Most people are aware of anorexia nervosa. However, there are some misconceptions about this condition that can lead to misunderstandings and failure to spot the signs of the disease in some sufferers. As an example, most people believe that people with anorexia automatically have a huge amount of weight loss, or an extremely low bodyweight. Yet, there are still some people who struggle to eat normally and who restrict their diet and yet who have an apparently normal figure. When this happens, the sufferer is said to have atypical anorexia nervosa.

What Is Atypical Anorexia Nervosa?

Most people have assumptions about what anorexia looks like in a sufferer. Yet, there are some people who present with all the restrictive eating behaviors of anorexia but without having a low bodyweight that allows them to be diagnosed easily with the condition.

The diagnostic criteria applied to anorexia from the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) states that individuals who have this disorder restrict their intake of calories relative to the requirement of calories that they need to maintain normal function. This, in turn, leads to a very low bodyweight when taking into account the individual’s physical health, gender, age, and developmental trajectory. Some other criteria include a severe fear of becoming fat or gaining weight together with body perception disturbances.

Someone who has atypical anorexia nervosa displays all of these criteria but with no weight loss. Actually, some people with this condition are at their ideal bodyweight or are even overweight for their sex and age. This is why their presentation is known as “atypical”.

Although there are a significant number of people who have atypical anorexia nervosa, it doesn’t have its own distinct eating disorder category. Instead, it comes under the OFSED or Other Specified Feeding or Eating Disorders category.

How Does Atypical Anorexia Nervosa Present?

This specific subtype of eating disorder is defined as having anorexic features with no elements of low bodyweight. So, for example, someone with atypical anorexia nervosa can be terrified of weight gain and becoming fat. They may also eat abnormally or display specific disordered eating behaviors including restricting food groups and calorie counting as well as avoiding functions and events involving food.

Why Is Atypical Anorexia Nervosa Dangerous?

Many people suffering from atypical anorexia nervosa often fail to recognize they have a severe eating disorder. This is because of the weight stigma surrounding this disease. Sufferers tend to think that they aren’t unwell enough to be suffering from an eating disorder since they are at or above their ideal weight. This trap can be a deadly one, preventing sufferers from getting professional help in order to recover. It’s vital to bear in mind that weight isn’t a defining characteristic for eating disorders. This belief must be challenged more vocally in order to address these misconceptions.

Someone can have eating disorder tendencies whatever their weight, shape or size. If you struggle to eat normally, or have abnormal thoughts and behaviors around food and your body, it’s important to seek medical help and advice. A professional assessment is often the best way to start understanding your eating disorder so you can connect with professionals who can treat you and address your problems. However an eating disorder presents itself, it can be severe in its consequences when left untreated. Even though atypical anorexia nervosa doesn’t present in the same way as a regular anorexia diagnosis, but it can be equally debilitating for the sufferer.

Misunderstandings About Atypical Anorexia Nervosa

There are many misconceptions and misunderstandings about atypical anorexia nervosa that mean those who suffer continue to fly under the radar. These include:

• People who have atypical anorexia nervosa have a normal weight or are only just over their ideal bodyweight. This is a myth. Weight discrimination is, unfortunately, often a feature of eating disorder treatment. A significant proportion of sufferers of atypical anorexia nervosa won’t get treatment because of the stigma of bodyweight. No restrictive eating disorder has a standard “look”.  Even if your BMI is higher than the recommended cut-off point for anorexia, that doesn’t mean you aren’t suffering. Some people who receive a diagnosis are actually categorized as overweight.
• People with atypical anorexia nervosa just haven’t developed “real” anorexia yet. Restricting food intake won’t always cause weight loss. How the body adapts to restricted food intake is very dependent on your genetics. If you reduce the amount you eat over time, the body will change how it utilizes the energy you’re taking in. So, whatever your bodyweight, your body begins to store energy differently. Even if you’re already obese or overweight, your body continues to store more as it believes it is starving to death. Your metabolism slows down and weight gain occurs. As a result, you tend to restrict even more and the cycle continues.
• The health consequences aren’t as severe as those in somebody with true anorexia. While your body may look different, what’s going on inside your body is almost exactly the same as somebody with a low BMI. The body often begins to take energy from the muscles, organs and immune system rather than from the stored fat. This can lead to heart problems, low bone density and other medical conditions that can have serious consequences.
• People with atypical anorexia nervosa have completely different side effects during recovery. Whether you’re suffering from standard anorexia or atypical anorexia nervosa, the recovery side effects remain the same. Skin changes, gastrointestinal issues, cravings, and emotional difficulties are identical in both cases. Gastroparesis – the feeling of being entirely full after taking a couple of bites and then feeling the food getting stuck in the digestive system is very common in both types of anorexia.
• There’s no need for intensive treatment. Although most people suffering from atypical anorexia nervosa don’t receive intensive treatment, they could often benefit from it. Residential and hospitalization programs can save lives and can help those with different presentations of eating disorders to come to terms with their condition and to enter recovery.

Which Symptoms Occur With Atypical Anorexia Nervosa?

Sometimes, atypical anorexia nervosa is called an invisible eating disorder since most people think of someone extremely thin if they think about anorexia. Those with atypical presentations are usually of a normal body weight or overweight. Some are even obese. This causes the condition to go undetected. Family members, friends, and even medical professionals may fail to spot the condition.

If you have atypical anorexia, it’s likely that you have a deeply held belief that you’ve got a serious weight problem and have issues with food. It’s also likely that you feel invalidated as you don’t fit the usual mold of somebody with eating disorders. The symptoms associated with atypical anorexia nervosa are exactly the same as those associated with typical anorexia. There is only one distinct difference – the sufferer doesn’t have a low body weight. Symptoms include:

• An intense terror of gaining weight
• Even if weight is lost, continuing to be afraid of putting on weight
• Having a distorted body image
• Adopting extreme weight loss measures like excessive exercise and fasting
• Weight control measures and disordered eating patterns may interfere with daily life
• An unrealistic idea about weight
• Being preoccupied with dieting, exercise, weight loss and food
• Counting calories
• Cutting out whole food groups
• Having ritualistic eating behaviors such as only eating specific food colors or food groups
• Spitting food out rather than swallowing it
• Being preoccupied with cleanliness or food sources
• Missing meals
• Avoiding any social situation involving food
• Calling some foods safe and others bad
• Social withdrawal and isolation
• Never eating in public
• Choosing to wear baggy clothes

The Effects Of Atypical Anorexia Nervosa

Everyone knows that typical presentations of anorexia have serious side effects that can prove fatal over time. Yet, many people fail to acknowledge that atypical presentations are also equally dangerous. Atypical anorexia comes with severe mental and physical health risks. In fact, atypical anorexics have been found to:

• Suffer from even more severe symptoms of disordered eating
• Lose even more weight across a longer time period
• Have lower self-esteem and poorer body image
• Feel more distressed about food and body image

There are also no major differences when comparing standard anorexics and those with atypical presentations in terms of:

• Low body temperatures
• Purging and binging episodes
• A low heartrate
• Co-occurring mental health disorders
• Self harm or suicidal ideations
• Resting pulse rate
• Hospital admissions
• Low blood pressure

Those suffering from atypical anorexia nervosa are also likely to have many of the same complications when compared to standard cases of anorexia, including both mental and physical issues. These complications may include:

• Difficulty in sleeping
• Electrolyte imbalances and dehydration
• Fainting spells
• Malnutrition that affects the skin, teeth, nails, hair and other physical elements
• An abnormal blood count
• Being extra-sensitive to the cold
• Fatigue
• Thinning hair
• An irregular or stopped menstrual cycle
• Gastrointestinal issues and constipation

When Should Your Family Begin To Worry?

A major danger with atypical anorexia nervosa is that it is very hard to spot. This is especially the case in larger individuals who are considered to be overweight or obese. They may even be praised for their efforts at weight loss and may be complimented on their dieting regime. All of this adds to the challenges. There are a few indications to be aware of. These include:

• Exercising excessively
• Placing a very intense focus on calorie intake and weight
• An increasing irregular menstrual cycle
• Restrictive eating patterns

If a loved one begins to avoid family meals or doesn’t eat in public, saying that they already ate or don’t feel hungry, this may be a warning sign to be aware of. Malnutrition leads to severe medical issues so if you think a loved one may be suffering from any kind of eating order including atypical anorexia nervosa, you should encourage them to get medical advice.

How Can Atypical Anorexia Nervosa Be treated?

There are new universal guidelines when it comes to treating atypical eating disorders like atypical anorexia. OSFEDs are treated by clinicians in a way that matches the eating disorder with most similarities to the individual’s symptoms. All eating disorders are very complex and long-term care or in-patient treatment may be required. Some treatments available for atypical anorexia include:

• Family therapies – anorexia, whether typical or atypical often goes hand-in-hand with strained family relationships. Family therapy can therefore be vital when treating any form of anorexia.
• Psychotherapy – having intensive therapies with a counselor who has a background in treating eating disorders couldn’t be more important. Those suffering from any form of anorexia will have an ingrained view about their world and themselves as well as distorted patterns of thinking. Therapists have to use a range of different approaches as it’s difficult to change those inaccurate views and believes. Psychotherapy is very beneficial in helping anorexics to work out what is causing their fear of gaining weight.
• Dual diagnosis treatments – having a co-occurring disorder such as a mental illness is very common those with any form of eating disorder. Mental health treatments must therefore be incorporated into any treatment for an eating disorder since untreated problems like personality disorders, anxiety or depression can worsen existing eating disorders.
• Group therapies – isolation and relationship problems often affect those with an eating disorder. Group therapies are helpful in giving sufferers a greater insight into themselves as well as how other people see them. By talking about their problems with others in the same situation, they can feel less isolated and find a safe place wherein to practice forging new relationships so relationships outside treatment can be improved.
• Nutrition counseling – atypical anorexia nervosa treatments should also include working with a dietician or nutritionist since the relationship with eating and food needs to change. Nutritionists can assist sufferers to maintain their healthy bodyweight.
• Medication – people with any form of anorexia often have co-occurring mental health disorders and medications may be necessary to treat both conditions simultaneously. When used alongside CBT (cognitive behavioral therapy), these medications can prove to be extremely beneficial.

Seeking Help

If you or someone you know is displaying restrictive eating behaviors and has the similar body image issues to a standard anorexia patient, but still maintains a normal or above-normal body weight, you shouldn’t automatically assume that no eating disorder is present. Seeking medical advice is always the best way to ensure that a problem is spotted quickly and treatment can be received as quickly as possible for the best outcome.

If you need help or advice, reach out to The Meadowglade today!