Eating Disorders Diagnosis Atypical Anorexia Nervosa By Cynthia Vinney Cynthia Vinney Cynthia Vinney, PhD is an expert in media psychology and a published scholar whose work has been published in peer-reviewed psychology journals. Learn about our editorial process Updated on August 18, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Rachel Goldman, PhD, FTOS Medically reviewed by Rachel Goldman, PhD, FTOS Facebook LinkedIn Twitter Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change. Learn about our Medical Review Board Print FG Trade / Getty Images Table of Contents View All Table of Contents DSM Criteria Causes Symptoms Consequences Treatment Atypical anorexia nervosa includes all the signs and symptoms of anorexia nervosa with the exception that those with atypical anorexia are not underweight. In fact, people with atypical anorexia are within or above what is considered a normal weight range. As is characteristic of all types of anorexia, they’ve undergone significant weight loss due to restrictive caloric intake. Having atypical anorexia nervosa doesn't mean you require any less help or treatment than those with typical anorexia. Atypical Anorexia Nervosa in the DSM Traditionally, eating disorders like anorexia has been characterized by low body weight. However, in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-5), published in 2013, atypical anorexia was included in the category Other Specified Feeding or Eating Disorders (OSFED). It was defined as a condition in which all criteria of anorexia nervosa “are met, except, despite significant weight loss, the individual’s weight is within or above the normal range.” Diagnostic Criteria Diagnostic criteria for anorexia include: Taking in an inadequate number of caloriesA fear of gaining weightBeliefs that body size impacts self-worth Atypical Anorexia Is Often Misdiagnosed or Overlooked Even though people who have atypical anorexia show the same symptoms as people with anorexia, the fact that they're not underweight leads to people overlooking or misdiagnosing them. In fact, parents and doctors may even praise the weight loss of those with atypical anorexia because, even though the speed with which they’ve lost the weight is unhealthy, they don’t "look" sick or emaciated. However, it's important to note that we can't necessarily see if someone is sick—not from their body, shape, or appearance. It's important to look beyond someone's appearance and not assume that someone is healthy, or not healthy, from how they look. Atypical anorexia is actually quite common. Under 8% of people with eating disorders are underweight, with one study showing that, in addition to being considered a healthy weight, approximately 25% of those with atypical anorexia are overweight or have obesity. Causes of Atypical Anorexia Nervosa The causes of atypical anorexia are the same as those of other eating disorders. And while the causes of eating disorders in general are not especially well understood, there are a number of risk factors that may leave certain people more vulnerable. These risk factors can be genetic, psychological, or sociocultural, and include: An immediate family member has had an eating disorder, alcohol or drug addiction, or another mental health condition such as anxiety or depression Body dissatisfaction and internalization of socially-constructed ideas about what the so-called “ideal” body should look like Anxiety, low self-esteem, obsessive-compulsive disorder, or perfectionism A history of being criticized, teased, or bullied because of one's body weight, shape, or size A history of sexual abuse Causes and Risk Factors of Anorexia Atypical Anorexia Nervosa Symptoms In many cases, because there’s such a strong association between anorexia and low body weight, people with atypical anorexia are often overlooked. In addition, those who have atypical anorexia may point to their body weight to prove they aren’t sick. However, there are a number of symptoms of atypical anorexia (and typical anorexia) that aren't based on an individual’s size or shape. These include: Excessive focus on body weight Fear of gaining weight or having fat Exercising excessively Weight impacts self-worth Preoccupation with food and a refusal to eat certain foods Refusing to eat socially Making excuses for not eating Increased irritability, mood swings, and other difficulties regulating emotions Difficulty concentrating Although there is a lot of symptom overlap, it's worth noting that the DSM-5-TR (text revision) states that the physiological signs of anorexia and atypical anorexia aren't necessarily the same. The Connection Between Body Image and Eating Disorders Consequences of Atypical Anorexia Nervosa Because these symptoms are so often overlooked, those with atypical anorexia are often sicker for a longer period of time and are less likely to get the focused treatment they need. Yet, due to the prolonged malnutrition people with atypical and classic anorexia experience, the medical consequences can be equally severe for both groups. These consequences can impact every part of the body, and in some cases, affect the individual for the rest of their life. They include: Thinning hair or hair loss Yellow or dry skin Loss of bone mineral density potentially leading to osteoporosis (i.e., fragile bones) Menstrual irregularities in women, including the absence of periods Anemia (i.e., a low red blood cell count) Gastrointestinal issues such as dysphagia or acid reflux Constipation and abdominal pain Low heart rate or low blood pressure Lack of energy Anxiety, depression, or suicidality Death Research has shown that adolescents with atypical anorexia who are overweight or have obesity are just as likely as those with anorexia to suffer from low heart rate and a rapid rise in heart rate when standing up. The mortality rate among those with anorexia is six times higher than that of people without anorexia, and although there is less research on those with atypical anorexia, given the similar medical consequences, it’s likely the mortality rate for people with this condition is equally high. Meanwhile, research shows that people with atypical anorexia often exhibit greater eating disorder psychopathology, including distress around body image and eating, than people with anorexia. Atypical Anorexia Nervosa Treatment The sooner someone with atypical anorexia nervosa seeks and receives treatment, the more likely they are to recover. However, due to the perception that people of normal, overweight, or obese body weights cannot have eating disorders, it may be challenging to get the care they need. One study showed that when family members, peers, or healthcare providers expressed skepticism at their symptoms, people with atypical anorexia were left feeling confused and ashamed, and in some cases, it worsened their condition. Meanwhile, another study found that atypical anorexia occurs more frequently than anorexia, but those with atypical anorexia are less likely to be referred to and treated for their eating disorder. Unfortunately, due to the lack of research on atypical anorexia, there are fewer guidelines on how to treat people with the condition. Treatment Can Be Challenging Treatment for those with atypical anorexia, especially those who are or used to be overweight or have obesity, may be especially challenging because the individual must physically recover from the malnutrition brought on by significant weight loss and psychologically recover from eating disorder psychopathology while also dealing with the medical complications associated with being overweight or having obesity. It's essential that a doctor, clinician, or inpatient treatment program can prioritize, treat, and monitor each of these issues. In order to ensure the best possible outcome, people experiencing symptoms of atypical anorexia should seek out healthcare professionals who specialize in eating disorders, adhere to Health at Every Size principles, and practice weight-inclusive care. A Word From Verywell If you're experiencing symptoms that might indicate an eating disorder, it's important that you seek medical care right away. Also, a mental health professional can help you cope with any body image or self-esteem issues you may be feeling. Remember that you are not alone and recovery and healing are possible. Why Full Anorexia Recovery Is Crucial for Brain Health 12 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Association; 2013. Warme A. Atypical Anorexia Nervosa - Not So Atypical? Nutrition Connection. 2022. Rastogi R, Rome ES. Restrictive eating disorders in previously overweight adolescents and young adults. 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Exploring the experience of being viewed as “not sick enough”: A qualitative study of women recovered from anorexia nervosa or atypical anorexia nervosa. J Eat Disord. 2021;9(142). doi:10.1186/s40337-021-00495-5 Harrop EN, Mensinger JL, Moore M, Lindhorst T. Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. International Journal of Eating Disorders. 2021;54(8):1328-1357. doi:10.1002/eat.23519 Nagata JM, Garber AK, Buckelew SM. Weight restoration in atypical anorexia nervosa: A clinical conundrum. International Journal of Eating Disorders. 2018;51(11):1290-1293. doi:10.1002/eat.22953 By Cynthia Vinney Cynthia Vinney, PhD is an expert in media psychology and a published scholar whose work has been published in peer-reviewed psychology journals. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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