Anorexia nervosa is one of the most well-known and most discussed eating disorders. Despite education and awareness efforts, many people, including health professionals, remain unaware of the more common atypical anorexia nervosa. a diagnosis that falls under Other Specified Feeding or Eating Disorders (OSFED). Many people with atypical anorexia may deem themselves as "not sick enough'" to get professional help or use their weight as 'proof' that they are "healthy" or "fine"
DIAGNOSTIC CRITERIA
To be diagnosed with anorexia nervosa according to the DSM-5 , the following criteria need to be met:
Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health.
Intense fear of gaining weight or becoming fat, even though underweight.
Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not technically underweight despite weight loss.
RESEARCH STUDIES HAVE NOT FOUND A DIFFERENCE IN THE MEDICAL IMPACTS OF ANOREXIA AND ATYPICAL ANOREXIA.
RESEARCH HAS INDICATED THAT PSYCHOLOGICAL DISTRESS RELATED TO BOTH EATING AND BODY IMAGE IS WORSE IN ATYPICAL ANOREXIA.
Because OSFED is less well-known, the diagnoses within are sometimes misunderstood as less common illnesses. In reality, OSFED is actually the most prevalent eating disorder category in the DSM.
SIGNS AND SYMPTOMS OF ATYPICAL ANOREXIA
Atypical anorexia is the same as anorexia, except without the criterion of an extremely low body weight. This means that just like anorexia, atypical anorexia includes an intense fear of gaining weight, an emphasis on body shape and appearance, and restriction of food intake. Atypical anorexia also includes weight loss, but despite that significant decline in weight, the person is still “normal” weight or “overweight.”
In addition to restriction, often people with this illness may exercise obsessively, binge eat, or purge.
Although someone with atypical anorexia may not appear “underweight,” many other signs can indicate that someone is suffering with this illness.
SIGNS AND SYMPTOMS
Social withdrawal
Anxiety
Hyperfocus on body weight ,shape and size
Low self-worth or distorted body image
Intense fear of being overweight
Hyperfocus on food, nutritional content, and /or bodily impact of food
Rigid rules around food
Excessive exercise
A negative or distorted view of their body weight or shape
Refusing to eat or be seen eating by others
PHYSICAL AND PSYCHOLOGICAL CONSEQUENCES
Increased emotional dysregulation (irritability, mood swings etc)
Difficulty thinking, concentrating and/or focusing
Gastrointestinal issues
Constipation
Brittle hair and nails
Reduced immune system
Bradycardia
Absence of menstruation (amenorrhea)
Fragile bones
Muscle weakness
Damage to vital organs
Bone and muscle loss/damage
Cardiovascular complications
Increased depressive symptoms and suicidal ideation
Death
ATYPICAL ANOREXIA FACTS
Atypical anorexia is researched a great deal less than the the already under-researched anorexia (and all eating disorders), but awareness and understanding is gradually increasing.
atypical anorexia hospitalizations comprise nearly one-third of hospital inpatient eating disorder treatment programmes.
1 in 4 adolescents with atypical anorexia present with bradycardia
1 in 3 adolescents with atypical anorexia present with amenorrhea
At least 40% of people struggling with atypical anorexia require hospital admission.
STIGMA AROUND ATYPICAL ANOREXIA
In 2021, plus-size model Tess Holliday went public with her struggles with atypical anorexia. Because Holliday lives in a larger body, she was bombarded with invalidating comments about her eating disorder. Some people couldn’t believe that a person in a larger body could experience anorexia.
Dismissing the experiences of people living in larger bodies is, unfortunately, nothing new. Weight bias and weight stigma are a long-ingrained part of our diet culture dominated society. Many people in larger bodies may not be diagnosed with an eating disorder—even when they show clear signs of one—simply because of their weight.
Even if people believe that a person in a larger body does indeed have an eating disorder, they may think that it is not as dangerous as an eating disorder that causes someone to be “underweight.” .
These are both examples of the real-life impact that weight stigma and bias on people living in larger bodies.
We live in a culture that idealizes thin bodies and encourages weight loss no matter the cost. Diet talk, comments about weight or 'compliments' for weight loss can be incredibly damaging, especially if the reason for the drop in weight is related to disordered eating or an eating disorder. Instead of people noticing that someone is struggling, they may be unknowingly encouraging disordered behaviour. To someone with an eating disorder, this will reinforce the disorder and the belief they are not “sick enough” to get help when this is the furthest thing from the truth.
RECOVERY IS ALWAYS POSSIBLE
Weight bias and weight stigma—along with impossible beauty standards—make it so much more difficult for someone with atypical anorexia to reach out for help. Again and again, diet culture sends the message that people in larger or even normal bodies must lose weight. But health cannot be measured by size, and for many, dieting is incredibly damaging.
It’s important to remember that diagnoses like atypical anorexia are imperfect classification schemes used to label symptoms, not people. If you have atypical anorexia, know that you deserve treatment for your eating disorder just as much as anyone else. Your pain matters. Though your illness may be less well-known, it’s not any less important.