Did you know that you can be of average or higher weight and still have anorexia? While anorexia nervosa is often associated with being extremely underweight, there is a form of the disorder that does not fit the stereotype: atypical anorexia. Atypical anorexia falls under the formal diagnosis of Other Specified Feeding or Eating Disorder (OSFED). This occurs when one meets the majority of the criteria for anorexia nervosa, like restrictive eating, but they are not clinically underweight. Understanding this diagnosis plays a vital role in helping destigmatize eating disorders and what it looks like when a person receives the diagnosis.
What is Atypical Anorexia?
According to the DSM-V-TR, atypical anorexia can be diagnosed when a person meets all of the criteria for anorexia nervosa, except that despite significant weight loss, the individual’s weight is within or above the normal range. This would look like someone with a history of living in a larger body restricting their food intake to the point that they lose a considerable amount of weight but remain in a range considered healthy (for example dropping from the 95th percentile for weight down to the 50th percentile). This individual would also have an intense fear of gaining weight or becoming fat and has misperceptions of the shape of their body.
The symptoms of atypical anorexia are also very similar to anorexia. One of the key differences is that someone with atypical anorexia may not believe they are actually sick enough to need treatment due to not being underweight. Symptoms include:
- An intense fear of gaining weight or being in a larger body
- An intense desire to change weight, body size or shape, at any cost
- A distorted body image or body dysmorphic disorder
- Low self esteem
- Mood swings
- Depression
- Anxiety
- Difficulty concentrating or focusing
- Fatigue
- Thoughts of suicide or self-harm
Why Is Atypical Anorexia Hard to Diagnose?
When it comes to diagnosing atypical anorexia, many medical providers may either miss the problem altogether or come up with a misdiagnosis due to the complexities of the diagnosis. In the medical and psychological fields, very little time is given to learning about eating disorders as a whole unless one goes out of their way to research them or seeks out a training site with a focus on eating disorders. Because of this, it is very common for providers to overlook some of the symptoms of eating disorders. With atypical anorexia being one of the least common eating disorders, it is also missed as a diagnosis due to lack of awareness.
It is common for atypical anorexia to be misdiagnosed for other mental health conditions. This can include major depressive disorder, generalized anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, or even a phobia. The primary reason for this is because weight loss is a common symptom of many of these diagnoses and it can be seen as a positive side effect for people who live in a larger body. By misdiagnosing atypical anorexia, there can be a delay in treatment which can result in the eating disorder becoming progressively worse and requiring a higher level of care for treatment.
Atypical anorexia can also be commonly misdiagnosed as another medical condition due to the effects of malnourishment on the body. Just like other eating disorders, it is very common for people with atypical anorexia to experience significant gastrointestinal problems. Whether it be constipation, bloating, or stomach pains, someone who is malnourished will commonly experience GI problems that they will seek help for. It is at this time that many medical doctors will miss the diagnosis of atypical anorexia due to the weight loss not being at a significantly low weight to cause alarm. Because of this, many people can go undiagnosed for months or years with continual GI pain and no solutions.
Cultural influences also have an impact on why atypical anorexia is hard to diagnose. Our society is obsessed with thinness and praises people who live in larger bodies when they lose any amount of weight. Many people with atypical anorexia have been told by doctors, family, friends, and people online that they need to lose weight. As a result, one may do anything to lose the weight and then receive an abundance of praise for doing so and for “looking so healthy.” In society’s mind, people with atypical anorexia finally look “healthy” and fit in with others. This response communicates to everyone that there is no problem occurring and the person who has lost weight should continue to do whatever it takes to maintain their weight.
The Risk Factors for Atypical Anorexia
As with all eating disorders, there is a strong genetic link for atypical anorexia. It is very common for someone with atypical anorexia to have a family member with an eating disorder as well. Other biological risk factors include gender and age. Females are more likely than males to develop atypical anorexia, though this could be due to underreporting in males. Adolescents and young adults are at a higher risk than other age groups due to the developmental stages they are in physically, cognitively, and socially. While genetic factors can be a significant risk fact for developing atypical anorexia, there are also environmental and psychological risk factors to be aware of.
As previously mentioned, societal views on bodies and weight heavily impact eating disorders, especially atypical anorexia. In western society, there is a pressure for people to live in smaller bodies and an intense shame placed on those who live in larger bodies. We see diet culture everywhere we turn. From ads about the latest fad diet to the newest weight loss medication everyone is taking. People who grow up in larger bodies may receive praise whenever they lose weight or even be told by medical providers that they need to lose weight and be more “healthy.” This combination can put one at risk for developing atypical anorexia in an effort to fit in with societal norms.
There are several psychological disorders that can co-occur with atypical anorexia that can put one at risk for developing the diagnosis. While anxiety disorders and mood disorders are the most common co-occurring diagnoses, an OCD diagnosis can increase risk for atypical anorexia. This being due to one having the obsession with losing weight or eating only certain foods and then compulsively doing so. OCD can also put one at most risk for developing the binge-purge subtype of atypical anorexia due to the compulsion to rid the body of food eaten with whatever means possible (laxatives, vomiting, excessive exercise, etc).
Treatment and Recovery
Recovery from any eating disorder, including atypical anorexia, is 100% possible by getting the correct diagnosis and beginning treatment as soon as possible. Because people with atypical anorexia do not “look sick” due to technically being at a “healthy” weight, it can be difficult to get that person and/or their loved ones to recognize the need for help. The best way to get the support needed for treatment, is to search for a mental health professional who specializes in eating disorders. These clinicians will know and understand the intricacies of atypical anorexia and will be able to provide the correct treatment.
Treatment for atypical anorexia can vary based on a person’s age, temperament, and support system. Here are some common treatment approaches:
- Cognitive Behavioral Therapy: CBT focuses on identifying and challenging thought distortions related to one’s body image, food, and self worth. It can help one to develop a healthier relationship with food as well as address underlying emotional and behavioral patterns that promote long-term recovery.
- Radically Open Dialectical Behavior Therapy: RO-DBT helps one to develop openness and flexibility in order to be able to regulate emotions and develop a more balanced approach to food and body image. This form of therapy is great for people who are over-controlled in their behaviors and emotions. It focuses on building social connectedness and reducing over-control behaviors.
- Family Based Therapy: FBT is for families of children or adolescents with eating disorders. It heavily involves the family in the treatment process by empowering the parents to take an active role in helping their child to restore healthy eating habits. FBT focuses on rebuilding trust, improving communication, and supporting the child in regaining control over their eating behaviors.
A diagnosis of atypical anorexia can feel daunting, overwhelming, discouraging, and unbelievable. Atypical anorexia is a complex and often misdiagnosed disorder that requires a comprehensive approach to treatment. While it shares many similarities with traditional anorexia, it also has its own unique characteristics that can make it more challenging to recognize and address. As with all eating disorders, early intervention, with the right therapeutic approach, is essential in helping one on their path to recovery. Understanding and supporting those with atypical anorexia can help break down the stigma surrounding eating disorders and foster a compassionate, open environment for healing.
If you or someone you know may be struggling with atypical anorexia, or any eating disorder, please reach out to us at Integrated Care Clinic today. All of our providers are specially trained to treat all eating disorders and desire to help you on your way to recovery now. Tap here to reach out and start the process today.
