Eating disorders do not always fall into precise patterns. They are not always as easy to spot or as clear cut as the criteria for diagnosis may seem. Sometimes symptoms appear in clusters and then disappear, or combinations of symptoms may transpire that fit the criteria for several types of eating disorders.
Atypical anorexia is one of these eating disorders. Although it follows the pattern of anorexia nervosa, atypical anorexia has different defining features that can make it much more difficult to diagnose.
Atypical Anorexia Defined
Atypical anorexia falls into a group of eating disorders categorised as other specified feeding and eating disorders (OSFED). According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), disorders in this group “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning”.
Atypical anorexia is defined by an intense fear of weight gain. People restrict their calorie intake heavily and may exercise obsessively, but they do not exhibit the extreme weight loss that others with anorexia nervosa do. Therefore, they may retain a normal body weight despite having an eating disorder.
The symptoms of atypical anorexia are similar to those of anorexia nervosa. They include:
- Obsessing about body shape, size, and weight
- Believing that they are bigger than they are
- Avoiding eating in front of other people
- Low self-esteem
- Difficulty focusing
Atypical Anorexia for Parents
Atypical anorexia can be confusing and worrying for parents and families. This form of anorexia is diagnosed in girls more often than in boys and is most common in those who are not living in a noticeably small body. They may be described as being at a ‘healthy’ weight.
When parents picture a child, teen, or young adult with anorexia nervosa, they will often imagine a girl in her teens or early twenties following a ‘fad diet’, driven by image, fashion, and fear of ‘being fat’. The girl imagined lives in a very small-sized body, and is someone who is the essence of the size zero eating disorder image pushed in popular media. This young girl is emaciated, troubled, physically unwell, and consistently losing weight.
Atypical anorexia usually begins in young people living in a larger sized body or those described as slightly overweight or overweight by healthcare professionals. They may have a growth chart that is in the 60-98th percentile. The young person may have also started dieting, exercising to lose weight, and restricting certain food groups.
The psychological process and thoughts of controlling, restricting, and losing weight are similar to those seen in anorexia. The impact and stress they have on the body is the same – the only difference is the starting weight, shape, and stature. This young person is also losing weight consistently.
The young person affected may not be classified as underweight by medical professionals. They typically have a weight and a corresponding body mass index (BMI) with a range that appears to be healthy. It is this ‘normal’ appearance that can prevent access to the proper treatment at the right time. Doctors and parents may miss the signs and symptoms of atypical anorexia as the young person is mistakenly seen as healthy.
Is the Name Atypical Anorexia Triggering for Some?
In short, yes. Young people diagnosed with atypical anorexia can feel incredibly triggered by the label and the name. This can often be due to the connotation of having a disorder within a body that is not small. Some people with atypical anorexia may view this as a failure, as others judge the size as big or not small enough.
This may trigger the eating disorder to have a louder voice and push further into restriction and weight loss. This can be incredibly dangerous and is one of the pitfalls of not receiving trauma-focused treatment and using appropriate eating disorder language.
Psychological distress related to body shape and size and eating is believed to be significantly worse in young people with atypical anorexia, leading to higher rates of depression, anxiety, and self-harm.
How Unwell Do You Need To Be To Receive Treatment for Atypical Anorexia?
Eating disorders are always serious. There is no such thing as having ‘a little bit of an eating disorder’ or ‘not having a serious eating disorder’. All eating disorders are severe and require professional help.
Atypical anorexia and other eating disorders often have a loud voice that tells young people that they do not deserve help or treatment and that they are not sick enough. It may or may not be linked to the numbers they see on the scales or the calories they have logged for the day or week.
Treatment is more successful and has better long-term outcomes in the early stages of an eating disorder. Early intervention in eating disorders protects the brain and body from further damage and increases the likelihood of long-term wellness.
One of the barriers to treatment is not looking small enough or unwell enough. Although young adults with atypical anorexia may look physically healthy and appear at a healthy weight, they can still be incredibly physically unhealthy due to their eating disorders. Young women with atypical anorexia may stop menstruating, and many people can experience brain fog and difficulty concentrating.
If you are worried about yourself or someone you love, do not hesitate to reach out to The Wave for help.
The Dangers of Atypical Anorexia
Parents, friends, and medical professionals may inadvertently reinforce the unhealthy behaviours seen in atypical anorexia by praising early weight loss. Young people may be told how great they look after losing weight, and this praise can be reinforced by likes on social media and positive attention from their peers. Unfortunately, praise and comments such as those noted above are reinforcing behaviours that can fuel the desire and motivation to keep the eating disorder strong.
One of the protective factors that can prevent young adults from developing an eating disorder is living in a body neutral home where diet culture is not welcomed. Bodies are for living in, not for fitting in. Parents can help by not making comments about body size and shape and encouraging their schools to do the same.
There are also many physical dangers of atypical anorexia. Prolonged anorexia without treatment can cause damage to both vital organs and muscles. Cardiovascular complications due to a lack of adequate calories and nutrition can also arise. Many young people with atypical anorexia may additionally struggle with self-harm and suicidal thoughts.
Can You Treat Atypical Anorexia?
Treatment for atypical anorexia follows the same basis as treatment for anorexia nervosa. Evidence-based treatments include trauma-focused care, eye movement desensitisation and reprocessing (EMDR), enhanced cognitive-behavioural therapy (CBT-E), dialectical behaviour therapy (DBT), mentalisation-based therapy (MBT), and interpersonal therapy (IPT). For some families, family-based treatment (FBT) or The Maudsley Method may be the preferred first treatment choice.
Treatment for atypical anorexia is effective, and there is hope. Young people should always seek recovery treatment from adolescent specialists with a multidisciplinary approach to care. The care team should include an adolescent eating disorder specialist psychiatrist, an eating disorder registered dietitian, and an eating disorder specialist therapist.
Meal support led by friendly meal hosts and eating disorder associates can help with young people’s anxiety when faced with plates and food choices.
Treatment Planning and Insurance Coverage for Atypical Anorexia
Treatment coverage for atypical anorexia may be a challenge for some policyholders, particularly USA insurance policies covering eating disorder treatment.
Most international and global insurance policies are understanding. BUPA Global, AXA, Allianz, and Cigna have overseas treatment teams that specialise in accessing the best possible care overseas and have a relationship in place with The Wave eating disorders treatment team.
Quick Facts About Atypical Anorexia
- Atypical anorexia makes up nearly one-third of inpatient eating disorder programme admissions.
- Young people with atypical anorexia may have experienced living in a larger body or may have been described as obese or overweight by medical professionals.
- If left untreated, atypical anorexia is likely to fall into a seriously underweight area meeting the criteria for anorexia nervosa.
- Anorexia nervosa can affect anybody at any time.
- One in three girls with atypical anorexia will not have monthly periods.
- Perfectionism can often be seen in young people with atypical anorexia.
- A history of trauma can make a young person more likely to develop concerns with food and their body.
- Eating disorders are likely to occur alongside other mental health issues.
- Anorexia can be diagnosed at any age – anorexia in the 30-50 age group is steadily rising.
- Anorexia affects boys and men, too – approximately one-quarter of those diagnosed with anorexia are men.
- Anorexia is responsible for more early deaths in female adolescents and young adults than any other psychiatric disorder.
- Anorexia is strongly linked to diet culture.
- Depression and suicidal thoughts often accompany anorexia.
- Mood swings and irritability are common with an eating disorder.
- Restriction may begin with gluten, dairy, vegetarian, or vegan food choices. People may use these diets to restrict themselves ‘under the radar’.
Atypical anorexia is a damaging eating disorder that has many similarities to anorexia nervosa. Young adults and children with atypical anorexia may appear to be a healthy weight, but they struggle with deeply unhealthy eating habits that impact their physical and mental health every day.
There is hope. Contact The Wave today for more information about our specialist eating disorder programmes and how we can help you.
Fiona Yassin is the International Clinical Director of The Wave Clinic. Fiona is a UK Registered Adolescent and Family Psychotherapist and Clinical Supervisor (Licence number #361609 NCP/ICP), further trained in the specialty of Eating Disorders and Borderline Personality Disorder Treatment. Fiona is trained in FBT (Family Based Therapy), CBTE for eating disorders, FREED (King’s College, London), EMDR for eating disorders (EMDRIA) and has a Post-Graduate Diploma in Neuroscience and Trauma from the University of Tennessee, Knoxville.
Fiona works with international families and family offices from the UK, Dubai, Kuwait, Singapore and Malaysia. Fiona can be contacted by email on [email protected].