Atypical Anorexia

You can’t tell if someone has an eating disorder just by looking at them. See how atypical anorexia affects people in a variety of body shapes and sizes.

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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. People of all genders, shapes and sizes can suffer serious, and even fatal, complications from atypical anorexia.

Atypical anorexia in the DSM-5

Atypical anorexia falls under the DSM-5 category as an other specified feeding or eating disorder (OSFED).  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]

Atypical anorexia vs. 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.
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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, another mood disorder, or substance use. Other traits highly associated with atypical anorexia and other eating disorders include: 

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.

Read: 10 Things Parents Need to Know About 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.

Eating disorders in athletes

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.

Read: Eating Disorders in Athletes: The Truth About Compulsive Exercise

Risk factor: diets and body shame

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]

Read: Tips for Navigating Body Comments & Diet Talk

Risk factor: being LBGTQ+

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 consequences 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:

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]

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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.

See how we treat malnutrition at Eating Recovery Center.

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.

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Atypical anorexia treatment options

Medical stabilization

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.

Individual therapy

Eating disorder therapy 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, mood disorders 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 (EFFT) 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 counseling 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.

Nutritional counseling for eating disorders

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.

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.