Categorizing and labeling any eating disorder is a tricky subject. On one hand, having a clear diagnosis makes it easier to create medical reports and prescribe treatment. However, creating rigid boxes for a diagnosis ends up leaving some people out. Each body is different, and eating disorders, like all mental illnesses, show up with a range of intensities, symptoms, and expressions. 

Having a cut-and-dry definition of an eating disorder means that some people who are suffering may be overlooked. This is why the Diagnostic and Statistical Manual of Mental Disorders includes the category OSFED (Other Specified Feeding and Eating Disorder). An OSFED diagnosis gives more room for eating disorders that cause significant distress but don’t meet all the criteria for another diagnosis. “Atypical” anorexia nervosa is one of the OSFED subtypes as someone with “atypical” anorexia may not meet all the diagnostic criteria for anorexia nervosa.  

What Is “Atypical” Anorexia Nervosa?

“Atypical” anorexia nervosa is an eating disorder in which someone exhibits all the same symptoms of anorexia nervosa, except they are not categorized as “underweight”, according to the Body Mass Index (BMI). “Atypical” anorexia nervosa is anorexia nervosa, just shrouded in weight stigma. Individuals experiencing “atypical” anorexia nervosa may display patterns of restrictive eating or excessive exercise in an effort to lose weight, but their body weight is at or above an “average” range. Again, based on their BMI, which is not an accurate metric for diagnosis. All bodies are different, and weight loss or gain is not a sole indicator of an eating disorder. 

Eating disorders can be just as harmful to someone who is within or above an “average weight range,” but they are much more likely to be overlooked in someone in a larger body. It’s important to remember that you can’t tell someone has an eating disorder based on how they look. In fact, less than 6% of individuals experiencing an eating disorder are medically diagnosed as “underweight.” 

What Causes “Atypical” Anorexia?

Eating disorders develop due to a variety of factors, including genetics, social pressures and/or messaging, cultural expectations, identity, and co-occurring mental illnesses. There isn’t a list of checkboxes that will determine the development of “atypical” anorexia. Because you can’t predict it, it’s important to be familiar with the signs and symptoms of eating disorders so you can find help for yourself or a loved one.  

Signs and Symptoms of “Atypical” Anorexia

Individuals with “atypical” anorexia nervosa share many of the same signs as anorexia nervosa. These include physical symptoms, emotional shifts, and behavioral changes. Additionally, OSFED, like other EDs, often co-occur with other mental illnesses like anxiety, OCD, and depression. While every eating disorder may present in slightly different ways, these signs and symptoms are general patterns seen in people suffering from “atypical” anorexia nervosa. 

Physical Symptoms

The main diagnostic difference between anorexia nervosa and “atypical” anorexia nervosa is the individual’s weight. Though someone with “atypical” anorexia may be within or above an “average” weight range, they may still experience significant weight loss. While weight fluctuations can be a sign of “atypical” anorexia, it’s important to remember that most of the physical symptoms and dangers of this eating disorder are due to malnutrition. A restrictive diet or intense calorie deficit can cause malnutrition for any body size. 

The first signs of malnutrition may be excessive fatigue or weakness. The person may experience bouts of dizziness and have difficulty concentrating. The stress of nutritional deficiencies might cause GI issues like abdominal pain and constipation. Someone with “atypical” anorexia nervosa may also have a stressed immune system and generally show lower energy levels. Eventually, the vitamin deficiencies will start affecting the hair, skin, and nails, causing brittleness and discoloration. 

If left untreated, malnutrition can develop into some serious health risks. It’s important to be familiar with the physical signs, but the earlier you can find support in eating disorder recovery, the better. 

Behavioral and Emotional Symptoms

Eating disorders are first and foremost mental illnesses. Though they can be more subtle, identifying the behavioral and emotional signs of “atypical” anorexia nervosa can play a key role in getting someone access to support more quickly. These signs include:

• Intense Fear of Weight Gain: Similar to anorexia nervosa, individuals with “atypical” anorexia are driven by a fear of gaining weight. Since “atypical” anorexia nervosa can show up in people in higher-weight bodies, this fear can have the added pressure of previous experiences with weight-stigma and fat shaming. 
• Low Self-Esteem and Distorted Body Image: People with “atypical” anorexia nervosa experience comorbid mental illnesses just as often as those with anorexia nervosa. They may be hyperfocused on their body image, and equate their self-worth with thinness.
• Behavioral Shifts Around Food: A person with “atypical” anorexia nervosa may change their eating behaviors including what, when, and where they eat.
• Emotional Dysregulation: Someone with “atypical” anorexia may seem increasingly dysregulated, more irritable, and more socially isolated. They may experience intense mood swings and have difficulty focusing. 

Risks of “Atypical” Anorexia

The complications and risks associated with “atypical” anorexia nervosa are incredibly serious and may require emergency medical treatment. Studies show equally severe medical complications as a result of “atypical” anorexia as anorexia nervosa.

Psychiatric Comorbidities

Many eating disorders co-occur with other mental illnesses, and “atypical” anorexia is no different. About 40% of people with “atypical” anorexia nervosa experienced another psychiatric comorbidity, including suicidal ideation. Treating mental health is an essential part of any eating disorder recovery plan.

Physical Complications

Though a mental illness, “atypical” anorexia nervosa can cause many medical complications for someone’s physical health. All of these are serious and some are potentially life-threatening.

• Damage to Vital Organs: Without proper nutrients, severe electrolyte imbalances can impact the body’s ability to retain fluids. This can result in vital organ failures, impacting the kidneys, the heart, and the brain.
• Cardiovascular Complications: Intense malnutrition can cause several serious cardiovascular complications including low blood pressure, bradycardia (low heart rate), and even cardiac arrest in patients with both anorexia nervosa and “atypical” anorexia nervosa. In fact, ¼ of adolescents with “atypical” anorexia present with bradycardia.
• Blood Production: When vitamin B12 levels drop dangerously low, the bow marrow will stop producing blood cells. This condition is called Pancytopenia and can be life-threatening.
• Bone Development: When eating disorders develop in younger bodies, they can affect the person’s development. “Atypical” anorexia in adolescents may compromise bone growth. In addition, individuals with “atypical” anorexia may even develop osteoporosis or osteopenia because they don’t develop proper bone density.
• Fertility: For individuals who menstruate, such intense malnutrition can affect menstruation, and they may not get a period for a prolonged time. One in three menstruating adolescents experience amenorrhea due to “atypical” anorexia. However, this can lead to permanent fertility issues in the future.

Don’t Let It Go Unnoticed

We’re all too familiar with rigid and patriarchal health and beauty standards. They have not only created a culture of comparison that can harm one’s self-esteem, but they have also created stigmas around eating disorders. These stigmas can cause someone to feel shame about their experiences and prevent people with eating disorders from getting help. This is especially true for people suffering from an OSFED, like “atypical” anorexia. 

When someone hears the term “eating disorder,” they may picture an emaciated, female-identifying, white adolescent. This image, spread by pop culture and Hollywood, does more harm to marginalized communities. In reality, people of color and LGBT+ communities experience an equal or higher prevalence of eating disorders, yet lower rates of treatment. Unfortunately, these stigmas and “idealized” body images can prevent people suffering from an OSFED from getting help. By spreading awareness of the different presentations of eating disorders, more people can get access to intervention and treatment.

Treatment for “Atypical” Anorexia

Recovery from “atypical” anorexia nervosa is possible. First, know that you are not alone. Whether you are suffering yourself or know someone who is, effective treatments are available. It’s incredibly frustrating that OSFEDs often go unnoticed for longer than the more widely known eating disorders. But no matter how long you have been suffering, there is help. The team at the National Alliance for Eating Disorders can help you find a treatment provider that can best fit your needs. 

There are also many types of psychological therapies that have been effective in supporting recovery from eating disorders. Cognitive behavioral therapy (CBT), interpersonal psychotherapy, acceptance and commitment therapy (ACT), and family based therapy (FBT) are among some of the treatments for “atypical” anorexia nervosa, though the field is ever expanding. However, just as the causes of eating disorders can be complicated, the treatment may be as well. What works for one patient may not work for another. Eating disorder recovery calls for a team of competent and specialized providers that can offer a range of support. If you need help building your recovery team, The Alliance can help you connect with providers in your area, as well as offer support as well.