Written by: Angela Derrick, Ph.D. & Susan McClanahan, Ph.D.
Date Posted: July 15, 2024 12:33 am
Atypical anorexia is a subtype of anorexia nervosa characterized by the same restrictive eating behaviors and psychological issues as typical anorexia but without the patient being underweight. Individuals with atypical anorexia can have normal or higher body weights, making it more challenging to diagnose due to weight stigma and the common misconception that only underweight individuals can have eating disorders.
People with atypical anorexia symptoms suffer from significant medical and psychological issues due to malnutrition. Despite these challenges, they often struggle to receive appropriate treatment because of weight bias in healthcare. Their weight does not, in fact, meet the criteria traditionally associated with anorexia. Not meeting the low weight standard can lead to feelings of invalidation and difficulty accessing a higher level of care.
As therapists experienced in treating atypical anorexia, we recognize that addressing weight stigma in medical and treatment settings is crucial to ensure that all individuals with eating disorders, regardless of their body size, receive the care they need
Weight stigma refers to the discriminatory acts and negative attitudes directed toward individuals based on their body shape, size, and weight. Weight bias prejudice manifests in various domains, including the workplace, healthcare, educational settings, and within families in the home.
The social stigma of living in a larger body can have far-reaching consequences. These individuals often face stereotypes of laziness, lack of self-discipline, and even low intelligence. This prejudicial treatment can lead to social isolation, reduced opportunities, not being paid as much as their colleagues who live in smaller bodies, and lower quality of life for individuals who do not fit the thin ideal. Fat bias, especially in our toxic diet culture, also affects mental well-being as it is unrelenting and often starts in childhood. Some of the negative psychological impacts include increased stress, anxiety, and depression, along with all manner of eating disorders.
In healthcare, weight discrimination can result in biased treatment from physicians. These physicians may tend to attribute health issues to a patient’s weight and, as a result, overlook other potential causes. The doctor’s focus on weight loss as a panacea can lead to inadequate medical care and, consequently, a patient’s reluctance to seek the care they need.
In educational environments, children and adolescents in larger bodies might experience bullying and discrimination, impacting their academic performance and mental health. It is not hard to extrapolate that an atypical anorexic can have a myriad of difficulties getting the help they need because of how they present.
Atypical anorexia is an eating disorder characterized by the same restrictive behaviors and intense fear of gaining weight seen in anorexia nervosa but without the low body weight criterion. Individuals with atypical anorexia, regardless of their body size, still suffer from the physical and psychological effects of restrictive eating. This condition is recognized in the DSM-5 under the category of Other Specified Feeding or Eating Disorders (OSFED). Despite not being underweight, individuals with atypical anorexia can experience severe health complications similar to those with anorexia nervosa. Additionally, they have to face a myriad of myths and misconceptions. Below are just a few:
Reality: The difference between atypical anorexia and anorexia nervosa is primarily in presentation. Contrary to popular belief, atypical is just as severe, if not more so, and potentially life-threatening as its classic sibling. Individuals can experience the same medical complications, such as malnutrition, even if they do not meet the traditional diagnostic criteria of being underweight. Both conditions involve restrictive eating, excessive exercise, and other behaviors aimed at controlling weight. The psychological distress and cognitive distortions about food, weight, and body image are also similar. These include intense fear of gaining weight, body dissatisfaction, and obsessive thoughts about food and eating. Unfortunately, because of the misguided sense that atypical anorexia is not as severe, diagnosis is often delayed. As a result, atypical anorexics are at greater risk of long-term health consequences.
Reality: Although historically perceived as a female issue, eating disorders do not discriminate. Boys, men, and non-binary individuals are also affected. They conservatively comprise 25% of the cases and are significantly less likely to seek help. Some barriers include equating getting help with weakness and discomfort with the change in power dynamic required to get help. Healthcare providers often do not recognize the symptoms in anyone who is not considered classically presenting. A gender-inclusive approach can lead to earlier interventions, giving everyone access to the help they need.
Reality: According to the Journal of Eating Disorders, Atypical Anorexia Nervosa (AAN), a new diagnosis in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and currently listed under the category of “Other Specified Feeding or Eating Disorders (OSFED),” describes those individuals who meet all criteria for anorexia nervosa (AN) except that despite significant weight loss, weight is in the normal or above normal range. Like those with AN, patients with AAN have intense fear of gaining weight and may engage in potentially dangerous weight control behaviors such as dietary restriction, fasting, excessive exercise, self-induced vomiting, and the use of laxatives, diuretics, diet pills, herbal remedies or complementary and alternative medications, to prevent weight gain.
As clinicians specializing in eating disorder treatment, we want to emphasize that atypical anorexia is a severe and complex mental illness. There are many determinants, including biological, psychological, and environmental. If you are experiencing negative body image or signs of disordered eating, it is imperative to seek help right away from a mental health professional. Compassionate and non-judgemental support when healing from an eating disorder is crucial due to the presence of deep-seated emotional distress along with intense societal pressures. Recovery extends far beyond just physical weight restoration. Subsequently, it is a complex and individualized journey that encompasses mental, spiritual, and emotional well-being.
From the National Eating Disorders Association
As clinical Psychologists with expertise in treating eating disorders, we want to underscore that addressing the physical, psychological, and nutritional aspects of atypical anorexia requires a comprehensive, multidisciplinary approach. Key components of effective treatment may include:
Eating disorders, including atypical anorexia nervosa, come in all shapes and sizes, all genders, all sexual orientations, all ages, and all races. They DO NOT discriminate. Stereotypes, such as only young white emaciated girls have eating disorders, undermine an individual’s ability to see themselves as legitimately needing help for a serious mental illness. These stereotypes prolong suffering and prevent people from seeking help because they aren’t “sick enough.” Diet culture is also promoted where toxic relationships with food and exercise are normalized. This unhealthy culture provides cover for denial. Coming out of denial and recognizing the potentially life-threatening reality of an eating disorder can be a shocking and brutal pill to swallow. Have you ever heard the saying nothing changes if nothing changes? Staying in denial supports that status quo. Coming out of denial changes everything, and this is where restoration and healing can finally begin.
Eating disorders are legitimate illnesses deserving of empathy and appropriate treatment. Raising awareness around this fact can help dismantle the stigma. Self-compassion can help move us in the direction of empathy. We realize that we are not alone in our suffering and are not to blame for our symptoms. What can feel like a moral failing turns out to be a treatable set of symptoms that many suffer with through no fault of their own. Fostering a compassionate understanding of the sufferer’s experiences creates a safe environment for healing. Let’s work together to dismantle the stigma surrounding eating disorders in order to ensure that everyone receives the care they need and deserve.
Are you struggling with symptoms of atypical anorexia or other disordered eating issues? You don’t have to fight through these symptoms alone–hope and help is available. At SpringSource, we strive to provide the most effective and compassionate care for individuals struggling with eating disorders and their often coexisting issues such as trauma, stress & anxiety, depression, and relationship issues.
We believe the paths to healing are varied and want to help you craft your individual recovery journey. We have offices in downtown Chicago and Northbrook, Illinois, for in-person support. We also offer virtual therapy.
Call SpringSource Psychological Center today at 224-202-6260 | info@springsourcecenter.com | We offer free 15-minute initial consultations—schedule here.
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