All About

Atypical Bulimia Nervosa

Atypical bulimia nervosa (ABN) is a form of bulimia nervosa (BN) that affects individuals differently. 

People with atypical bulimia nervosa will present the same binge and purge behaviors as those with BN, however, the regularity of the episodes is far less frequent. This means people with ABN may not show the same weight loss or body changes as someone with bulimia nervosa.

Atypical Bulimia Nervosa

What is

Atypical Bulimia Nervosa

Atypical bulimia nervosa (ABN) is considered an Other Specified Feeding or Eating Disorders (OSFED) because it mimics many of the same symptoms of bulimia nervosa. However, ABN doesn't necessarily meet all the qualifications for diagnosis as BN. 

Atypical bulimia nervosa is described as potentially including recurrent bouts of binge eating and the overuse of purgatives without any significant weight change, or the standard over-concern regarding body shape and weight. (1)

The associated behaviors tend to occur at a lower frequency and/or for less than three months at a time.

Diagnosing

Atypical Bulimia Nervosa

Properly diagnosing atypical bulimia nervosa can prove challenging because it doesn't follow a specific pattern. That's why the DSM-5 suggests that anyone who meets most of the criteria of bulimia nervosa (BN), but is missing characteristics such as severe weight loss or prolonged binge/purge periods, may fall under atypical bulimia nervosa.

Signs & Symptoms of

Atypical Bulimia Nervosa

If a patient presents several of the following signs and symptoms, they may have atypical bulimia nervosa: (8)

  • Recurring episodes of binge eating which may be months apart 
  • Eating more than normal over two hours, with an accompanying sense of losing control
  • Exhibiting behaviors to avoid gaining weight, including fasting, excessive exercise, diuretic use, and laxative use
  • Binge/purge eating behavior that occurs at least once a week over a period - occurring at irregular intervals for those with atypical bulimia nervosa 
  • Believing their body shape and weight is poor for no reason, often due to distorted thinking or body dysmorphia. 

Other general symptoms include:

  • Dizziness
  • Lightheadedness
  • Heart Palpitations
  • Dry skin

Effects of Atypical Bulimia Nervosa

Atypical bulimia nervosa can wreak havoc on a person's life and greatly challenge their ability to cope with everyday stressors and life events. That's because atypical bulimia nervosa can have a strong effect on a person's behavior and mood, as well as causing them to engage in behaviors that put their mental and physical health at risk. 

Those struggling with chronic atypical bulimia nervosa suffer from cyclic episodes of binge eating and purging. As a result, people with atypical bulimia nervosa often feel out of control and unable to understand why they have these binges and purges. 

As the disorder progresses, people with atypical bulimia nervosa tend to engage in compulsive behaviors. Such behaviors may include excessive exercising, fasting, and purging. 

The physical and psychological effects of atypical bulimia nervosa may cause a host of other symptoms, including a lack of energy, poor concentration, insomnia, and digestive issues. (9) 

Short-Term Effects

The most common short-term effects of atypical bulimia nervosa include:

  • Cravings for food
  • Binging behaviors
  • Loss of self-esteem
  • Irritability
  • Gastrointestinal difficulties
  • Hemorrhoids
  • Dehydration 

Long-Term Effects

The most common long-term effects of atypical bulimia nervosa include the following:

  • Weight changes (both gaining and losing)
  • Feelings of shame
  • Depression
  • Suicidal ideation
  • Tooth decay
  • Ulcers

Related Disorders

Many people with atypical bulimia nervosa struggle with negative feelings about their bodies and may also struggle with binge eating and other eating-related disorders. Those with atypical bulimia nervosa may also experience other eating disorders, such as:

  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
  • Compulsive overeating

It’s important to note that many patients suffer from underlying disorders. A co-occurring disorder is when a patient has two or more disorders, either mental or physical, that are occurring together.

Your care team will be sure to treat not only your atypical bulimia nervosa but also any other co-occurring disorders to ensure you are getting the best possible treatment.

Treatment of

Atypical Bulimia Nervosa

Treatment should include a team of medical doctors and mental health professionals, as well as nutritionists. (10)

Your clinical care team will use various methods to help you break the pattern of binge-purge behavior. Your team will also correct distorted thinking patterns that lead to poor body image and the urge to partake in unhealthy behaviors around food and exercise. 

Therapies for Atypical Bulimia Nervosa

The most common treatment for atypical bulimia nervosa is through psychological counseling and may include:

  • Cognitive behavioral therapy
  • Individual and group psychoeducational therapy
  • Dialectical behavioral therapy
  • Family based treatment/Maudsley Method

Medication for Atypical Bulimia Nervosa

People who suffer from atypical bulimia nervosa may also be treated using antidepressants, mood stabilizers, or antipsychotic medications. However, it’s crucial that you speak to your medical team before taking any medications, as they could have undesired side effects.

Understanding

Atypical Bulimia Nervosa

To better understand the struggles of those with atypical bulimia nervosa, you must first realize how widespread eating disorders have become. Eating disorders, including ABN, affect over 30 million Americans and this number is only increasing as current pandemic pressures present themselves. (3, 12)

When the world feels out of control, many look inwards for areas of their lives that they can control, including their food intake and exercise routines. 

Therefore, examining eating disorders should be done from a place of empathy and compassion, as each individual body has its own shape, size, requirements, and stressors. It is crucial to practice kindness for yourself and others struggling with eating disorders like ABN, in order for proper healing to occur. 

Living with Atypical Bulimia Nervosa

Bulimia nervosa is among the top three most common eating disorders in the United States, with approximately 1.0% of those identifying as young women and 0.1% of those identifying as young men meeting the diagnostic criteria outlined by the DSM-5. (4)

Atypical bulimia nervosa is associated with a variety of challenges. Binge eating is a common symptom of the disorder, and people with this condition often isolate themselves during periods of binge eating. ABN is also associated with depression, anxiety, and other mood and psychological disorders. 

Atypical bulimia nervosa is closely tied to mental health struggles, including suicidal ideation. Studies have shown people with bulimia or atypical bulimia nervosa, have an increased risk of attempting suicide, with over 31% of people with bulimia surveyed admitting to attempting to take their own life. (13)

Some people with the disorder may also have problems with substance use, with studies showing that of those hospitalized with an eating disorder, 22% of them also had an alcohol or substance use disorder. (4)

Coping With Atypical Bulimia Nervosa

While living with ABN can be scary, with the right treatment and support system by your side, recovery is absolutely possible. Learning proper coping mechanisms is a great way to boost your recovery process. 

The most important thing you can do to cope with atypical bulimia nervosa is to adopt a proactive approach and take charge of your life so you no longer have to live with the effects of the disorder. You can do this by making positive changes in your life, such as seeking out professional treatment and speaking with a counselor and nutritionist. 

Another key to coping with atypical bulimia nervosa is doing your best to avoid possible triggers such as highly emotional situations or confrontations. You also want to make sure you surround yourself with a stable support system to ensure that you’re in the safest possible environment conducive to healing. 

If you're struggling with atypical bulimia nervosa, seek out treatment. The earlier you get help, the better your chances for recovery.

History of Atypical Bulimia Nervosa

While bulimia nervosa was added to the DSM-3 in the 1980s, it wasn't until the DSM-5 revision that atypical bulimia nervosa was added under the section Eating Disorder Not Otherwise Specified (EDNOS). The entry for ABN was then updated again in 2013 and is now found under bulimia nervosa OSFED. (6)

Atypical Bulimia Nervosa in Pop Culture

Eating disorders have been in the spotlight for some time, especially with more celebrity and pop culture icons coming forward and sharing their struggles with various eating disorders. In the last few years alone, the topic of maintaining a healthy body shape and size has been plastered all over social media and television as people have been glued to their devices and looking for ways to maintain their health and well-being.

One study published in the International Journal of Eating Disorders showed a clear association between social media usage and disordered eating. In the study, 51.7% of those identifying as female and 45% of those identifying as male started having distorted views on both eating and exercise. (7) The study also identified Instagram as the most popular platform used by those with disordered eating, although Snapchat and Facebook were close runner-ups.   

Researchers believe eating disorders directly result from constant exposure to advertising for unhealthy diets and the compulsive behaviors that can often go along with such diets. (7) In addition, social media also directly impacts the way people think about themselves and their bodies. 

Social media users have also been found to exhibit higher levels of body dissatisfaction, especially when it comes to image-based social media sites such as Instagram. (11)

How to Help Someone with

Atypical Bulimia Nervosa

You can effectively help someone who's struggling with atypical bulimia nervosa through the following means:

  • Being supportive, and listening 
  • Having confidence in the person
  • Educating yourself on atypical bulimia nervosa 
  • Keeping them physically comfortable
  • Supporting them in their efforts to find treatment 

Within Health’s care team is attuned to your needs and offers clinically superior treatment for atypical bulimia nervosa. Call our admissions team to start your healing from eating disorders today.

Frequently asked questions

What's Atypical Bulimia Nervosa?

Atypical bulimia nervosa (ABN) is a unique type of bulimia nervosa (BN) that involves binge eating and purging behaviors that are different from the classic BN symptoms. It is typically characterized by fewer episodes of binge eating and more episodes of purging than classic BN.

Why is Atypical Bulimia Nervosa So Difficult to Diagnose?

The traditional diagnostic criteria for bulimia nervosa don't account for the atypical features of ABN, often leading to a misdiagnosis, especially in the early stages of the illness for all genders.

The differences between atypical bulimia nervosa and classic bulimia nervosa are subtle and not always apparent to clinicians or patients.

Is Recovery Possible?

With the right treatment team and a close-knit support system by your side, a full recovery from atypical bulimia nervosa is possible.

Resources

  1. Springer Link. (2008). Atypical bulimia nervosa. 
  2. American Psychiatric Association. (2013). DSM-5 Diagnostic Criteria For Eating Disorders.
  3.  Johns Hopkins All Children's Hospital. (n.d.). Eating disorder facts.
  4. National Eating Disorders Association. (2021, July 14). Statistics & research on eating disorders.
  5. Suicide Attempts and Eating Disorders | Suicide Prevention Resource Center. (2021, August 27). Suicide attempts and eating disorders.
  6. Neuropsychiatric disease and treatment. (2016, July 7). Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive-compulsive spectrum. 
  7. Wiley Online Library. (2019, December 3). The relationship between social media use and disordered eating in young adolescents.
  8. Medscape. (2021, May 26). Bulimia nervosa. Practice Essentials, Background, Frequency. 
  9. National Collaborating Centre for Mental Health (UK). (2004). Treatment and management of bulimia nervosa. Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. 
  10. Cleveland Clinic. (2019, December 12). Bulimia Nervosa: Signs & Symptoms, Complications & treatment.  
  11. SAGE Journals. (2019, November). Social media is not real: The effect OF 'INSTAGRAM vs reality' images on women's social comparison and body image - MARIKA Tiggemann, ISABELLA anderberg, 2020
  12. Haseltine, W. A. (2021, August 27). How the pandemic is fueling eating disorders in young people. Forbes
  13. Udo, T., Bitley, S., & Grilo, C. M. (2019). Suicide attempts in U.S. adults with lifetime DSM-5 eating disorders. BMC Medicine, 17(120). https://doi.org/10.1186/s12916-019-1352-3
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