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.
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.
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:
By not ingesting sufficient calories or nutrients for normal body functioning, people with AAN may experience a number of dermatological complaints, including: (4)
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.
Other physical complications associated with atypical anorexia nervosa include, but are not limited to: (5)
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.
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.
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.
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)
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)
Common physical symptoms of AAN are stomach issues, including, but not limited to:
These complaints could be genuine, or they could be used as an excuse to avoid eating with others.
One of the key behavioral characteristics of AAN is a preoccupation with weight and food. A person with AAN is likely to:
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)
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.