A Conversation about Atypical Anorexia
Struggles with disordered eating are far more common than many realize. Despite the opinions of some, disordered eating is a significant mental health struggle. Struggles with disordered eating affect people of every age, gender identity, background, race, in sexual orientation. Statistics provided by the National Association of Anorexia Nervosa and Associated Disorders indicate as many as 9% of the US population (just under 30 million Americans) will struggle with an eating disorder at some point in their lives. Of those, less than 6% are diagnosed as “underweight” according to current medical criteria. Second to opioid overdose, eating disorders rank among the deadliest mental illnesses leading to over 10,000 deaths each year.
What Is Disordered Eating?
Contrary to the name, disordered eating is about more than food. Eating disorders are challenging and complex mental health conditions that often require comprehensive mental health intervention and medical treatments at a treatment facility like Meadowglade to overcome. Another common misconception surrounding disordered eating is that it is “a choice.” An unfortunate number of people believe that someone who struggles with an eating disorder does so by choice. These dangerous misconceptions and failure to understand the psychological and physical impacts of disordered eating can lead to dangerous effects for someone trying to manage an eating disorder.
Eating disorder or disordered eating is an umbrella term for a range of psychological conditions that lead to unhealthy eating habits. Depending on the disorder and the individual, they may start with an obsession about food, concerns about body weight, or desire to achieve or maintain a specific body shape. In the most severe cases, disordered eating can lead to death if left untreated. Disordered eating is most often reported in adolescents and young women; however, it is essential to note it can affect men, and it can affect anyone at any age. As many as 13% of youth may experience symptoms of at least one eating disorder before they reach age 20.
Although a specific root cause leading to the development of eating disorders is unclear, experts indicate disordered eating may have roots in various factors, including genetics, personality traits, social pressures, cultural ideals, and chemical levels in the brain.
Anorexia (anorexia nervosa) is indeed the most well-known eating disorder. It typically develops during adolescence and young adulthood, and as with many forms of disordered eating often impacts women more frequently than men. Someone who struggles with anorexia nervosa often views themselves as overweight even if, by medical standards, they are dangerously underweight. The mental challenges associated with anorexia will force them to consistently monitor their weight, avoid eating certain types of food, and severely restrict calories to obtain or maintain a specific bodyweight.
Common symptoms of anorexia nervosa include restricted eating patterns, intense and overwhelming fear of gaining weight, distorted body image, denial of being underweight, a significant influence of body weight on the perception of self and self-esteem, and being significantly underweight when compared to others of similar age and height.
Anorexia is typically categorized into two subtypes, the restricting type and the binge eating and purging type. An individual with the restricting type will lose weight solely through dieting, fasting, or excessive (often unhealthy) exercise. Conversely, someone with the binge and purging type may binge on large amounts of food or eat very little. In either case, after finishing their food, they will purge using activities such as vomiting, laxatives or diuretics, or excessive exercise.
Understanding Atypical Anorexia Nervosa
Many people assume that someone with anorexia will be significantly underweight or exhibit dramatic weight loss. However, some individuals struggle with restrictive eating or abnormal eating behaviors commonly associated with anorexia nervosa who are of average body weight. This is called atypical anorexia nervosa. An individual with atypical anorexia nervosa will not meet the low weight criteria for a diagnosis of anorexia as described in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) or DSM-5.
According to the diagnostic criteria for anorexia nervosa from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), someone struggling with anorexia nervosa “will have a restriction of energy intake relative to their caloric requirement, which leads to a significantly low body weight in the context of several factors, including gender, physical health, age, developmental trajectory, and more.” Other criteria include an intense fear of gaining weight and/or becoming fat and a disturbance in body perception.
Someone who struggles with atypical anorexia will exhibit the same criteria without weight loss. In many cases, someone with atypical anorexia will fall within or above a “normal” weight range for their age, sex, etc. This is why their presentation is considered atypical. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), atypical anorexia nervosa is categorized under Other Specified Feeding or eating disorders (OFSTED), which is one of the most prevalent eating disorders among adults today.
Other Specified Feeding or Eating Disorders Explained
Behaviors, symptoms, and challenges associated with disordered eating range from person to person. Other Specified Feeding or Eating Disorders is a classification category for those who do not meet the diagnostic criteria for any other disordered eating diagnosis. Other Specified Feeding or eating disorders has five subcategories, including atypical anorexia nervosa, bulimia nervosa with less frequent behaviors, binge eating disorder with less frequent behaviors, purging disorder, and night eating syndrome. Although each condition shares similarities with a primary condition (for example, atypical anorexia nervosa shares symptoms with anorexia nervosa), there are differences associated with each illness that result in the need for an alternate classification.
The creation of this category as part of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was vital to improving access to mental health treatment for individuals with disordered eating conditions. Previously, there was a misconception that unspecified eating disorders were less significant than those that met the diagnostic criteria for anorexia nervosa or bulimia nervosa. This was a dangerous misconception, as eating disorders that fell under the category in previous editions of the DSM could be equally as dangerous and damaging to the individual’s mental and physical health. It is important to recognize that an individual who struggles with an “other specified eating disorder” is equally as “sick” as someone who meets the diagnostic criteria for a primary condition. Their diagnosis is valid, and they can benefit from professional support and guidance to help improve their mental and physical health.
The Dangers of Atypical Anorexia Nervosa
Many who experience atypical anorexia nervosa may not realize they have a severe and dangerous eating disorder because they do not meet the weight-related criteria people equate with anorexia nervosa. Because they are within or exceed a normal weight range, they may believe their symptoms are not severe enough for them to have an eating disorder.
This dangerous way of thinking can prevent someone who needs life-saving medical and mental health treatment from reaching out to seek help. It is essential to remember that weight is not the sole defining criteria for disordered eating. It is possible to have an eating disorder regardless of weight, size, or shape. Because atypical anorexia nervosa does not present with the classic symptoms, it can be debilitating and dangerous for someone who is struggling.
Treating Atypical Anorexia Nervosa
Many people who have atypical anorexia do not seek or receive the help they need to overcome their illness. Part of this is for the reasons mentioned above. Because they do not know or realize they are sick, they do not understand the potentially dire need for mental health support. Another common challenge to treatment is weight stigma among healthcare providers. Although someone may display classic signs of an eating disorder, many health professionals overlook potential illness because the individual’s weight falls within an appropriate range.
Treatment for atypical anorexia nervosa generally follows the same basic principles used when treating anorexia. Similar interventions, including dietary advice and support, prepared meals, food exposure therapies, and mental health support around body image, are combined with psychological interventions such as cognitive behavioral therapy as part of a comprehensive treatment program.
The type of treatment that works best for you will depend on your unique symptoms and treatment needs. Without proper diagnosis and treatment, twenty percent of people suffering from anorexia nervosa will prematurely die from health complications directly related to the eating disorder. These complications can include heart problems, gastrointestinal problems, and suicide. Only one in ten people who suffer from an eating disorder (not just anorexia nervosa) will seek and receive treatment. Treatment for eating disorders is the most successful when intervention is early; before many of the potential medical side effects associated with the eating disorder have an adverse impact on the individual’s health.
A residential treatment program like Meadowglade is often the most successful intervention for treating disordered eating. For treatment to be the most successful, it must be multifaceted. This means it must include medical care, mental health care, nutritional education, and counseling. Therapy sessions will often include a combination of individual therapy, family therapy, and group therapy.
At Meadowglade, we understand it can be challenging to choose to seek treatment for disordered eating. When you struggle with a condition that is unclear or do not realize you have an eating disorder, the challenges are far more significant. Left untreated, eating disorders can lead to overwhelming and debilitating physical and psychological difficulties. In some cases, symptoms of disordered eating can lead to dangerous and even fatal medical complications. If you or a loved one are concerned about disordered eating or your feelings concerning food and body image seem unhealthy, reach out to your primary care provider or a mental health provider at Meadowglade. Our admissions team is here to answer your questions and help you learn more about how our programs can help you overcome an eating disorder like atypical anorexia.