Atypical Anorexia

Atypical anorexia shares many features of ‘typical’ anorexia, but without extremely low body weight. Learn what this means for the symptoms and treatment of atypical anorexia.

When people hear the terms “eating disorder” or “anorexia,” the image of an extremely thin person often comes to mind. In many cases, however, serious eating disorders are not accompanied by extremely low weight. People with eating disorders can be a normal or even above-average weight. This does not mean that an eating disorder is not serious.

This is the case for atypical anorexia nervosa, an eating disorder included in the most recent diagnostic guidelines under the category “other specified feeding or eating disorder” (OSFED). Atypical anorexia shares all of the features of ‘typical’ anorexia, except for extremely low body weight.

What Is Atypical Anorexia?

The atypical anorexia definition refers to an intense fear of weight gain and an extreme restriction of food and energy intake without extreme weight loss or very low body weight. This means that people with this eating disorder can have a normal or above-average body weight.

Some people believe that a normal body weight means that an eating disorder is less severe. However, the facts about atypical anorexia nervosa show that eating disorders come in many different forms. People with atypical anorexia still have problematic thoughts related to their bodies, weight and relationship with food. Regardless of how it affects a person’s size, atypical anorexia is a serious psychiatric condition that can greatly impact someone’s life, career and relationships. 

Presentation of Atypical Anorexia

An Atypical anorexia diagnosis is different from typical anorexia. Even though they are different diagnoses, they share many characteristics. These include: 

• Extreme emphasis placed on body shape and appearance
• Fear of weight gain
• Restricted energy intake

However, people with atypical anorexia are not severely underweight and do not have to experience significant weight loss to be diagnosed. This is the key difference between typical and atypical anorexia.

Because someone with atypical anorexia may be a normal weight or overweight, the eating disorder may not be as obvious. However, there are still many behaviors associated with the disorder. Atypical anorexia nervosa signs and symptoms include:

• Making excuses or avoiding situations where food is present
• Having an extremely rigid eating schedule or routine
• Obsessing about body size or shape
• Believing that they are a bigger size than they are 

As with typical anorexia, people with atypical anorexia may use food restriction as a coping strategy for stress, feelings of body dissatisfaction or low self-worth.

Living with Atypical Anorexia

Atypical anorexia can take over someone’s daily life, mentally and physically. Someone with this eating disorder may think about food and their body constantly. This can include calculating calories, thinking of ways to avoid situations with food or obsessing over body weight. 

This can be disrupting to other aspects of daily life, including social functioning, productivity at work and relationships with friends and family. People with atypical anorexia can also experience physical health problems due to malnutrition, or mental health conditions like depression or anxiety.

Dangers and Effects

Although atypical anorexia is not accompanied by severe weight loss or dangerously low body weight, there are still many concerning effects. Atypical anorexia carries similar dangers to typical anorexia. These can include:

• Extremely low heart rate
• Low blood pressure and lightheadedness
• Symptoms of anxiety, depression or obsessive-compulsive disorder
• Suicidal thoughts

There is some evidence that distress and poor body image may be even higher in people with atypical anorexia versus typical anorexia. This may be because people with atypical anorexia do not experience the “reward” or “relief” associated with weight loss. 

Treatment for Atypical Anorexia

Atypical anorexia nervosa treatment is similar to the strategies used in typical anorexia. Treatment usually addresses problematic behaviors and co-occurring health conditions as well as beliefs about self, body and weight.

Treatments for atypical anorexia include:

• Family-based therapy, which includes the whole family in addressing malnutrition and normalizing eating behaviors
• Nutritional rehabilitation
• Individual therapy
• Cognitive remediation therapy
• Exposure-based therapy

The type of treatment can depend on the person, their age and the severity of the eating disorder. Treatments might be used in isolation or in combination.

Ongoing Research

As a fairly recent addition to the psychiatric diagnostic manual, less is known about atypical anorexia than typical anorexia or other eating disorders. As a “new” disorder, this means that researchers have had less time to track the long-term outcomes for people with atypical anorexia.

Importantly, new research is looking at whether the absence of low body weight in atypical anorexia leads to different health outcomes than typical anorexia. 

One study has found that total weight loss or recent weight loss is a better predictor of health complications than being at a severely low weight. If a person has a significant weight loss but remains overweight or at a normal weight, they may still suffer from health problems like an extremely low heart rate. Although more research is required on the topic in the future, this work shows that it is important to take eating disorders seriously, regardless of body weight.

Eating disorders can lead to other mental disorders or substance abuse. If you or someone you care about shows signs of atypical anorexia in addition to a substance use disorder, contact The Recovery Village today to discuss treatment options.

If you or a loved one are suffering from atypical anorexia or other types of eating disorders, the Nobu app might be able to help. It is free and for anyone that is looking to reduce anxiety, work through depression, build self-esteem, get aftercare following treatment, attend teletherapy sessions and so much more. Download the Nobu app today!

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more

Medically Reviewed By – Dr. Sarah Dash, PHD

Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more