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Atypical Anorexia: Why This Diagnosis Is A Problem

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What Does Atypical Anorexia Mean? 

Atypical anorexia (atypical AN or AAN) is the diagnosis that is given when a person is experiencing: 

  • Restriction in energy intake
  • Intense fear of gaining weight 
  • Disturbances in the way body weight/shape is experienced
  • Weight loss (recent rapid weight loss or total weight loss is too significant over the span of weight loss)
  • Drive for thinness
  • Guilt after eating

Atypical anorexia nervosa has all of the same diagnostic criteria outlined in the DSM-V of anorexia nervosa except the diagnosis does not include the low body weight criteria. 

Let’s explore some of the similarities between anorexia nervosa and atypical anorexia nervosa.  

In this article, we’ll go through some of the mental and physical health risks of atypical anorexia and how to minimize some of the barriers to healthcare access for people with this diagnosis.

Is Atypical Anorexia Valid? 

Yes. Atypical anorexia nervosa IS anorexia nervosa. 

I think to really emphasize this and hit home the point that these two diagnoses are one and the same is the original definition of anorexia.  Anorexia quite literally translates to lack of or loss of appetite for food.  

If you are experiencing body image disturbances or anxiety around food your experiences are valid. You deserve to receive medical and psychiatric support for your eating disorder or disordered eating no matter what your body weight, shape, and size are. 

AAN has serious health and psychological risks associated with the condition. Like those with anorexia nervosa, someone with a diagnosis of atypical anorexia nervosa may need intervention including hospital or inpatient treatment. 

What’s It Like To Have Atypical Anorexia? 

Symptoms

The physical symptoms of atypical anorexia are often congruent with the standard diagnoses of anorexia nervosa. They include: 

  • Slowed heart rate
  • Low pulse rate
  • Electrolyte imbalances (changes in sodium, potassium, phosphorus)
  • Elevated cholesterol 
  • Loss of period for women
  • Lightheadedness
  • Dizziness
  • Headaches
  • Fainting
  • Low bone mineral density
  • Hypotension 

Risks 

Those with atypical AN have many of the same medical risks as those with AN. 

However, those with Atypical AN are not likely to receive the same social and medical support as those with typical AN even though their health is likely severely compromised. 

Because of the weight stigma associated with eating disorders, those with atypical AN may feel as though they are failing at both their eating disorders and normalizing their relationship with food. 

This can increase the anxiety the person is feeling around their eating disorder even further, and potentially increase restriction and compensatory behaviors. 

Additional risks with atypical AN over AN are: 

  • Delayed treatment 
  • Reinforcement of the eating disorder by peers and support persons 
  • Prolonged weight loss 

It is important to implement an eating disorders recovery meal plan customized by a haes dietitian to meet the nutrient needs of someone recovering from atypical AN.

Those with atypical AN experience the same risks of refeeding which include the potential for

Comparing Anorexia And Atypical AN

Some things to consider as we examine those diagnosed with atypical anorexia over anorexia include: 

  • People with atypical anorexia had usual body weights which fell in the “overweight” or “obese” categories according to BMI standards (71% for atypical anorexia, 12% for anorexia nervosa). 
  • According to research, there is no difference found in occurrences of bradycardia (slowed heart rate) between AAN and AN patients. Both diagnoses experience bradycardia to the same extent. 
  • Those with Atypical AN typically have a greater overall weight loss than those diagnosed with  AN (17.6kg atypical AN, 11kg AN)
  • Psychiatric comorbidities and suicidal ideation are not statistically different among those with AN and atypical AN
  • Greater total weight loss and greater recent weight loss have a greater risk of low pulse rate (a dangerous or life-threatening side effect of restrictive eating)
  • Only 20% of those with AAN seek treatment for their condition

Problems With Attaching “Atypical” to the Word “Anorexia”  

The diagnosis AAN is extremely problematic from the mental health standpoint of the person experiencing restrictive eating.  

The body is very good at preserving body weight.  In fact, for the majority of people with anorexia nervosa, an “emaciated appearing” body will never exist despite rapid weight loss and health complications.  

This is because the body has mechanisms in place to prevent weight shifts even if a person is starving.  

These include 

  • Slowing down the heart rate
  • Reducing digestion rates
  • Stopping menses
  • Taking nutrients necessary from the bones and other non-preferred sources of fuel  

When we think about atypical anorexia, we should really be referencing those in an emaciated body. The emaciated appearing body is the exception rather than the norm when it comes to food restriction and eating disorder symptoms.

Treatment for Atypical Anorexia 

Barriers To Treatment: 

There are many barriers to treatment for someone with atypical anorexia that can pose health risks or even be life-threatening. 

Some barriers to treatment for atypical anorexia are: 

  • People with atypical AN may not meet weight admission criteria for some inpatient eating disorder facilities or hospitals
  • People with atypical AN may not qualify for insurance reimbursement for recovery services
  • People generally will not notice an eating disorder is present with atypical AN as these individuals don’t meet the stereotypical ED image of someone in an emaciated body
  • Disordered eating behavior resulting in weight loss for someone with atypical AN is likely to be praised by those in western society seemed in diet culture.  This increases the eating disorders behavior. 
  • Many with atypical AN do  not believe they are “sick enough” to receive treatment for their eating disorder 
  • With the diagnosis still being relative, research in this area is limited 

Since early detection of eating disorders is the key to a full recovery, those with atypical AN often suffer longer and more severely than those with a traditional AN diagnosis. 

Treatment that is weight-based continues to provide barriers to care for those with eating disorders. 

Treatment Overview

Those with atypical AN receive treatment in inpatient residential centers, hospitals,  outpatient,  and virtual outpatient settings. 

When you seek out treatment with atypical anorexia, it is common to expect: 

  • The necessity for weight restoration
  • Challenging fear foods and incorporating these into the meal plan
  • Assessing for body dysmorphia or other types of body checking and minimizing these behaviors
  • An eating disorder recovery meal plan tailored for your needs by a HAES dietitian 
  • Encouragement to stop calorie counting and other food ritual behaviors
  • A healthcare team of professionals such as an rd, therapist, and PCP 

Even if someone’s weight is within a normal BMI range, it is critical to weight restore for someone with Atypical Anorexia.  Malnutrition is still present and poses health risks to those who have lost weight with AAN, even if their weight is a “healthy BMI” or over the “healthy BMI” criteria.

© 2022 Peace and Nutrition

What is Atypical Anorexia?

Atypical anorexia is an eating disorder that includes all the diagnostic criteria for anorexia nervosa (restrictive eating, distorted body image, rapid weight loss) except the person does not meet the weight criteria for anorexia nervosa.

Is Anorexia Nervosa More Harmful Than Atypical Anorexia Nervosa?

No. Both of these conditions have serious health complications which can include bradycardia, reduced pulse rate, electrolyte imbalances, decreased bone mineral density, and even death.

Does Atypical Anorexia Require Weight Regain?

Yes. For most people weight restoration is critical for resuming normal metabolic and organ function even if the person is at a healthy BMI or by BMI standards “overweight” or “obese”

What are some problems with a diagnosis of atypical anorexia?

Access to care may be compromised by facility standards or insurance reimbursement, weight bias may exist, Persons with restrictive eating may not believe that they are sick enough to receive care, the eating disorder may go unnoticed for longer, persons with atypical AN may be praised for weight loss

Shena Jaramillo. Registered Dietitian

Hi I'm Shena. I'm an eating disorders dietitian in Washington state. I hold bachelors degrees nutrition & dietetics, cultural anthropology & psychology. I believe in honoring your hunger, having your cake whenever you want it, and that critically analyzing diet culture can change the world!

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