles a day even when injured)

Some athletic coaches and dance teachers continue to encourage weight loss in young athletes — via any means necessary. This harmful practice continues even though dieting and food restriction can lead to health complications and decreased athletic performance.

Dieting and Body Shaming

Other risk factors for the development of atypical anorexia include being overweight, being body shamed or teased about one’s weight, or having a history of dieting.

  • A study of teenagers found that 40% of females who were “overweight” and 20% of males who were “overweight” were engaging in eating disorder behaviors. [4]
  • Another study found that 70% of patients with atypical anorexia had been “overweight” or “obese” in the past while only 12% of people with anorexia had been “overweight” or “obese.” [5]
  • Further research found that people with atypical anorexia were teased about their weight more often than others as they were growing up. [6]

LBGTQ+ Identity

People who identify as LGBTQ+ are far more likely to experience mental health problems, including eating disorders, than the general public. People who identify as gender-diverse or gender-non-conforming have higher rates of atypical anorexia than people who identify as male or female. [1]

Atypical Anorexia Symptoms

The symptoms of atypical anorexia are similar to anorexia: a severe restriction of daily food intake and engaging in behaviors to avoid weight gain, like dieting, fasting or excessive exercise. Mental health symptoms in people with atypical anorexia can include:

  • An intense fear of gaining weight or fear of being in a larger body
  • A drive to change one’s weight, body size or shape, at any cost
  • Dissatisfaction with one’s body size, shape or appearance, a distorted body image or body dysmorphic disorder
  • Low self-esteem, mood swings, anxiety or depression
  • Trouble concentrating or focusing
  • Fatigue
  • Suicidal thoughts or self-harm

Many people with atypical anorexia believe that they are not sick enough to need treatment because they are not underweight. But the weight loss or sustained calorie restriction associated with atypical anorexia can cause serious problems.

Signs to Watch For

If you, or someone you care about, are preoccupied with food, body weight, size or shape, or have unusual eating behaviors, it may be time to seek professional help for an eating disorder. Do these signs of atypical anorexia seem familiar?

  • Increased irritability, low self-esteem or moodiness
  • Skipping meals or avoiding eating with others
  • Being overly focused on nutrition labels or calorie counts
  • Avoiding certain foods or food groups
  • Binge eating to numb painful emotions
  • Trouble regulating emotions
  • Frequent weighing or checking one’s body in mirrors

Some people with atypical anorexia may not have any noticeable physical symptoms. However, even though physical symptoms are absent, the individual may still be suffering emotionally.

Physical Complications of Atypical Anorexia

The physical complications associated with atypical anorexia are as serious as the complications associated with anorexia. As people with atypical anorexia restrict their food intake, they are at risk for a number of serious problems, including:

  • Bradycardia (abnormally low heart rate)
  • Low blood pressure
  • Loss of bone mineral density
  • Hormone changes or reproductive health issues
  • Injuries that are slow to heal or stress fractures
  • Fatigue
  • Gastrointestinal issues

Notably, the medical condition of patients with atypical anorexia can be as bad, if not worse, than patients with anorexia. [6] While individuals with atypical anorexia may not appear to be underweight based on body mass index (BMI) alone, if they lose a significant amount of weight in a short amount of time (or if they restrict calories for an extended period of time) they can experience symptoms of malnutrition. [7]

woman portrait

How Can I Be Malnourished if I’m Not Underweight?

Contrary to popular belief, malnutrition can occur at all body weights. [7] Malnutrition can be caused by:

  • Being on a very restrictive diet

  • Losing a significant amount of weight (even if you are still within or above the “normal” body mass index (BMI) range) [1]

  • Depriving yourself of calories for an extended period of time, even if your body has resisted weight loss [1]

Signs of malnutrition to watch for include:

  • Fatigue

  • Weakness

  • Trouble concentrating

  • Dizziness

  • Vitamin deficiencies

Even if you are not clinically underweight, any rapid, or significant weight loss can lead to serious medical complications. The good news is that many of the physical health risks associated with atypical anorexia can resolve with eating disorder treatment.

Is Atypical Anorexia Dangerous?

Since people with atypical anorexia do not appear to be visibly emaciated, providers are less likely to refer these individuals out for eating disorder treatment. This means that people with atypical anorexia, especially at higher weights, may not get the help they need and deserve. Of great concern, people with atypical anorexia may be at risk of bradyarrhythmia, raising the risk of early death. [2] Atypical anorexia is also associated with a rise in suicidal thoughts.

Suicidal Thoughts and Atypical Anorexia

Having suicidal thoughts or making a plan to end one’s life means that an individual is in severe pain and their life may be in danger. If you or someone you care about is having thoughts of suicide, get help now by going to the emergency room or calling 988, the Suicide and Crisis Lifeline.

Atypical Anorexia Treatment

Atypical anorexia treatment utilizes a variety of interventions to help individuals overcome eating disorder thoughts and behaviors. Treatment team members collaborate to provide medical and nutritional support, individual therapy, group therapy, family therapy and more.

virtualcare

Medical Treatment

Patients with atypical anorexia may require medical stabilization at the start of treatment to address unresolved medical complications. When you arrive for treatment, one of the first things the treatment team will do is run labs to assess for symptoms of malnutrition. Medical doctors and psychiatrists monitor and support patients who are acutely ill. Psychiatric medicines and other medications are prescribed to support healing. Nursing professionals work closely with the treatment team to address atypical anorexia complications, providing medical care when emergency medical intervention is needed.

Nutritional Rehabilitation

Once the patient is medically stable, one of the first goals of treatment will be to re-introduce standard eating habits as a way to normalize eating behaviors and food intake. Patients meet with registered dietitians regularly throughout atypical anorexia treatment. Since many patients are nervous or even unwilling to eat in treatment, mealtime support is supervised by behavioral health counselors. Registered dietitians and clinicians are also available as needed. Education on food portions, food plating and nutrition fundamentals is provided.

Individual Therapy

Psychotherapy is an integral part of atypical anorexia treatment. Experienced eating disorder clinicians work one on one with patients, applying a number of evidence-based clinical interventions to support behavioral change. Therapists introduce coping skills to patients, and challenge negative thought patterns. Some of the evidence-based therapies used in atypical anorexia treatment include:

Co-morbid mental health conditions, including anxiety, depression, bipolar disorder and others are also addressed in therapy.

Group Therapy

Group therapy is another critical component of atypical anorexia treatment. In group therapy, patients benefit from peer and professional support as they learn how to resolve and repair destructive eating and exercise routines, strict food rules and harmful eating disorder thoughts and behaviors. Recovery skills and relapse prevention skills are taught while patients work on body acceptance and body image issues. Experiential therapies including art, psychodrama, mindfulness, movement and yoga are also incorporated into the eating disorder treatment program.

Family Therapy

A family-centered approach to atypical anorexia treatment is critical. Family members and other members of the support-system play a major role in an individual's recovery at all ages of the lifespan. Family-Based Treatment and Emotion Focused Family Therapy empower parents, partners and others to become agents of change for their loved ones, supporting them in sustaining long-term recovery. In family therapy, education is provided to parents, partners, family members and loved ones to help them better understand the impact of atypical anorexia and how to overcome the eating disorder.

Virtual Treatment

The growing field of virtual eating disorder treatment provides a more flexible option for atypical anorexia treatment, allowing individuals to work with experienced treatment providers from the comfort of home. Virtual eating disorder treatment experts provide evidence-based nutritional support and therapeutic treatment. Interventions in virtual treatment are similar to the therapeutic offerings listed here.

Atypical Anorexia Recovery

When an individual starts treatment for atypical anorexia, they receive medical, nutritional and therapeutic care from experienced eating disorder professionals. Groups, community meetings, nutritional support and individual therapy all support the individual’s recovery by:

  • Addressing physical health effects and medical complications
  • Helping patients return to regular eating habits and patterns
  • Improving mental health, body image and mood

In treatment, each patient receives an individualized eating disorder treatment plan emphasizing skill building to promote recovery after treatment. When an individual completes treatment, aftercare planning and alumni services provide a plan of action and continuity of care to maintain the progress made in treatment.

Eating Disorder Treatment for Those with Higher Weights

Providers are more likely to refer individuals with visibly low body weights out for eating disorder treatment. Conversely, people with atypical anorexia, often at “normal” or higher weights, may not be referred out for treatment, despite having multiple physical and mental health complications. This points to the need to educate healthcare professionals on atypical anorexia and the severity of the illness, regardless of patient weight at time of assessment — or their weight history. It’s important to seek help for restrictive thoughts and behaviors before the illness worsens and medical complications intensify.

Levels of Care

Eating Recovery Center offers the full continuum of care for individuals with atypical anorexia and other eating disorders. Learn about the different levels of care here.

How to Get Help for Atypical Anorexia

Unfortunately, many individuals with atypical anorexia will not seek help because they don’t think they are “sick enough.” And some healthcare providers refuse to refer people with atypical anorexia out for treatment because they appear to be at a “healthy” weight — even though they are experiencing mental and physical health problems related to their eating disorder. Some healthcare providers may even prescribe weight loss to overweight patients, increasing their risk for an eating disorder.

It is our passion to help people recover from eating disorders.

If you or someone you care about are struggling with eating disorder thoughts or behaviors, please tell someone. You can call us at 877-825-8584 for a free, confidential consultation with a member of our team. You can recover from atypical anorexia. We can show you how.

Atypical Anorexia Facts and Statistics

The number of people diagnosed with atypical anorexia is growing. [1]

Multiple studies have found that atypical anorexia is at least two or three times more common than anorexia. [1,3]

An estimated 0.2-4.9% of people will experience atypical anorexia in their lifetime. [1]

An estimated 25-40% of patients seeking inpatient eating disorder treatment have a diagnosis of atypical anorexia. [2]

Despite how common and serious it is, people with atypical anorexia are less likely to receive inpatient care for eating disorders. This means that their symptoms and related medical complications may persist for a longer duration of time. [2]

One study found that the peak age for onset of atypical anorexia was between 19 and 20 years of age. [3]

If a person has restricted their food intake to lose weight but are still within the normal body mass index (BMI) range — or above the normal BMI range — they may have atypical anorexia. [1]

If a person has deprived themselves of calories for an extended period of time, yet their body has resisted weight loss, they may have atypical anorexia. [1]

While those with anorexia often have lower body weights than those with atypical anorexia, people with atypical anorexia have been shown to experience greater levels of functional impairment, emotional distress and suicidal thoughts. [3]

Contrary to popular belief, malnutrition caused by eating disorders can occur at all body weights — not just very low body weights. [7]

Symptoms of malnutrition may appear in people who restrict their diets, even if they have “normal” weight or higher weight bodies. [8]

People with atypical anorexia tend to suffer from their eating disorders longer than those with anorexia. This is likely due to the fact that the eating disorder is harder to diagnose without the very-low weight criteria being met. Thus, patients with atypical anorexia are less likely to be referred out for eating disorder treatment. [9]

Some may suggest that atypical anorexia is less serious than anorexia, because a person’s weight is not dangerously low. However, studies show that people with atypical anorexia are less likely to be referred out for inpatient eating disorder treatment, even though that may be the most beneficial treatment program. [10]

Recovery from atypical anorexia consists of addressing one’s mental and emotional health, stabilizing weight, addressing medical issues, and returning to standard eating behaviors. These steps will restore one’s health and well-being. [11]

People who identified themselves as “other gender” when presented with binary gender options (male or female) had more than double the rates of anorexia and atypical anorexia than other genders. [12]

Without treatment, atypical anorexia can be deadly. [2]

Frequently Asked Questions About Atypical Anorexia

What is atypical anorexia?

Atypical anorexia is an eating disorder that is nearly identical to anorexia. The difference? While people with anorexia are clinically underweight, people with atypical anorexia can weigh in the “normal” range or live in larger bodies. People of all genders and all shapes and sizes can suffer serious, and even fatal, complications from atypical anorexia.

What causes atypical anorexia?

Atypical anorexia has multiple causes. Some of the many factors that contribute to atypical anorexia include:

  • Social and cultural causes
  • Genetic and biological causes
  • Psychological or mental health causes
  • Participation in sports or athletics
  • Being teased, bullied or body shamed
  • Identifying as LGBTQ+

What are the symptoms of atypical anorexia?

Atypical anorexia symptoms are similar to anorexia symptoms, aside from one thing: while people with anorexia have very low body weights, people with atypical anorexia may have lost a significant amount of weight, yet still weigh in the “normal” or “above-normal” range — or they may not have lost a significant amount of weight. Individuals with atypical anorexia are hyper focused on their body weight, shape or size. They may restrict their food intake or use eating disorder behaviors to “purge” calories consumed.

What are the health risks associated with atypical anorexia?

As people with atypical anorexia restrict their food intake to lose weight, multiple health complications can occur, including:

  • Bradycardia (abnormally low heart rate)
  • Low blood pressure
  • Loss of bone mineral density
  • Hormone changes or reproductive health issues
  • Injuries that are slow to heal or stress fractures
  • Fatigue
  • Gastrointestinal issues
  • While individuals with atypical anorexia may not appear to be underweight based on body mass index (BMI) alone, the amount of weight they have lost in a short amount of time (or sustained calorie restriction) can lead to serious physical health problems, including symptoms of malnutrition.

    How is atypical anorexia treated?

    Atypical anorexia treatment utilizes a variety of steps to help individuals overcome eating disorder thoughts and behaviors. Treatment team members collaborate to provide medical and nutritional support, individual therapy, group therapy, family therapy and more. There are a number of different levels of care to support people with atypical anorexia on the road to recovery including:

    • Inpatient
    • Residential
    • Partial hospitalization program (PHP)
    • Intensive outpatient program (IOP)
    • Virtual eating disorder treatment

    Do I have anorexia?

    Atypical anorexia affects people in a wide variety of body shapes and sizes. Similar to other eating disorders, people who struggle with atypical anorexia are consumed with worry about their body shape, size, weight or appearance. While people with atypical anorexia are not severely underweight, the physical and mental health complications associated with atypical anorexia can be serious. Fortunately, most of these complications resolve with treatment. Do you think you or someone you care about has atypical anorexia? Get to know the signs to watch for or take our atypical anorexia self-assessment test today.

    References

    [1] Harrop, E.N., Mensinger, J.L., Moore, M. & Lindhorst, T. (2021). Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. International Journal of Eating Disorders: 54(8); 1328-1357.

    [2] Golden, N.H. & Mehler, P.S. (2020). Atypical anorexia nervosa can be just as bad. Cleveland Clinic Journal of Medicine 87(3); 172-174.

    [3] Stice, E., Marti, C.N. & Rohde, P. (2013). Prevalence, Incidence, Impairment, and Course of the Proposed DSM-5 Eating Disorder Diagnoses in an 8-Year Prospective Community Study of Young Women. Journal of Abnormal Psychology: 122(2): 445-457.

    [4] Neumark-Sztainer D.R., Wall M.M., Haines J.I., Story M.T., Sherwood N.E., & van den Berg P.A. (2007). Shared risk and protective factors for overweight and disordered eating in adolescents. American Journal of Preventive Medicine, 33(5), 359–369.

    [5] Sawyer S.M., Whitelaw M., Le Grange D., Yeo M., & Hughes E.K. (2016). Physical and psychological morbidity in adolescents with atypical anorexia nervosa. Pediatrics, 137(4), 4080 10.1542/peds. 2015-4080.

    [6] Freizinger, M., Recto, M., Jhe, G. & Lin, J. (2022). Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap. Children (Basel); 9(6): 837.

    [7] Garber, A. K. (2018). Moving beyond "skinniness": presentation weight is not sufficient to assess malnutrition in patients with restrictive eating disorders across a range of body weights. Journal of Adolescent Health, 63(6), 669-670.

    [8] Peebles, R., Hardy, K. K., Wilson, J. L., & Lock, J. D. (2010). Are diagnostic criteria for eating disorders markers of medical severity? Pediatrics, 125(5), e1193–e1203.

    [9] Lebow J., Sim L.A., Kransdorf L.N. (2015). Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders. J Adolesc Health; 56(1):19–24.

    [10] Kennedy G.A., Forman S.F., Woods E.R., et al. (2017) History of overweight/obesity as predictor of care received at 1-year follow-up in adolescents with anorexia nervosa or atypical anorexia nervosa. J Adolesc Health; 60(6):674–679.

    [11] Dimitropoulos, G., Kimber, M., Singh, M., Williams, E.P., Loeb, K.L., Hughes, E.K., Garber, A., Elliott, A., Vyver, E., & Grange, D. (2019). Stay the course: practitioner reflections on implementing family-based treatment with adolescents with atypical anorexia. Journal of Eating Disorders: 7(1).

    [12] Mitchison, D., Hay, P., Slewa-Younan, S., & Mond, J. (2014). The changing demographic profile of eating disorder behaviors in the community. BMC Public Health, 14, 22–31.

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