Atypical anorexia nervosa symptoms

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Atypical anorexia nervosa (AAN) shares many of the same characteristics as anorexia nervosa (AN), except for low body weight. (1) Individuals with AAN are likely to be within or above the “normal” weight range for their age and sex.

While sudden, unexplained, or severe weight loss is a strong indicator that a person may be suffering from anorexia, weight loss may not be present at all in atypical anorexia nervosa. If there is any weight loss, it is likely to occur over a more extended timeframe.

Here are some physical and behavioral signs and symptoms of atypical anorexia nervosa, so you can recognize a potential issue in yourself or a loved one, even if body weight is in the “normal” range.

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Signs of atypical anorexia nervosa

Physical signs of atypical anorexia nervosa

Fluctuations in weight

There is a common misconception that, if a person is within the “normal” body weight range, they can’t be suffering from anorexia. However, low body weight does not need to be present with AAN. (2)

Many people suffering from AAN may start off as having an above-average weight and undergo a dramatic weight loss, yet still be what is considered a “normal” weight. 

Nutritional deficiencies

By severely restricting their food intake, sufferers of atypical anorexia nervosa are more likely to have nutritional deficiencies, or in severe cases, malnutrition. This is true even if body weight is above or in the “normal” range.

Research has shown that the body can go into starvation mode if as little as ten percent of body weight is lost quickly. (3) This rapid weight loss can lead to a whole host of problems, including but not limited to muscle weakness, fatigue, abdominal pain, skin problems, and missed periods.

Nutritional deficiencies associated with AAN can often be detected in lab tests as:

  • Low potassium levels
  • Low calcium levels
  • Low magnesium levels
  • Low phosphate levels
  • Low glucose levels in the blood

Dermatological complaints

By not ingesting sufficient calories or nutrients for normal body functioning, people with AAN may experience a number of dermatological complaints, including: (4)

  • Abnormally dry skin and/or membranes, e.g., in the mouth or eyes
  • Discoloration and mottling of fingers and toes due to poor circulation
  • Lanugo hair growth
  • Brittle hair and nails

In some cases of AAN, there may be carotenemia, which is characterized by a yellow tinge to the skin and an orange discoloration of the palms of the hands and soles of the feet. This discoloring is the result of an excess of beta-carotene levels in the blood through overconsumption of carotene-rich foods, such as carrots. People with AAN may eat an excess of these foods to avoid calorie-rich foods.

Associated physical complications

Other physical complications associated with atypical anorexia nervosa include, but are not limited to: (5)

  • A weakened immune system
  • Amenorrhea (loss of menstrual cycle) or stunted puberty
  • Low bone density
  • Bradycardia (low heart rate) or a sudden rise in heart rate
  • Low blood pressure
  • Low blood cell count
  • Chest pain
  • Dizziness and fainting
  • Constipation

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Emotional and behavioral signs of atypical anorexia nervosa

Food restriction and food rituals

People with AAN will severely restrict their intake of food due to a preoccupation with their weight. This restriction may present in the refusal to eat certain foods, or entire food categories. 

This food restriction usually goes hand in hand with the development of food rituals. You may notice that someone with AAN will drink large quantities of water or low-calorie drinks to stave off hunger. They may also skip meals, eat smaller portions at mealtimes, or eat lots of low-calorie foods, such as celery or carrots.

Compensatory behaviors

Sufferers of AAN may engage in the same compensatory behaviors as those with anorexia nervosa. This behavior may include a strict and excessive exercise regimen, bingeing, purging, and/or using laxatives.

Dressing in layers

Someone with AAN will tend to dress in layers of baggy clothes. This hides their body, of which they have a disproportionately negative view. It also keeps them warm.

The body needs to burn a certain number of calories to maintain a comfortable body temperature. Even a mild calorie restriction can significantly lower body temperature, meaning those with AAN tend to feel cold most of the time.

Psychological comorbidities

Additionally, people with atypical anorexia often have psychological comorbidities, which are psychological disorders that often occur with other psychological disorders, such as anxiety and depression. Research indicates that almost 40% of adolescents with AAN have psychological comorbidities and 43% engage in self-harm or suicidal ideation. (6)

Symptoms of atypical anorexia nervosa

Physical symptoms of atypical anorexia nervosa

Fatigue and sleep problems

Calories provide your body with energy to get through each day. People with AAN often don’t consume enough calories for their daily needs, making it more likely that they will experience constant fatigue. This fatigue will worsen if the individual is also engaging in a strict exercise regimen.

Food restriction and strict dieting can also cause sleep problems. Research has shown that severe calorie restriction is linked to sleep interruptions and a decrease in deep sleep. (6)

Non-specific gastrointestinal complaints

Common physical symptoms of AAN are stomach issues, including, but not limited to:

  • Stomach cramps and abdominal pain
  • Bloating
  • Acid reflux and indigestion
  • Nausea
  • Lack of appetite

These complaints could be genuine, or they could be used as an excuse to avoid eating with others.

Emotional and behavioral symptoms of atypical anorexia nervosa

Preoccupation with weight and food

One of the key behavioral characteristics of AAN is a preoccupation with weight and food. A person with AAN is likely to:

  • Count calories, grams of fat and carbohydrates, and sugar content of foods
  • Frequently comment about feeling overweight or “fat” despite weight loss
  • Feel uncomfortable eating around others and avoid social functions as a result

Body dysmorphia

Research suggests that those with AAN have worse psychological distress relating to their body image than those with anorexia nervosa. (7)

It’s common for individuals with AAN to have a distorted body image. They believe they are bigger than they are, which not only causes low self-esteem, but also denial about the severity of their condition. (8)

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When to get help for atypical anorexia nervosa

Those with atypical anorexia nervosa may feel like they aren’t sick enough to have a potentially deadly eating disorder, because they are within or above the “normal” weight range.

It's important to understand that weight is not a defining character of an eating disorder. Some can suffer from anorexia-related tendencies, regardless of their size, shape, or weight. 

If you or one of your loved ones is struggling with obsessive thoughts about food and body weight, or abnormal eating patterns, it’s time to get some help and support. 

As daunting as it may be, having a professional assessment can help you understand what you may be struggling with and direct you toward the right treatment. Through treatment, you’ll  address your disordered eating habits and work towards understanding the underlying issues that trigger them.


Eating disorders–like atypical anorexia nervosa–can have severe, lifelong consequences if untreated. Seeking help is the first step on your road to recovery.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. National Eating Disorders Association. (2018, July 30). Other Specified Feeding or Eating Disorders.
  2. Ekern, B., (2020, January 23). Atypical Anorexia Nervosa: Signs and Symptoms. Eating Disorder Hope.
  3. Teens Don't Have to Be Underweight to Have Anorexia. (2018, December 3). Futurity. 
  4. Atypical Anorexia Nervosa Symptoms, Risks, & Treatment. ACUTE. (n.d.).
  5. Ekern, B., (2021, February 3). What is Atypical Anorexia? Eating Disorder Hope. 
  6. Spritzler, F. (2017, June 5). 9 Signs That You're Not Eating Enough. Healthline.
  7. Sawyer, S. M., et al. Physical and Psychological Morbidity in Adolescents with Atypical Anorexia Nervosa. Pediatrics, (2016): 137:4.
  8. Rittenhouse, M. (2021, Aug 30) What is Atypical Anorexia Nervosa: Symptoms, Causes and Treatment. Eating Disorder Hope.

FAQs

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