What is atypical anorexia?

December 16, 2022

Swedish Behavioral Health Team

[5 MIN READ]

Atypical anorexia has the same behaviors and health risks as anorexia nervosa, including restricted eating, intense fear of gaining weight and distorted body image.
Body mass index (BMI) is the determining factor between a diagnosis of atypical anorexia and “typical” anorexia.
A behavioral health expert at Swedish explains the differences between the two eating disorders and outlines how to recognize when professional help is needed.

For many, the word anorexia conjures a mental picture of an excessively thin young woman with sunken cheeks and skeletal arms. But that image isn’t always an accurate representation of reality.

People with eating disorders don’t all look the same. And they aren’t necessarily underweight and frail.

Most everyone has heard of anorexia nervosa – an eating disorder that causes distorted body image and intense fear of gaining weight regardless of how thin you are. Despite the many people it affects, atypical anorexia isn’t nearly as well known. But maybe it should be.

According to the National Eating Disorders Association, specific criteria must be met before you are “officially” considered anorexic, including:

Intense fear of gaining weight or becoming fat even when underweight.
Refusal to maintain a healthy weight of at least 85% of the expected weight for someone the same age and height.
Inaccurate self-perception of your body’s weight or shape.
Placing extreme limits on what you will and will not eat.

A diagnosis of atypical anorexia has similar criteria. Still, you may not be considered anorexic because your body mass index (BMI) doesn’t hit an arbitrary number, according to Senior Director for Behavioral Health Services, Acute Care at Swedish, Kelsey Smith, MBA, LICSW.

“BMI is an archaic and outdated way to determine ‘normal’ weight’ that can reinforce shame around someone’s weight even if they’re healthy,” explains Kelsey.

“Many people that are above a normal BMI are actually a healthy weight. Someone may lose just as much weight as someone with regular anorexia, but because they don’t meet that BMI threshold, they will not be classified as anorexic. Instead, they’re going to be considered atypical anorexia,” she adds. “Both pose serious threats to your mental, emotional and physical health if left unaddressed. Our culture needs to continue to embrace that our society is full of many different body types and they are all healthy and beautiful.”

Other signs of atypical anorexia include:

Fasting or eating tiny amounts of food
Obsessing about food and eating
Exercising excessively
Taking laxatives or diet pills

Dying to be thin

“Someone with atypical anorexia will have just as many health risks as someone with a standard anorexia diagnosis. Even though they may be in a different weight range, they’re still going to have the same health concerns, such as electrolyte imbalance, vital sign instability and a dangerously low heart rate,” says Kelsey.

“There can be damage to vital organs. There can be bone or muscle loss. They may develop osteoporosis because they’re not giving their bones the necessary nutrition if they’re struggling with an eating disorder while they’re developing as an adolescent or early adult. They can have cardiovascular complications at any age if their disorder becomes serious,” she adds.

“Not only does someone with atypical anorexia have a negative body image, they often feel guilty or ashamed about their diagnosis,” continues Kelsey. “In their mind, they think they didn't meet the standard of having regular anorexia. It’s like they failed. There can be intense psychological symptoms, including body shame and body dysmorphia. Sometimes it can result in death because of the extreme behaviors of starvation that they’re engaging in.”

Increased anxiety, depression and isolation

Emotional issues often accompany the physical challenges of atypical anorexia.

“Atypical anorexia can lead to isolation because being around other people is uncomfortable – especially when food is involved. It may trigger feelings of comparison and the belief that others are better than them,” says Kelsey.

In addition to affecting your physical health, the condition may cause:

Anxiety
Confused or unclear thinking
Difficulty focusing
Poor memory or judgment
Sadness and depression
Mood swings
Increased isolation from others

“It’s almost like someone with an eating disorder has radio static playing in their head,” says Kelsey. “You know how when you change radio stations and it sounds fuzzy? Someone with an eating disorder has that sensation all the time. There are so many voices in their head telling them what’s not good for them, what they shouldn’t be doing or how they’re not good enough. They may have difficulty focusing.”

A medical condition, not a lifestyle choice

People with atypical anorexia tend to have low self-worth and a distorted body image. That means they see their bodies differently than the world does.

“It’s like if you’re in a funhouse and you see those mirrors that distort your body. That’s how someone with an eating disorder sees themselves. They believe their distorted view of their body is accurate even though those around them see it differently,” says Kelsey.

“They have an intense fear of being overweight or having fat on their body. There’s this hyper-focus on food and nutritional content and the bodily impact that food will have. They may refuse to eat or be seen eating by others. They may be restrictive in their food types, such as avoiding all carbs, sugars and fats. They may engage in over-exercising or other behaviors that make up for their calorie consumption. They can go through very long periods of fasting,” she explains. “There’s always this feeling that they’ve never reached their goal. It’s never enough.”

Who gets atypical anorexia?

Atypical anorexia affects people across the age and gender spectrum. “It can be especially prevalent during puberty where there’s a lot of body changes,” says Kelsey. “It pops up in the adolescent population a lot and we’ll see it when someone is in their late teens or early 20s when they’re developing their identity of who they are, what they value and how people value and see them.”

“We see a lot of females that struggle with eating disorders, but the rate of males struggling with eating disorders is also increasing. Men may struggle with orthorexia or trying to work out a ton to have a sculpted figure. They may be very uncomfortable in their skin,” she continues.

“We also see great risk to develop eating disorders in our transgender population. Research shows that transgender adolescents and children are at a greater risk for developing eating disorders. There may be anxiety around the conflict a person experiences between the way they feel and think of themselves and their current physical body type or assigned gender. It’s important to know that not all transgender people suffer from this condition, but for those who do the American Psychiatric Association has noted that those who struggling with this disease experience significant emotional distress,” adds Kelsey.

Getting the help you need

“What’s tough about eating disorders is they can sometimes be disguised as living a healthy lifestyle. Some people may not know the difference between eating a healthy nutrition plan versus being restrictive about it. When you’re in it, it’s hard to recognize you need help. It’s like that analogy of the frog in boiling water – as it slowly gets worse and worse, you don’t realize how bad it’s gotten,” says Kelsey.

“If you notice significant weight loss – especially with low self-worth or distortion of how you appear – it’s a sign something may be going on. If you are excluding certain foods and are very rigid in your routine, that may indicate that your issue is serious,” she explains.

Treatment for atypical anorexia is very similar to other anorexia treatments.

“It may start with having a therapist and dietitian walk you through creating a healthy meal plan. It usually includes therapy to process through the feelings behind the food and talk about their fixation and fear,” says Kelsey.

Higher levels of care are also available through intensive outpatient programs, partial hospitalization and inpatient or residential treatment.

Whatever your level of need, Swedish offers potentially life-changing care. “Swedish has behavioral health therapists and providers embedded in primary care that can help you get the care you need,” says Kelsey. “If you need more intensive treatment, specialized facilities in the Greater Seattle area address eating disorders and disordered eating. We can provide those referrals when needed.”

“Most importantly, don’t be afraid to ask for help when you need it,” says Kelsey. “The prevalence of eating disorders in our society is much greater than people are aware of. When people think of eating disorders, they think of someone that looks very frail or emaciated. But really, anyone can struggle with an eating disorder or have disordered eating.”

Learn more and find a provider

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