Atypical anorexia is an eating disorder characterized by under-eating, a distorted body image, and an intense fear of gaining weight. It is a less common variant of anorexia nervosa, a disorder that affects body weight, body shape, size, and eating behavior. It is one of the most serious eating disorders and is associated with significant physical and psychological complications.
Atypical anorexia: definition and overview
Atypical anorexia nervosa (AN) is a subtype of an eating disorder that has all the diagnostic criteria for anorexia nervosa, with the exception of not meeting the weight criteria. This form of an eating disorder is also referred to as EDNOS (Eating Disorder Not Otherwise Specified) or OSFED (Other Specified Feeding Eating Disorders). Individuals who struggle with atypical anorexia have similar characteristics as those with anorexia, including distorted body image and fear of weight gain and shape change. However, their symptoms may differ from those of someone with a ‘traditional’ diagnosis of AN.
Atypical Anorexia is associated with various factors such as:
- Intense fear of becoming ‘fat’, even when significantly underweight (as in true AN), yet still falling short of meeting diagnostic criteria for full-blown AN due to not falling within the appropriate BMI range
- Poor self-esteem
- Extreme perfectionism
- Distorted body image
- Difficulty making basic decisions independent from food and/or body related issues
- Food rituals required before meals can be consumed
- Poor insight into their eating disorder issues
- Generally low quality relationships with family/friends and inability to recognize people’s genuine attempts to help them recover
People struggling with atypical anorexia are at risk for long term medical complications such as amenorrhea and osteoporosis, as well as mental health challenges like depression and anxiety. Treatment typically involves evidence based multi modal approaches—the type depending on severity—such as nutritional counseling, individual therapy, psychopharmacology, support groups etc.
There are many signs that indicate if a person might have atypical anorexia or another related illness including changes in daily routines like sleeping or exercise habits; avoiding social activities where food could be present; skipping meals; limiting calorie intake; anxiety about gaining weight or changing shape; gaining acknowledgement through dieting/exercise behavior; ritualistic behaviors regarding meal times/food choices etc. It’s important to note that recovery looks different for each individual so it’s important that treatment is tailored to meet ones unique needs if they struggle with this condition.
Symptoms and signs of atypical anorexia
Atypical anorexia is a disorder different from the traditional form of Anorexia Nervosa, commonly referred to simply as “anorexia.” While the two disorders have some similarities, there are also significant differences between them.
Atypical anorexia is characterized by many of the same behaviors as traditional anorexia including restrictive eating, extreme preoccupation with weight, and body image issues. However, unlike traditional anorexia sufferers do not always display severe weight loss and other traditional symptoms like amenorrhea may be absent. Although atypical anorexics may appear thinner than their peers or family members they often appear relatively normal or even overweight depending on age and stage in life.
Some symptoms and signs of atypical anorexia are:
- Binge eating
- Severe depression
- Preoccupation with food choices
- Avoidance of meals or social settings that involve food
- Fear of gaining too much weight
- Body image distortion (often in which the person appears overweight to observers)
- Intense fear of failure or disapproval by others
- Feelings of guilt and shame surrounding food consumption
Someone suffering from atypical anorexia may also try to compensate for calories consumed by purging vomited food, excessive exercise or taking laxatives. It is important to note that even in cases where outwardly a person does not display more drastic dietary restrictions such as severely excessive dieting or fasting, a person can still struggle greatly with body image issues and intense anxiety around any route leading to increased weight gain – for instance overeating rarely eaten foods of higher caloric value even if it still falls within the range considered normal for that person.
Atypical anorexia is a condition where a person experiences many similar symptoms to anorexia nervosa, but does not have a dangerously low body weight. It is believed to be partially caused by socio-cultural influences, such as peer pressure and other external pressures to be a certain size and shape. Eating disorders can also be caused by genetic and physiological factors, such as a family history of eating disorders, trauma, or mental illness.
To better understand the causes of atypical anorexia, it is important to look at all the potential factors that may contribute to the development of this condition, including:
- Socio-cultural influences
- Genetic and physiological factors
- Family history of eating disorders
- Mental illness
The exact cause of atypical anorexia is unknown, but it is thought to have biological and environmental components. Research suggests there may be a genetic factor involved in the development of this disorder. It is also believed that environmental factors such as stress, trauma, or other life changes can trigger the onset of atypical anorexia.
It is likely that a combination of physical and psychological factors contribute to the onset of atypical anorexia. Biological theories suggest that changes in hormone or neurotransmitter levels or alterations in brain structure could be either causing or resulting from the eating disorder. Additionally, some researchers posit that disturbances in neurocircuitry related to appetite regulation are involved in the development of anorexia nervosa.
Other things that may influence eating behavior include:
- Cultural pressures about body image.
- Disordered thinking about eating.
Psychological factors that may contribute to the development of atypical anorexia include:
- Difficulty managing emotions or anxiety
- Low self-esteem
- A history of trauma or abuse
- Lack of social support
- Family dynamics such as a poor relationship with parents
Additional environmental and personal risk factors can include psychosocial stressors like bullying, isolation, perfectionism or fear of failure.
Individuals with atypical anorexia may also struggle with Obsessive-Compulsive Disorder (OCD) and Social Anxiety Disorder (SAD), which can fuel compulsive behaviors such as excessively counting calories and closely monitoring food intake. They may also experience body dysmorphia which is a distorted self-image that causes them to see themselves in an overly negative or exaggerated way. This distorted body image intensifies their fear of gaining weight due to their unrealistically high standards set for their physical appearance, leading to further restriction in eating pattern.
Behavioral issues such as impulsiveness and difficulties managing stress could lead to bingeing or purging behavior in individual suffering from atypical anorexia nervosa.
Social factors often contribute to the development of atypical anorexia. Pressure from family or peers to reach what is perceived as an “ideal” weight or body image, or a desire fit in, can lead an individual to restrict food intake. For example, someone participating in sports may feel driven to reduce their body weight in order to become more competitive or garner more attention on the team.
In addition, people with atypical anorexia may be seen by their families and friends as picky eaters with eating habits that fall outside the normal range, leading them to fear social judgement and avoid social situations where food may be present. Moreover, they may have inadequate support systems due to lack of understanding regarding their experiences with food and eating patterns.
Finally, research has suggested that atypical anorexia could be rooted in trauma experienced during childhood. For example, feeling a lack of control due to early life events could manifest into anxiety over food choices and intake later on in life.
Atypical anorexia is a condition that is difficult to diagnose, as the medical signs and symptoms can be variable. To be diagnosed with atypical anorexia, a person must have disturbed eating patterns and excessive weight loss or maintenance of a very low body weight that is not appropriate for their age, sex, developmental trajectory, and physical health. In addition, a person must also have a fear of gaining weight, body image disturbance, or extreme body dissatisfaction.
Let’s look into how atypical anorexia is diagnosed:
Atypical anorexia is a type of eating disorder characterized by disordered eating, fear of gaining weight or weight obsession, and body image issues. Diagnosis typically involves an in-depth examination of the individual’s medical history, with a focus on behaviors, symptoms, and attitude towards food and eating. The criteria used to diagnose atypical anorexia vary depending on the individual’s age as well as any other associated physical or mental health issues.
Diagnostic criteria for diagnosing individuals with atypical anorexia may include:
- Weight loss at least 15% below the expected body weight for age and sex
- Distorted Body Image
- Fear of gaining Weight
- Amenorrhea (absent or irregular menstrual periods) in females
- Obsessive or compulsive behavior regarding food and exercise
- Inability to maintain satisfactory body weight for height/age
- Visible signs associated with extreme weight loss such as dry skin, enlarged glands (glands in neck area), fine hair growth on face, swollen joints or bones.
- Mood swings accompanied by irritability, shame concerning body symptoms/weight.
Tests used to diagnose atypical anorexia
Diagnosing atypical anorexia can be challenging, as individuals with atypical anorexia often demonstrate more diverse symptoms than individuals with typical anorexia. As a result, physical, psychological and clinical tests must be conducted and evaluated in order to diagnose this condition.
- Physical Tests: Physical tests such as blood work, urinalysis and electrocardiography (ECG) are used to rule out other medical conditions that could potentially explain the individual’s symptoms. In addition, the individual may also receive a physical exam to detect any signs of malnutrition or dehydration.
- Psychological Tests: Mental health professionals such as psychologists and psychiatrists use psychological tests to assess a person’s mental health status and gain insight into underlying disorders or co-occurring conditions that could ultimately explain the individual’s behaviors. These assessments might include the use of diagnostic tools such as paper-and-pencil tests that measure eating disorder behaviors, thought patterns surrounding body image and mood disturbances such as depression or anxiety.
- Clinical Interviews: During clinical interviews with relevant medical care providers and mental health clinicians, individuals affected by atypical anorexia may be asked questions related to their medical history, family dynamics and lifestyle choices in order to gain further insight into the client’s presentation of these syndromes.
Once all these steps are followed, a diagnosis of “atypical anorexia” can then be given depending on how specific criteria are met within the DSM-5 diagnostic guidelines developed by the American Psychiatric Association (APA).
Treatment for atypical anorexia must be tailored to the individual’s needs. A combination of cognitive-behavioral therapy (CBT), nutrition education, and family-based therapy are often utilized. Medications may also be recommended to address depression and anxiety.
It is important that treatment is both consistent and supportive.
When it comes to treating atypical anorexia, it is important for the individual to get professional medical help as soon as possible. Proper diagnosis and treatment are essential for successful recovery. Treatment typically consists of a combination of medical, nutritional, psychological and physical therapies.
- Medical treatment may include medication to help stabilize an individual’s moods or behaviors and address obsessive-compulsive features of the disorder. Nutritional counseling by a registered dietitian is often recommended to ensure the patient receives adequate nutrition. Regular visits with a physician can help monitor a person’s health and ensure any medical conditions related to their weight are managed properly.
- Psychological therapies can include behavior modification therapy, cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT). These treatments focus on helping individuals recognize and challenge unhealthy thought patterns, behaviors or belief systems that contribute to their disorder or develop healthy coping skills to manage emotions or stressors that may lead to relapse.
- Physical therapies can also be beneficial in treating atypical anorexia, particularly in restoring healthy muscle tone and strength which improves quality of life immensely. Such activities might include swimming, walking, jogging or bicycling outdoors; weight training; tai chi; yoga; dancing; Pilates; martial arts etc. Activities can be done alone or with family members and friends – whichever the individual feels most comfortable with. It’s also important for individuals with atypical anorexia to learn relaxation techniques such as breathing exercises, meditation or mindfulness as these are helpful for both stress reduction and improving body image issues which often accompany this condition.
Medications used to treat atypical anorexia can vary depending on the severity of the disorder and the underlying cause of the symptoms. Generally, medications are prescribed to help manage some of the associated symptoms, such as depression or mood instability. These can include antidepressants and antipsychotic drugs.
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), are used to address depression that may accompany anorexic behaviours. SSRIs and SNRIs help raise levels of serotonin and norepinephrine in the brain, both of which influence mood. Common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa) and escitalopram (Lexapro). SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor).
Antipsychotic medications can be used to address any psychosis or associated symptoms related to atypical anorexia, such as hallucinations or delusions. Examples of this type of medication include aripiprazole (Abilify), risperidone (Risperdal) and olanzapine (Zyprexa).
Psychotherapy is one of the main forms of treatment for atypical anorexia and can often be used alone or in combination with other treatments like nutritional counseling, medical services and medication. Psychotherapy is essential to help individuals suffering from atypical anorexia better understand their disorder and how to make changes in their behavior.
Commonly used therapeutic approaches for addressing atypical anorexia include:
- Cognitive Behavioral Therapy (CBT) which focuses on restructuring negative thoughts about body image, shape, size beliefs and motivation to engage in disordered eating behaviors. Qualified therapists help individuals create more realistic goals that are healthy in nature focused on emotional regulation, improved communication skills and managing potential triggers.
- Interpersonal Psychotherapy which focuses on examining the relationship between a person’s disordered eating behavior and issues related to personal relationships or stressors within their environment (e.g., school or home).
- Family Based Treatment (FBT) which is designed for parents of young children struggling with atypical anorexia who are unable to make healthy food choices independently; FBT puts emphasis on parental responsibility for treating the child’s pathological dieting as well as improving self-esteem and restoring regular eating patterns.
- Nutritional Counseling which seeks to teach people how to eat balanced meals while providing useful information on nutrition such as vitamins, minerals, portion sizes, fats etc., so that persons with atypical anorexia can learn healthier meal plans.
- Supportive psychotherapy which is another approach used theoretically to provide non-judgmental support while helping clients manage current life situations that may be contributing the the development of disordered eating behaviors.
Atypical anorexia prevention is an important step for those at risk of developing the condition. Early recognition of warning signs and risk factors, along with prompt and appropriate intervention, can help to stop this disorder from developing. The goal of prevention is to intervene before any physical or psychological harm occurs.
There are a variety of prevention strategies, including education, early intervention, and professional treatment. Let’s take a closer look at the prevention strategies available:
Self-care strategies can be tremendously helpful in preventing and addressing atypical anorexia. Self-care includes taking steps to create a sense of safety and stability, fostering a balanced perspective toward yourself, and staying attuned to your needs.
Some common self-care strategies include:
- Acknowledging your worth without comparing yourself to others.
- Practicing positive self-talk, actively reframing negative thoughts about yourself into positive affirmations.
- Developing healthy sleep habits such as avoiding screens before bedtime and choosing calming activities like listening to music or reading before bed.
- Engaging in regular physical activity that focuses on strength building and cardiovascular activity like yoga or running.
- Experimenting with different forms of relaxation including deep breathing, mindfulness meditation, or progressive muscle relaxation techniques.
- Establishing consistent meal times that involve eating until you feel comfortably full rather than overeating or undereating. If your appetite is diminished due to illness or stressors, focus on eating nutrient dense foods that are high in essential vitamins, minerals, fiber and healthy fats.
- Building supportive relationships by surrounding yourself with people who will not judge you but instead value you for who you are as a person rather than how you look physically.
- Developing hobbies such as volunteering at an animal shelter or playing an instrument that offer opportunities to express emotion safely while forging meaningful connections with others outside of the family unit.
Support from family and friends
When individuals with atypical anorexia receive support from family and friends, it can significantly help them overcome their disorder. Loved ones need to remember that support is essential for recovery and must be given without judgment. This includes caring for the person without giving into their demands and distracting them from thoughts of food, calorie tracking, or body image issues.
People who are supporting someone struggling with atypical anorexia should also remain positive and not focus on what the person is not doing well.
It is also beneficial when a family member or close friend can accompany the individual to appointments and other events related to treatment or management of atypical anorexia. This is helpful for providing emotional reassurance as well as practical navigation of heath management activities such as:
- Refilling prescriptions
- Sticking to dietary recommendations
- Doing follow-up visits with physicians
- Engaging in outpatient therapies or day programs if necessary
Having this kind of help will assure that the person remains motivated in recovering from atypical anorexia while having someone they trust by their side throughout this journey.