What is atypical anorexia nervosa?
Atypical anorexia nervosa is a term that refers to certain cases of anorexia nervosa that do not follow the established pattern. Generally speaking, most atypical anorexia nervosa cases meet all the criteria of AN, with the exception of a low body weight.
Some studies suggest that the prevalence of this condition lies around 13% for those identifying as female and 4.9% for those identifying as male, but this eating disorder affects all genders. (3)
For patients suffering from anorexia, one of the primary criteria for diagnosis is a significant weight loss. However, for those suffering from atypical anorexia nervosa, significant weight loss may not be present at all. At least not in the quick fashion that makes it so noticeable with those suffering from traditional AN.
Diagnosing atypical anorexia nervosa
Atypical anorexia nervosa is a newer diagnostic category for eating disorders in the DSM-5, so careful diagnosis is a critical part of proper healing.
To correctly diagnose atypical anorexia nervosa, there are a few things that the clinician needs to take into account. While unexplained or severe weight loss should be a quick indicator that a patient may be suffering from anorexia, the body weight alone may not be definitive.
Other criteria that you will need to take into account when diagnosing atypical anorexia nervosa include: (1)
- Skipping meals or taking smaller portions of food
- Being uncomfortable with eating in front of others
- Drinking excessive amounts of water or non-caloric beverages
- Showing extreme concern with their body weight and shape
- Experiencing stomach cramps, other non-specific gastrointestinal complaints
Should you or a loved one fit into any of the above descriptions, they should be evaluated by a mental health professional or physician. However, even if they do not fit into the profile of someone with anorexia, this does not mean that they are not experiencing the symptoms associated with OSFED.
In diagnosing atypical anorexia nervosa, an individual's weight may be considered part of the evaluation process. However, someone suffering from atypical anorexia nervosa will more likely present with a significant weight loss over a more extended period than a sudden drop in weight.
However, if an individual meets any of the below-mentioned criteria, though are not considered underweight, they are more likely to receive a diagnosis of atypical anorexia nervosa: (4)
- Restricting food intake relative to the energy needs of the individual
- Presenting a fear of gaining weight or of being perceived as overweight
- Having a distorted self-image
- Severely criticizing their body shape or weight
- Being in denial about the severity of their condition.
Atypical anorexia nervosa signs & symptoms
The American Psychiatric Association has defined the following signs and symptoms for the disorder: (1)
Emotional and behavioral
- Dressing in layers to hide weight loss or stay warm
- Being preoccupied with weight, food, calories, fat grams, and dieting
- Refusing to eat certain foods, progressing to restrictions against whole food categories
- Making frequent comments about feeling "fat" or overweight despite weight loss
- Developing food rituals
- Skipping meals or taking small portions of food at regular meals
- Drinking excessive amounts of water or non-caloric beverages
- Maintaining excessive, rigid exercise regimen
- Fluctuations in weight
- Sleep problems
- Dry skin
- Poor wound healing
- Impaired immune functioning
Effects of atypical anorexia nervosa
The effects of atypical anorexia nervosa may result in the following: (7)
Short-term effects of atypical anorexia nervosa may result in several medical problems that can require hospitalization, including:
- Cardiac arrhythmias
- Chest pain
- Low potassium
- Low calcium levels
- Low magnesium levels
- Low phosphate levels
- Low blood pressure
- Low blood cell count
- Low glucose levels in blood
- Myocardial infarction
- Sudden rise in heart rate
Long-term effects of atypical anorexia nervosa may result in the following medical problems:
- Chronic fatigue
- Degenerative joint disease
Since atypical anorexia nervosa doesn't fit into the standard diagnostic category as anorexia, it may be misdiagnosed as one of several other eating disorders, including:
- Anorexia nervosa (AN): patients with AAN may have the classic picture of anorexia nervosa, which includes extreme body dissatisfaction and what appears to be an inability to gain weight.
- Bulimia nervosa (BD): patients with AAN may develop ritualistic eating patterns, including binge eating followed by compulsory purging behaviors.
- Binge eating disorder (BED): patients with AAN may binge eat when they think nobody is watching, although these sessions are rare.
- Avoidant/restrictive food intake disorder (ARFID): patients with AAN may refuse to eat certain food groups, but may not have weight loss.
- Body dysmorphic disorder (BDD): patients with AAN may develop an extreme preoccupation with their appearance, similar to BDD.
Like many other eating disorders, you may also be suffering from a co-occurring disorder, which is another psychiatric disorder (such as depression or anxiety) that occurs alongside an eating disorder.
When seeking treatment, you must work with your team to treat both your eating disorder and your co-occurring disorder to ensure that you receive the best treatment available and increase your chances of a full recovery.
Atypical anorexia nervosa treatment
Atypical anorexia nervosa can be a very challenging condition to treat. However, with the right support system in place, it is more than accessible.
It’s important to note any underlying psychological conditions and triggers that may present for atypical anorexia nervosa. For most patients, a holistic approach to treating AAN offers the best chance at recovery.
Typically, treatment for atypical anorexia nervosa involves a multidisciplinary team – and therapeutic intervention focused on:
- Behavioral techniques
- Lifestyle counseling
- Nutritional counseling
Therapies for atypical anorexia nervosa
The following therapies have shown to be effective in the treatment of atypical anorexia nervosa: (8)
- Cognitive behavioral therapy (CBT)
- Interpersonal psychotherapy for binge eating disorder (IPT-BED)
- Simplified dialectical behavior therapy (simplified DBT)
Medications for atypical anorexia nervosa
There are no medications approved for the treatment of atypical anorexia nervosa. However, several medications can be used to help treat the disorder's symptoms, including anxiety and depression medications and supplements to resolve nutritional deficiencies.
It’s vital to note that you should never start taking any medications or supplements without first consulting with your treatment team, as doing so can lead to unwanted side effects.
Understanding atypical anorexia nervosa
Atypical anorexia nervosa, like any eating disorder, should be approached with kindness and compassion for the struggling individual. There is much shame and stigma attached to eating disorders, especially lesser-known classifications like atypical anorexia nervosa. Thus, building a better understanding of AAN is a valuable part of the healing process for people with AAN, and those who love them.
Living with atypical anorexia nervosa
Atypical anorexia nervosa, like many other eating disorders, has the potential to affect the physical and psychological health of the patient.
The patient is likely to develop certain complications, such as:
- Gastrointestinal distress
- Low self-esteem
- Mental disorders
- Suicidal ideation
Due to the chronic nature of the condition, it affects the patient's quality of life. Some patients may also develop a loss of social identity, which can lead to isolation. Studies show that 97% of individuals who suffer from an eating disorder also suffer from one or more co-occurring conditions, including: (2)
- Major depression
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Alcohol/substance use disorder
The best way to cope with an illness like atypical anorexia nervosa is to work closely with experienced health professionals. Having someone to talk to about your concerns, and to ask questions, can be extremely reassuring and comforting.
Other coping mechanisms may include:
- Group or individual therapy (counseling)
- Family therapy
- Nutrition counseling
History of atypical anorexia nervosa
Prior to it’s addition to the DSM-5, atypical anorexia nervosa stood for a “less severe form of anorexia nervosa.” (4) In 2013, the American Psychiatric Association recognized the disorder with its diagnostic category, based on the DSM-5 diagnostic criteria. (5) More recent studies have indicated that patients with atypical anorexia nervosa can be just as medically ill as their peers with anorexia nervosa and can have even greater eating disorder psychopathology, which means the early assessment of atypical anorexia nervosa being “a less severe form of anorexia nervosa” is actually a dangerous misclassification. (8,9)
As we continue to learn about AAN, more understanding and compassion for those struggling with this eating disorder are being established in treatment protocols.
Atypical anorexia nervosa in pop culture
Atypical anorexia nervosa is not often discussed in the media, but people are beginning to learn more about it.
Pop culture references of eating disorders typically vilify the disorders, as well as those struggling with them. However, instead of scaring the public, many who identify with these characters showcased in books and TV films, such as “Little Miss Perfect,” and “Starving in Suburbia,” feel ashamed of their own condition. Most portrayals serve as nothing more than harmful triggers to those actively struggling.
Increasing awareness of AAN through thoughtful, accurate representation in film and media will provide a more comprehensive understanding while opening treatment pathways for many who live with this condition.
How to help someone with atypical anorexia nervosa
The best way to help someone with atypical anorexia nervosa is to be there for them and positively influence their lives. It is also helpful to understand the disease and the symptoms that are typically associated with it. If your loved one is suffering from atypical anorexia nervosa, here are a few ways you can help support them:
- Try to be patient with your loved one: In the early stages of the illness, patients with AAN may be very emotional, withdrawn and may have a hard time communicating with others.
- Be supportive: Encourage your loved one to eat and drink things that are normal and healthy for their body.
- Don't compare: Everyone is unique and their specific body’s shape and size may vary from yours, while still being healthy. Don't compare your loved one's weight to others and don't try to force them to eat more or less than they are comfortable with.
- Don't criticize your loved one's body shape or size: This may actually increase your loved one's feelings of low self-esteem and body dissatisfaction.
- Don't control your loved one's food and drink intake: This can make them feel more anxious and insecure. Leave decisions around their nutrition to their treatment team.
At Within Health we believe in treating each eating disorder personally. If you or a loved one are struggling with atypical anorexia nervosa, or another eating disorder, help is available at your fingertips. Call our admissions team to get started.