Exploring Atypical Forms of Major Eating Disorders

When thinking about eating disorders, you are most likely to focus your attention on the three most common conditions: anorexia nervosa, bulimia nervosa, and binge eating disorder. Each of these disorders comes with a set of classic symptoms and a clinical picture professionals and others can use for identification. However, in some cases, individuals may present with an atypical form of one of these eating disorders. When they have an atypical form of one of the major eating disorders, the condition can be more difficult to recognize, diagnose, and treat. Below is some information to help you understand atypical forms of the three most common eating disorders so you can seek eating disorder recovery support for yourself or a loved one. 

Major Eating Disorder Basics

To understand how to recognize atypical forms of major eating disorders, it is necessary to learn about how these conditions usually present.

Anorexia Nervosa

Anorexia nervosa is a disorder that usually involves extreme food restriction and an unreasonable concern with weight. People with anorexia nervosa are usually underweight, and they usually engage in restrictive eating behaviors, such as only eating certain types of food or avoiding eating in public.

Bulimia Nervosa 

Bulimia nervosa is similar to anorexia nervosa in that people with the disorder are usually preoccupied with their weight and appearance. However, people with bulimia nervosa typically use purging behaviors to reduce their calorie intake. Examples of purging behaviors include self-induced vomiting, laxative abuse, and excessive exercise.

Binge Eating Disorder

Binge eating disorder is characterized by episodes of binging, in which the individual repeatedly eats a large amount of food in one sitting. During this episode, the individual may feel out of control. Typically, eating continues despite feelings of fullness, discomfort, or even illness. Unlike people who have bulimia nervosa, people with binge eating disorder do not typically engage in purging behaviors to compensate for the excess calories they have taken in.

All of these eating disorders require treatment. Without the right treatment program, people who struggle with eating disorders are likely to get worse over time. Unfortunately, when eating disorders present in an atypical form, it can be more difficult to recognize them, leading to treatment delays. 

Atypical Forms of Anorexia Nervosa

Someone who has an atypical form of anorexia nervosa has some of the symptoms of the disorder but may not meet the requirements to be diagnosed with it and/or may lack one or more of the hallmark symptoms. The most common presentation of atypical anorexia nervosa is an individual who has a normal weight or is overweight but still possesses the other symptoms of the disorder, including food restriction, weight preoccupation, and poor body image. Even though these individuals are not underweight, they are still at risk of both physical and psychological complications because of anorexia nervosa.  

Possible complications of untreated atypical anorexia nervosa include:

  • Nutritional deficiencies 
  • Hormonal imbalances
  • Anemia
  • Loss of muscle or bone mass
  • Heart problems
  • Kidney problems
  • Electrolyte imbalances

Because they do not have the most common symptom of anorexia nervosa, people who have the atypical form of this disorder are less likely to seek treatment. They may even believe that they cannot possibly be sick because they are not thin enough. Even in cases where the individual realizes a problem exists, they may be too embarrassed to talk to a doctor because of their weight, or they may worry that they will not be taken seriously. 

Atypical Forms of Bulimia Nervosa

As with atypical anorexia nervosa, atypical bulimia nervosa most commonly occurs when someone has some of the symptoms of bulimia nervosa but does not meet the criteria for an official diagnosis and/or lacks some of the hallmark symptoms. Perhaps the most common presentation of atypical bulimia nervosa is an individual who engages in binging and purging occasionally, but not regularly enough to meet the DSM criteria for diagnosis with bulimia nervosa. Although this individual is not binging and purging every week, they may still experience psychological distress and physical complications related to their eating disorder.

Some of the potential complications of untreated atypical bulimia nervosa include:

  • Gastrointestinal problems
  • Ulcers
  • Tooth decay
  • Hemorrhoids
  • Electrolyte imbalances
  • Dehydration

People who have atypical bulimia nervosa are more likely to experience mental health complications, such as depression or suicidal thoughts. Because the condition is not as dramatic or noticeable as the most typical form of bulimia nervosa, patients are more likely to go without treatment for longer periods. Even those who are distressed by their symptoms are more likely to forego the treatment they need simply because they do not deal with these issues as frequently as others with the disorder.

Atypical Forms of Binge Eating Disorder

To be diagnosed with binge eating disorder based on the criteria included in the DSM, patients must engage in binge eating episodes at least once each week for three months or longer. These episodes are not followed by compensating behaviors, such as excessive exercise or laxative use. However, they are accompanied by feelings of guilt and disgust. 

Someone with atypical binge eating disorder may meet some but not all of the DSM criteria necessary for diagnosis. For example, the individual may engage in binge eating disorders only once or twice a month instead of weekly. Even though this person does not meet the criteria to be diagnosed with the most typical form of binge eating disorder, they may still be distressed by their condition and in need of professional treatment. 

Advice for Family Members

If you have a loved one who is exhibiting some eating disorder symptoms but does not entirely fit the clinical picture for one of the major eating disorders, this individual may have an eating disorder with an atypical presentation. For this reason, it is important to encourage your loved one to see a doctor even if you are not sure that a problem exists. When atypical eating disorders are left untreated for an extended period, they are more likely to lead to severe physical complications and/or cause worsening psychological distress for the individual. 

When you suspect that a loved one may be suffering from an atypical form of a major eating disorder, it is important to approach the issue gently and cautiously. Do not be confrontational. Instead, speak to your loved one respectfully and lovingly. If your loved one is not yet ready to seek treatment, reassure the individual that you will be available to provide support if they change their mind. In some cases, it takes time for the individual struggling with an eating disorder to realize that they need professional help.

Treating Atypical Forms of Major Eating Disorders

Despite the fact that they do not meet the requirements for diagnosis and/or cause exactly the same symptoms of traditional eating disorders, atypical presentations of major eating disorders are still dangerous and harmful to those who are affected by them. For this reason, professional treatment is highly recommended for anyone who is struggling with an atypical eating disorder. Without proper treatment, a variety of complications can result, including both physical complications and mental health concerns. People with atypical eating disorders are more likely to deal with a range of psychological issues, including depression, anxiety, and suicidal ideation. Likewise, because someone who has an atypical eating disorder is more likely to fall through the cracks when it comes to treatment, the risk of complications is exacerbated.

Treatment for atypical forms of major eating disorders is similar to treatment for standard presentations of these conditions. The exact approach to treatment will depend on the specifics of the disorder, and treatment plans should be tailored to meet the needs of each specific patient. Some of the services that may be utilized in the treatment of atypical forms of eating disorders include:

  • Medical/nursing care
  • Psychiatric care
  • Behavioral therapy
  • Individual counseling/psychotherapy
  • Support group meetings
  • Medication
  • Nutrition education
  • Fitness planning
  • Exposure therapy

For people with atypical forms of major eating disorders, the eating disorder recovery process faces unique obstacles. For example, because they may not meet the criteria to be officially diagnosed with one of the major eating disorders, insurance companies may resist claims filed for eating disorder recovery services. To help with this issue, the DSM now includes a diagnostic category known as “Eating Disorder Not Otherwise Specified” or “EDNOS,” which encompasses atypical eating disorders that do not fit into other categories. 

Treatment for Atypical Eating Disorders at Oliver-Pyatt Centers

Oliver-Pyatt Centers is an established eating disorder treatment center that offers a range of programs, including residential programs, partial hospitalization programs, outpatient programs, and transitional living. In many cases, our clients begin with a more intensive treatment program and gradually transition to a program with more flexibility. However, all treatment plans at our facility will be based on the needs of the individual.

At Oliver-Pyatt Centers, we offer a variety of treatment services, including medical, psychiatric, and clinical care. While enrolled in our residential treatment program, clients have access to 24-hour nursing care, 24-hour access to a psychiatrist, weekly medical appointments, meetings with a nutrition specialist, comprehensive family support and much more. Our facility also offers treatment specifically designed for clients who have co-occurring disorders, such as substance use disorders and/or a history of trauma. We work closely with our clients, their families, and insurance providers to maximize the benefits of health insurance coverage and ensure the affordability of treatment.

Oliver-Pyatt Centers is operated by a team of specialists who understand eating disorders and the mechanisms behind them. We know that everyone’s experience with an eating disorder is different, and we also know that not all cases present in the same way. When individuals come to our facility with an atypical form of one of the primary eating disorders, we can customize treatment based on their individual needs.  Please contact our facility today to learn more about our services or to begin the enrollment process.