Atypical Anorexia?
Atypical Anorexia, despite what the name may imply, is actually the most common type of Anorexia.
The diagnostic criteria (as outlined by the DSM-5) for “typical” Anorexia Nervosa captures a very limited population, because it includes requirements that the individual must have a “significantly low body weight.” Atypical Anorexia (falling under the Other Specified Feeding or Eating Disorder- OSFED diagnosis) was developed to acknowledge that individuals can still meet all features of Anorexia Nervosa, without being at a clinically-defined ‘low body weight’.
What this means is that a person may be severely restricting their food intake, be consumed with thoughts about food and weight, and be experiencing extreme fear about weight gain, all while being at what is considered to be a “normal” body weight or living in a larger body. They might be taking additional measures to lose weight or prevent weight gain such as excessive exercise. People who are living with Atypical Anorexia might lose a significant amount of weight, but due to weight bias deeply ingrained in our society, this weight loss is often met with praise. The painful and dangerous reality underneath is completely missed or disregarded. This response can even be expressed by medical providers, family, and friends. Instead of registering need for concern or asking people about what is going on, our society congratulates them for going down a clothing size. Their behaviors are often reinforced and the diagnosis delayed (if acknowledged at all), meaning referrals and access to appropriate care may never be obtained. In addition, people who are battling with this can internalize shame or the belief that they are not sick enough, or do not have an eating disorder at all. Even the name “Atypical Anorexia” can be invalidating and alienating, because people often understand it to mean that it is less serious, or that they don’t belong in treatment - which could not be further from the truth.
Some warning signs or red flags that might indicate you or a loved one might be battling Atypical Anorexia include:
Refusing meals or certain types of food or frequent excuses to avoid eating, or eating with others
Meticulously reading of nutritional information or focus on calories.
Frequent or extreme dieting
Rapid weight loss
Irritability
Fatigue
Hair thinning
Excessive exercise
Frequent weighing of self or body checking behaviors such as pinching parts of the body
There is no single cause for any eating disorder, including Atypical Anorexia. However, there are some factors that have been understood to contribute to or increase the risk of development. Some of these include:
Having a family member who has or had an eating disorder, or family member who was highly focused on shape and weight
Having low self-esteem or perfectionistic tendencies
Having a history of trauma
History of bullying or being criticized about weight.
Personal history of frequent dieting
Having other mental health diagnoses including anxiety disorders, OCD, Depression, substance use disorders or PTSD.
The severity of an eating disorder is not determined by weight, and you cannot determine how sick someone is by looking at them.
People in all body sizes who are engaging in severely restrictive behaviors are at risk for the same medical and psychological complications associated with malnutrition. These include cardiac problems, cognitive issues, and electrolyte imbalances. It is imperative that we share this message to help reduce stigma and barriers to treatment - because with treatment - (especially early treatment), most health risks are reversible. The longer someone goes under the radar or denies the reality of having an eating disorder, the more severe the risks become. If you see yourself, or someone you care about in this post, please reach out. We can provide you with more information and guide you through the next steps for screening and admission to our IOP - or if we are not the right fit - we would love to help you find the right referral.
At Empowered, we understand that there is no single standard presentation of an eating disorder. Every individual has their own story, background, experiences, and struggles that contribute to the development and maintenance of their eating disorder. Every person who is fighting this battle deserves compassionate treatment and the opportunity to recover and redefine their relationship with food and their body. Treatment at our IOP would include a personalized nutrition plan and support for nutritional stabilization, therapeutic work around challenging beliefs and myths about food and exercise, and work to support exploration and healing of underlying trauma and the development of coping skills for emotional regulation and effective emotional expression.