What is Atypical Anorexia?

When most people think about eating disorders, the terms anorexia and bulimia tend to come to mind. 

Today we're going to focus on a lesser-known eating disorder diagnosis: Atypical Anorexia.

 

What is atypical anorexia you ask?

 

Well, according to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5; a.k.a. THE diagnostic bible for psychologists and psychiatrists), Atypical Anorexia falls under a diagnostic category called Other Specified Feeding or Eating Disorders or OSFED.

 

So, let’s back up for a moment. For reference, there are several eating disorder diagnostic categories including:

  • Anorexia Nervosa
  • Bulimia Nervosa
  • Binge Eating Disorder
  • Avoidant or Restrictive Food Intake Disorder (ARFID)
  • Other Specified Feeding or Eating Disorders (OSFED)
  • Unspecified Feeding or Eating Disorders (UFED)
  • Pica
  • Rumination Disorder

 

We’re going to focus on a diagnosis from the OSFED category, which include feeding or eating behaviours that cause clinically significant distress and impairment to areas of functioning, but do not meet the full criteria for any other eating disorder. Atypical Anorexia falls under this category. 

So, this means that in the case of atypical anorexia, an individual would meet all of the same diagnostic criteria as anorexia nervosa, but the individual’s weight remains within a normal or above normal weight range.*

*Sidenote: I use the phrase “normal weight range” because it is used within the DSM and not because I agree with it philosophically or think it is particularly helpful. 

Why does this matter?

Well, the introduction of the diagnosis atypical anorexia is a big deal for a few reasons.

Until 2013, if you were someone who was:

1)Restricting your food intake (a.k.a. skipping/limiting meals)

2)Pre-occupied with you weight and/or shape (a.k.a. you and your body are not friends),

3)Had an intense fear of gaining weight (a.k.a. you are constantly worried about gaining weight), 

but were not (yet) clinically underweight, you could not be diagnosed with anorexia nervosa, and in many cases, would not be able to access eating disorder treatment to get help.

Heck, you could even be losing weight rapidly and experiencing all of the same psychological and physical complications that come along with having an eating disorder, but if you had a BMI of 18 or over, you technically weren’t “sick enough” to qualify for eating disorder help, by DSM-IV standards. 

I want to be clear that I write “sick enough” in quotations because of course if anyone is experiencing the above symptoms they are sick enough for help and what a ridiculous notion to be perpetuated for literally decades.

Fact: I know people who have had physicians/nurses/parents say to them “You are not sick enough yet” when attempting to seek help.

Another fact: By the time an individual is “sick enough” by DSM-IV standards, they often have had an eating disorder for years, making the illness more entrenched and treatment more difficult and complicated.

Most important fact: If someone is struggling at all, they are sick enough for help.

Maybe it was because more people die from eating disorders than any other psychiatric illness, or that the majority of people who were presenting with eating disorder symptoms didn’t meet the strict criteria of anorexia nervosa and bulimia nervosa, but at some point, someone was like:

Hey! What if, instead of waiting to help people until they are emaciated, we intervened earlier, you know, to help them before their body starts shutting down?

And the diagnosis of atypical anorexia was created. Hallelujah.

And you know what? Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia. Both are serious psychiatric illnesses, and both require professional help. Which means, thanks to the DSM-5, people can get help sooner now, which (not surprisingly) is linked to better treatment outcomes

Which brings me to another important point: anyone can have an eating disorder.  

That’s right, anyone. And you know what else?

You can’t tell who is struggling with an eating disorder by looking at them.

 

Eating Disorders Come in all shapes and sizes.

The notion that eating disorders only affect skinny wealthy white women is archaic/incorrect/boring. 

Overweight? You can have an eating disorder. Underweight? You can have an eating disorder. Totally normal weight as defined by our messed up societal beauty standards? You can have an eating disorder. Man? You can have an eating disorder. Woman? You can have an eating disorder. Trans? You can have an eating disorder.

You get it: Literally anyone can have an eating disorder.

So what can we do about it?

Well, a few things.

1) If you suspect you may have an eating disorder, reach out for help here or here

2) If you suspect someone you know is struggling with an eating disorder, let them know that you care about them and encourage them to reach out for help here or here

2) Stop engaging in Fat Talk. You don’t know who may be struggling with an eating disorder, and real talk: the only body that is your business is your own. Engaging in this type of talk about ourselves and others is damaging. For everyone. Let’s change the culture that contributes to the development of eating disorders in the first place.

And now, a moving and poetic personal account of atypical anorexia by the magnificent Blythe Baird:

If you or anyone you know in the Calgary area is experiencing a mental health crisis call the 24-hour Distress Centre line at 403-266-4357 or 911.

 
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