*This article contains a discussion of body weight and weight bias which may be triggering for some people.
Anorexia nervosa is very well-known. It’s usually the first thing people think of when they hear the term “eating disorder.” Affecting millions of people (about 0.9 percent of women, which sounds small but adds up when discussing hundreds of millions of people) in the United States alone, the disorder is well-defined. Most general practitioners and therapists of all stripes can correctly spot the signs of anorexia nervosa, and even people who don’t know much about the disorder are capable of noticing the telltale symptoms and behavioral signs.
However, there is another form of anorexia nervosa that isn’t as easy to spot – atypical anorexia nervosa.
Because the symptoms of atypical anorexia nervosa are similar but not a readily apparent as the ones from “typical” anorexia nervosa, it often goes undiagnosed or misdiagnosed. As we’ll see, this is a dangerous situation, as atypical anorexia nervosa can have the same risky physical and mental health consequences as its more well-known cousin, if not always as dramatic in nature. Here, we’ll explore the differences between the disorders, the reasons misdiagnoses happen so often, and what treatment can do for people with atypical anorexia nervosa.
What Is Anorexia Nervosa?
The most famous form of restricting eating disorder, anorexia nervosa is a complex mental health disorder in which a phobia formed around food and gaining weight. Per the DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), the bible of mental health diagnosis, the criteria for anorexia nervosa are:
- Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of the age, sex, developmental trajectory, and physical health (less than minimally normal/expected).
- Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain.
- Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of the seriousness of low body weight.
With subtypes defined as:
- Restricting type: During the past 3 months, has not regularly engaged in binge-eating or purging.
- Binge-eating/purging type: During the past 3 months, has regularly engaged in binge-eating or purging
Anorexia nervosa is extremely dangerous; in fact, it has the highest death rate of any form of mental health disorder. Not only is extreme weight loss and food restriction a risk factor for all sorts of maladies, but the lack of fuel for the brain can also lead to distorted thinking patterns and a high risk of suicide. Without treatment at an eating disorder treatment center, an anorexia nervosa diagnosis can be fatal.
Although the DSM-V lists a few aspects of behavioral and physical symptoms like restricting food intake and extreme weight loss, it doesn’t go into detail about the dangers of anorexia nervosa. Some of the physical consequences include:
- Stoppage of menstruation in women
- Constant feeling of being cold
- Constant fatigue and lethargy
- Strokes and seizures
- Decreased cognition
- Confusion and lightheadedness
- Lanugo (growth of small, fine hairs all over the body, thought to be the body’s reaction to the constant feeling of coldness)
- Organ failure, especially kidneys, liver, and heart
- Thinning hair or hair falling out
- Drying skin and brittle nails
Behavioral signs for anorexia nervosa include:
- Social withdrawal and self-isolation
- Avoiding meals or social situation where eating is a focus
- Distorted body image (dysmorphia), specifically seeing themselves as overweight
- Chewing and spitting
- Obsessive or excessive exercising
- Continued weight loss even after becoming emaciated
- Food rituals that help to avoid eating
- Counting calories obsessively
- Trying various extreme diets and fasting regimens
How Is Atypical Anorexia Nervosa Different?
Atypical anorexia nervosa meets all the same diagnostic criteria as presented by the DSM-V, except coming to an extremely low body weight. In a case of atypical anorexia nervosa, the individual in question also restricts food intake, suffers from a distorted body image and body dissatisfaction, experiences fear of gaining weight, and can experience many of the health consequences related to “typical” anorexia nervosa.
The major difference between the two disorders is that people with atypical anorexia don’t experience the dramatic and sudden weight loss associated with anorexia nervosa.
People with atypical anorexia nervosa usually maintain a medically acceptable BMI and may sometimes be overweight. This can lead to a litany of dismissive myths that prevent them from getting the eating disorder treatment they desperately need. Although the weight loss is not as sudden or extreme as with anorexia nervosa, it can proceed over a much longer period, with similar results. In some cases, the individual is overweight when the disorder begins – while their body weight may not become too low, the effects of malnutrition of the brain, organs, and skin can be just as pronounced. In short, atypical anorexia nervosa is a dangerous, potentially deadly disorder just like its cousin.
Weight Bias in Diagnosis and Myths About Atypical Anorexia Nervosa
Because people with atypical anorexia nervosa usually appear to be at a “normal” body weight, the chances they will be undiagnosed with an eating disorder or misdiagnosed are much more likely. Even doctors and psychiatrists who have made diagnoses of anorexia nervosa in the past might overlook the behavioral symptoms of atypical anorexia nervosa, or worse, encourage their patient’s weight loss.
Some of the myths about weight and eating disorders someone who needs treatment for atypical anorexia nervosa might include:
- You aren’t really sick.
There is a typical “look” that many medical and psychological professionals as well as members of the eating disorder recovery community associate with eating disorders – extremely thin, with dry skin, etc. as described above. If that stereotypical look isn’t present, people may discount their eating disorder out of hand. However, atypical anorexia nervosa is just as dangerous if left untreated, and this attitude ignores the suffering of people with the disorder.
- The health consequences aren’t so bad – you look fine.
Diet culture is pervasive, even in the medical community. Too often, body weight and BMI are stressed by medical professionals, even in people with eating disorders. This ignores the principle of HAES (Healthy at Every Size), in which intuitive and nutritious eating are a greater focus than the person’s body weight. A person with atypical anorexia nervosa may hear positive reinforcement about their weight loss, even from their doctor. The issue here is that the lack of nutrition and related psychological issues wreak the same havoc on the individual’s body regardless of their weight. If a person is eating nutritiously and also overweight, HAES demonstrate they are healthier than someone restricting to achieve a “normal” BMI.
- You don’t have “real” anorexia nervosa.
Because people associate anorexia nervosa so intensely with the image of an emaciated young woman, a “straight-sized” person with atypical anorexia nervosa might face a lack of acceptance that they have a real disorder, especially among other people with eating disorders. It can allow the individual to “pass” as someone with an eating disorder, making it easier to hide disordered behaviors and furthering the damage caused.
These kinds of myths leave people with atypical anorexia nervosa underserved as far as eating disorder treatment goes. And even worse, overlooking a different subtype of the disorder perpetuates these anti-HAES, fatphobic myths, leading to even more people left in the lurch, unable to get the help they need.
How Is Atypical Anorexia Nervosa Treated?
On the positive side of things, if someone can overcome the weight bias and misconceptions about atypical anorexia nervosa, there are many different treatment options available. The methodologies used at eating disorder treatment centers for clients with anorexia nervosa are just as useful when it comes to atypical anorexia nervosa recovery. In general, there are two primary forms of eating disorder treatment, residential and day treatment:
Sometimes called inpatient eating disorder treatment, residential treatment involves the client living at the eating disorder treatment center 24/7 for a set period. Usually, this begins at 30 days, but it can be extended much longer if the severity of the eating disorder warrants it. Residential treatment includes the full spectrum of medical, psychiatric, therapeutic, and nutritional care.
- Day treatment
Day treatment can include partial hospitalization programs (PHP), intensive outpatient programs (IOP), and step-down programs for recent graduates from residential treatment. These programs offer more flexibility since there is no requirement that the client lives at the facility, instead attending sessions daily or several times per week. This form of treatment is also more accessible because of lower costs.
Both residential and day treatment programs for atypical anorexia nervosa include a wide array of treatment methodologies. These include evidence-based methods that help clients identify their disordered thoughts and behaviors and then replace them with healthier alternative coping skills. Chief among them is Cognitive Behavior Therapy (CBT) which allows a therapist and client to objectively assess the way a person thinks about their body image and their eating patterns. Over time, this leads to a greater personal understanding and correction of disordered behaviors. Group therapy is a near-universal feature of eating disorder treatment as well. Most recovered clients come to greatly appreciate the bonds they form with fellow clients and the freedom of expressing themselves with a group of people who are in the same boat.
There Is Hope!
As we’ve seen, atypical anorexia nervosa can devastate a person’s life. With the misconceptions and myths about the disorder still all too present, it can also be discounted or ignored. It may seem hopeless if you or someone you love has this dangerous disorder, but please don’t lose hope. Treatment centers like Oliver-Pyatt Centers have the professional staff, experience, and compassion needed to facilitate a full recovery. Reach out today and start your way to a happier, healthier life – one without atypical anorexia nervosa.