Atypical Anorexia

What is atypical anorexia?

Atypical anorexia or atypical anorexia nervosa is an eating disorder where people lose weight in ways that could be dangerous. It shares many symptoms with anorexia nervosa, like:

• Body image disturbance (thinking you weigh more than you do).
• Rapid, significant weight loss.
• Changes in eating and exercise habits.

But people with atypical anorexia had a higher body mass index (BMI) to start with. So, the outward signs of rapid weight loss may be less noticeable.

Atypical anorexia can cause serious medical and mental health conditions more serious than those caused by anorexia nervosa, partly because it’s harder to diagnose.

How common is this condition?

The number of people diagnosed with atypical anorexia nervosa is growing. About 25% to 40% of people in eating disorder treatment centers have this condition. The American Psychiatric Association first recognized atypical anorexia in the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

What are the symptoms of atypical anorexia?

Atypical anorexia symptoms include:

• Binge eating (eating a lot at one time and losing control of how much food you eat).
• Eating less and skipping meals.
• Exercising more than you used to and too hard.
• Feeling anxious or having mood swings.
• Feeling tired.
• Finding it hard to pay attention.
• Not liking how your body looks.
• Taking laxatives to lose weight.
• Thinking about hurting yourself.
• Vomiting.
• Wanting to be thinner no matter what.
• Worrying about getting heavier.

What causes the condition of atypical anorexia?

Studies show that a mix of factors can cause atypical anorexia. These factors include:

• Genetics: Studies show that if eating disorders run in your family, you might have a higher chance of having one, too.
• Trauma: You might start eating less to manage feeling sad, angry or scared — or after bad (traumatic) experiences.
• Environment and culture: Pressure from society and culture to be thin can make you feel like you must be skinny, too.
• Peer pressure: For kids and teens, it’s tough if friends or others make fun of them for how they look. This pressure can make them want to lose weight at any cost.
• Emotional health: Trying to be perfect or having bad relationships can lead to low self-esteem (feeling bad about yourself). Low self-esteem can lead to unhealthy eating habits.

What are the risk factors?

Anyone can develop an eating disorder like atypical anorexia, but it mostly affects teenagers and young adults, especially those assigned female at birth. LGBTQIA+ people are also more at risk. But it can also happen to anyone.

You may also be more at risk for atypical anorexia if you:

• Have a history of eating disorders or other mental health conditions in your biological family.
• Experienced trauma (physical, emotional or sexual).
• Have another mental health condition like anxiety, depression or obsessive-compulsive disorder.
• Participate in activities where your weight or body size is a factor (like gymnastics, wrestling, swimming).
• Go through a major life change like starting a new school or job, a divorce or a move.
• Have a driven personality and strive for perfection (perfectionist).

What are the complications of this condition?

Atypical anorexia can negatively affect different parts of your body like your:

• Electrolytes: Imbalances happen when you don’t have the right amount of minerals in your body, leading to muscle or heart problems.
• Kidneys: Quick weight loss can make it harder for your kidneys to filter out waste.
• Heart: Eating too little can cause you to have a slow heart rate (bradycardia) and low blood pressure (hypotension).
• Brain: Not enough food can lead to seizures, which are sudden changes in your brain.
• Stomach: You may experience nausea, bloating, constipation and vomiting.
• Endocrine system: Losing weight too quickly can affect your hormones, decreasing your levels of testosterone or estrogen. Low estrogen may stop your menstrual period.
• Blood: Not eating enough can cause anemia, making you feel very tired.
• Bones: Reduced bone density means your bones are weaker and more breakable.
• Hair: You might lose some hair or it might thin out. Fine hair may also grow on your body (lanugo).

How is atypical anorexia diagnosed?

Healthcare providers diagnose atypical anorexia by:

• Performing a physical exam.
• Reviewing your symptoms.
• Learning more about your eating and exercising habits.

They’ll also order some tests to rule out other medical conditions. These tests include:

• Complete blood count (CBC) to assess overall health.
• An electrolyte blood panel to check for dehydration and your blood’s acid-base balance.
• Albumin blood test to check for liver health and nutrient deficiency.
• Electrocardiogram (EKG) to check heart health.
• Urinalysis to check for a wide range of conditions.
• Bone density test to check for weak bones (osteoporosis).
• Kidney function tests.
• Liver function tests.
• Thyroid function tests.
• Vitamin D levels.
• A pregnancy test in people who are of childbearing age.
• Hormone tests to find issues with your period in people AFAB and measuring testosterone in people assigned male at birth (AMAB).

If there’s no other medical condition causing your symptoms, your healthcare provider may use the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) to determine if you have an eating disorder like atypical anorexia.

The diagnostic criteria for atypical anorexia include:

• Eating much less food than is usual for you.
• Fear of gaining more weight.
• Seeing your body in a way that’s not accurate or true. For example, you can’t see your actual body size or understand that you are smaller than you think. You might believe how you look is the most important thing about you and ignore the danger of eating too little.

How do providers treat atypical anorexia?

Treating atypical anorexia involves working with a team including your provider, a nutrition expert and a therapist who knows a lot about eating disorders. They’ll help you and your family understand and manage the recovery process.

Depending on your current medical and mental health state, you may need to receive treatment while in the hospital. Treatment for atypical anorexia involves a combination of the following strategies:

• Psychotherapy: Psychotherapy can help you change the way you think about food and body weight. It can also help you change how you respond to difficult situations. Options include individual, group and family therapy. Cognitive behavioral therapy (CBT) helps many people with eating disorders. This form of therapy helps you understand and change the thought patterns that drive your behavior and emotions.
• Medication: As people with eating disorders often have other conditions, providers often prescribe medication to treat them. Taking antidepressants or anxiolytics (antianxiety drugs) may help.
• Nutrition counseling: A registered nutritionist or registered dietitian who specializes in treating eating disorders can help improve your eating habits. They can also give you tips for grocery shopping and planning and cooking your meals.

How long does it take to recover from atypical anorexia?

The time it takes to recover from atypical anorexia differs for everyone. Being patient and sticking to your treatment plan will give you the best chance at recovery.

Specific treatment goals include:

• Making sure you’re healthy and any complications have resolved.
• Helping you get back to eating nutritious meals as often as needed.
• Improving how you think and feel, especially about your weight.

What’s the outlook for someone with atypical anorexia?

The chances for a successful recovery from atypical anorexia depend on:

• How long you’ve had atypical anorexia.
• How severe your condition is.
• The type of treatment you receive and how well you follow it.

Like other eating disorders, atypical anorexia gets worse the longer it’s left untreated. The sooner you have a diagnosis and start treatment, the better chances you have of recovering. If left untreated, atypical anorexia can be life-threatening.

Fortunately, recovering from atypical anorexia is possible. You can return to healthy eating habits. The risk of getting sick again (relapse) is high, so recovery requires long-term treatment. It’s important to stick with your treatment plan. You’ll need the support of your family and friends to help you stay on track.

How should I take care of myself?

No matter how scary or uncomfortable, it’s important to tell a loved one and your healthcare provider that you have atypical anorexia. The people closest to you need to know what you’re going through so they can support and help you.

If your healthcare provider has diagnosed you with atypical anorexia, here are some things you can do to help your recovery:

• Get enough sleep.
• Stay away from alcohol or drugs.
• If you take prescribed medication, be sure to take it regularly and don’t miss doses.
• If you participate in talk therapy, be sure to see your therapist regularly.
• Reach out to family and friends for support.
• Consider joining a support group for people with eating disorders.
• See your healthcare provider regularly.

Why do people with atypical anorexia still have health problems if they’re not severely underweight?

Although people with atypical anorexia may not have underweight, they lose weight too fast. This can cause serious medical problems. They also don’t get the proper vitamins and nutrients from not eating the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) suggested servings of whole grains, fruits, vegetables and low-fat dairy — or not eating enough. Both situations can also negatively affect their health.