Atypical anorexia is a relatively new eating disorder diagnosis that has people wondering: “What’s so atypical about anorexia? How is it different from regular anorexia?” Why does 20% of the population have one disorder but less than 1% have the other?
Read on for answers to all your related questions, such as:
- What is the definition of atypical anorexia nervosa?
- Is there a difference between anorexia and atypical anorexia?
- Do the different diagnoses mean different treatment approaches?
- Are eating disorder labels helpful or even relevant to eating disorder treatment?
- Where and how do you get treatment for atypical anorexia?
Note: It is a privilege to get a diagnosis at all, as those without adequate insurance coverage often cannot afford to see an eating disorder specialist. While a formal diagnosis is validating, it’s not accessible for everyone. You don’t need a label to prove you’re suffering!
Atypical Anorexia: Definition and Symptoms
Atypical anorexia is an eating disorder with all the same signs and symptoms as “typical” or “classical” anorexia, except individuals who suffer from this illness are not “clinically underweight.”
Individuals with may show some or all of the following cognitive/behavioral symptoms of atypical anorexia:
- Intense fear of weight gain
- Refusal to maintain a weight that is healthy for them
- Overvaluation of weight and shape
- Negative/distorted body image
- Excessive levels of exercise
- Periods of fasting
- Obsession with calorie counting
- Fear of eating in front of others
- Avoidance of foods deemed “unhealthy” or “not allowed”
- Avoidance of certain food groups
- Fear of eating food with unknown calories or ingredients
- Use of purging behaviors to lose weight (classified as anorexia, binge-purge subtype)
- Hiding food
- Lying about eating
Related: This is how to tell whether your current exercise routine is actually a dependency.
What’s the difference between atypical anorexia and anorexia?
The only difference between “atypical” anorexia and “typical” anorexia is that people in the first group are at or above a “normal BMI,” despite losing weight at a rapid pace. But BMI is a problematic measure of health for two huge reasons:
- There is no one single number that indicates a person’s health. One person’s “healthy weight” can be a dangerous weight for someone else.
- More importantly, eating disorders are mental illnesses, and physical symptoms have nothing to do with how much someone is struggling mentally.
Studies show that losing just 5% of body weight, no matter a person’s initial weight, can result in serious physical and cognitive eating disorder symptoms. There are many possible physical complications of atypical anorexia, but whether a person has physical symptoms of an eating disorder or not, their eating disorder is still serious and dangerous.
Do diagnostic labels matter? Why do we have them?
Eating disorder diagnoses exist for a few reasons:
- To provide a standardized classification of symptoms
- For treatment providers to understand what symptoms you have
- To inform a treatment approach
- For insurance billing
Sometimes a diagnosis is validating and useful for treatment. However, some individuals may feel invalidated by their diagnosis (which is often the case with atypical anorexia.) And as eating disorder research progresses, it seems like different eating disorder diagnoses (not just anorexia and atypical anorexia) are more alike than you may think.
Related: If you think you’re not “sick enough” to have an eating disorder, read this.
Transdiagnostic Approach to Eating Disorder Diagnosis and Treatment
Researchers have proposed a transdiagnostic approach to treating eating disorders. The transdiagnostic approach recognizes that eating disorders are all a form of coping with similar issues. The behaviors are different, but the motivation behind using them is the same. For example, an individual who faces anorexia and one who faces binge eating disorder both engage with food in a certain way to cope with stress. The only difference is that while one avoids food, the other consumes it in excess. Both behaviors are harmful ways of coping.
The transdiagnostic approach makes sense when considering the fact that many people may cross over to another diagnosis over time. As an example: many people with anorexia may eventually cross over to bulimia as a coping mechanism later on, because they fear extreme hunger (even though it’s totally normal in recovery.)
Instead of trying to treat the specific behaviors associated with a diagnosis, treatment providers would focus on helping you deal with the things underneath the disorder, such as trauma or negative body image.
Related: What is the relationship between trauma and eating disorders?
How does an atypical anorexia diagnosis affect sufferers?
DELAY IN RECEIVING A DIAGNOSIS
While eating disorder awareness is rising, most of society has trouble shaking off the stigma of how eating disorders are “supposed to look.”
Even as someone shows up to a doctor’s office with severe weight loss and cognitive impairment due to malnourishment, many providers don’t “see” them as having a problem.
In fact, a lot of providers may applaud their patients on their weight loss, even if the methods used are unhealthy.
DIFFERENCES IN INSURANCE COVERAGE FOR ATYPICAL ANOREXIA TREATMENT
Unfortunately, many insurance providers (who are not trained in eating disorder treatment) base a person’s recovery on their physical state — specifically on weight.
Using weight as a qualifier for treatment is very damaging, because it:
- Invalidates the fact that eating disorders are not actually about weight.
- Acts as a gatekeeper, holding individuals back from getting the life-saving support they need to heal.
- Keeps people from getting help sooner, despite research showing that the earlier you address an eating disorder, the easier it is to recover from one.
- Drives individuals to get worse in order to feel validated or worthy of receiving treatment.
Some individuals have even reported that they were so desperate to receive treatment, they continued losing weight just to qualify for it. And an all-too-common occurrence when it comes to treatment coverage: when someone is at or above a minimum “healthy” BMI, they spend much less time in treatment. Insurance companies deem someone whose BMI is above a certain threshold as “recovered enough” to not need treatment anymore — which is incredibly untrue.
Related: Read more about the effects of weight stigma on eating disorder treatment and recovery.
WEIGHT RESTORATION REQUIREMENTS
Everyone who uses disordered behaviors to suppress their weight needs to weight restore in recovery, full stop. It doesn’t matter if you’re underweight or clinically obese — if you restrict food, use purging behaviors, or any other eating disorder behavior, your body is not at it’s ideal weight (also known as your set point weight.)
But many people report treatment centers not placing clinically “normal” or overweight individuals on a weight restoration meal plan. This is due to weight stigma, an unfortunately common characteristic in many general and eating disorder specific treatment professionals.
They cannot imagine someone in a larger body could be malnourished, and don’t prescribe the nutrition needed to heal the body — all due to their own fatphobic biases.
Related: This is exactly why everyone with a restrictive eating disorder needs weight restoration.
INVALIDATING FRIENDS, FAMILY, AND TREATMENT PROVIDERS
Someone who starts out at a “normal” weight, or slightly underweight, might first be congratulated for their weight loss. But eventually, people really start to notice how thin they’re getting and go looking for eating disorder symptoms. It’s validating for an eating disorder sufferer to know that someone is worrying about them.
A person with atypical anorexia may not receive that same sort of worry. People may not even notice, or may even dismiss your concerns about your disordered behaviors since you’re not “that underweight.”
Worse still, friends and family may discourage or disapprove of your weight restoration in recovery, claiming you “let yourself go” — again, an untrue statement rooted in fatphobic
It doesn’t matter what your eating disorder diagnosis is, or even if you are formally diagnosed: your eating disorder is serious and life-threatening.
To get treatment for atypical anorexia, find providers who are both aware of weight bias and who actively work on dealing with any fatphobia both in themselves and who can help deal with any internalized fatphobia on your end.
Look for providers who understand that healthy looks different on everyone. These providers practice according to the HAES (Health at Every Size) movement.
Also, ask people who started treatment in larger bodies about their experiences. They are usually more than happy to point you in the direction of size inclusive treatment professionals (and steer you away from those who are not before they can damage your recovery.)
If you or a loved one is suffering from an eating disorder, talk to someone about recovery, or simply learn more about the holistic eating disorder recovery programs we offer.
