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What is the restricting type of anorexia?

Anorexia nervosa (AN) is a serious eating disorder, which involves an intense fear of gaining weight, a distorted body image or perception of one's body weight, shape, or size, and, often, significantly low body weight.

To deal with their fear of gaining weight, people with AN use all types of maladaptive coping mechanisms. And while many people assume the weight loss involved with AN comes from severely limited diet or food intake, this is only one way the condition can manifest.

Restricting type AN often involves this limited diet, but the condition has a number of other distinctions.

4
 minutes read
Last updated on 
June 13, 2023
June 13, 2023
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In this article

Different types of anorexia nervosa

In fact, there are two main subtypes of anorexia nervosa:

  • Restricting type AN
  • Binge/purge type AN

Binge/purge anorexia nervosa is actually similar to bulimia nervosa (BN) or some types of binge eating disorder (BED). This subtype involves periods of binge eating, followed by the use of various purging methods, such as self-induced vomiting, as compensatory behavior.1

Anorexia nervosa restricting type describes someone who restricts their food intake without binging and purging—or, more specifically, someone who engages in these restrictive behaviors without resorting to binging and purging in 3 months or more.1

Instead, people who struggle with this restrictive food intake disorder will severely limit their diet or food intake, though sometimes people with restrictive type AN use other methods to limit the impact of food on their bodies, including laxative and enema misuse and excessive exercise.1

Characteristics of anorexia nervosa, restricting type 

Individuals who meet the diagnostic criteria for anorexia nervosa of any type exhibit a fear of weight gain and disturbed eating and behavioral patterns connected to this fear.

What is different about anorexia nervosa restricting type is that people with this form of AN primarily prevent weight gain from restricting their food intake. They may engage in several other maladaptive behaviors, but they will not engage in binging and purging.

There may also be some other subtle differences in how this subtype presents. 

A 2016 study found that individuals with restrictive type anorexia nervosa tend to have a lower body mass index (BMI) and are less likely to use diet pills when compared with the binge/purge subtype.2 Another study found that those who have the restricting subtype of AN are more likely to have medical complications related to being underweight, such as lower bone mineral density, liver problems, and low blood sugar levels.3

Learn why body weight or body mass index isn't a good indication of how healthy you are.

Learn more

The chronic under-eating, and accompanying significant weight loss, that occurs with restrictive type AN can also lead to malnutrition and a host of related health problems. 

Binging/purging vs. restrictive subtypes

Those with one type of AN don't necessarily always exhibit the symptoms of that type. It's also possible for individuals with anorexia nervosa to transition from one subtype to the other.

A study in the International Journal of Eating Disorders found that it is common for people to move from restrictive anorexia nervosa to the binge/purge type. And while the results showed that it is not as common for people to transition from the binge/purge to the restricting subtype, that change is certainly still possible.4

One possible reason behind this is the hunger that can build from periods of chronic food restriction, driving people to binge in order to compensate.

A study in The Journal of Clinical Endocrinology & Metabolism found that individuals with AN restricting type tended to have higher levels of ghrelin, a hormone responsible for signaling hunger.5 These increased ghrelin levels could lead to binging episodes, which could, in turn, be followed by a compensatory purging, eventually developing into a regular cycle and thus starting the transition to the binge/purge subtype.

Treatment for anorexia nervosa

Regardless of which subtype it presents as, anorexia nervosa requires treatment from a mental health professional to overcome.

In treatment for anorexia nervosa, someone can work through any underlying psychological issues that may be driving or maintaining an unhelpful eating pattern, learn ways to challenge unhealthy thinking patterns, and develop a healthier relationship with food and themselves.

Remote treatment is available

If you’re living with AN restricting subtype, or another eating disorder, support is available. A team of treatment professionals can help you to move beyond the grips of the eating disorder and develop healthy patterns of eating that nourish your body and allow you to live a healthier, happier life. 

Call (866) 293-0041

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.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. DSM-IV to DSM-5 Anorexia Nervosa Comparison. (2016, June). Substance Abuse and Mental Health Services Administration. Accessed June 2023.
  2. Peterson, C. B., Pisetsky, E. M., Swanson, S. A., Crosby, R. D., Mitchell, J. E., Wonderlich, S. A., Le Grange, D., Hill, L., Powers, P., & Crow, S. J. (2016). Examining the utility of narrowing anorexia nervosa subtypes for adults. Comprehensive Psychiatry, 67, 54–58.
  3. Rylander, M., Brinton, J. T., Sabel, A. L., Mehler, P. S., & Gaudiana, J. L. (2017). A comparison of the metabolic complications and hospital course of severe anorexia nervosa by binge-purge and restricting subtypes. Eating Disorders: The Journal of Treatment & Prevention, 25(4), 345-357.
  4. Peat, C., Mitchell, J. E., Hoek, H. W., & Wonderlich, S. A. (2009). Validity and utility of subtyping anorexia nervosa. International Journal of Eating Disorders, 42(7), 590-594.
  5. Germain, N., Galusca, B., Grouselle, D., Frere, D., Billard, R., Epelbaum, J., & Estour, B. (2010). Ghrelin and obestatin circadian levels differentiate binging-purging from restrictive anorexia nervosa. The Journal of Clinical Endocrinology & Metabolism, 95(6), 3057-3062.

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Further reading

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