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“Atypical” Anorexia

The stereotypical image of an eating disorder is that of an emaciated young woman.  She is typically portrayed as a skinny, beautiful, white girl from the suburbs who cannot see her body with accuracy and instead believes herself to be too heavy. 

While she makes for a catchy headline on a clickbait article, she only represents the 6% of people with eating disorders who are medically underweight. (and let’s not forget, she also doesn’t represent men, people of color, or any other variation in eating disorder presentation)

The other 94%, because they are of average or larger body size, are often overlooked and undertreated by a society that only imagines eating disorders as the stereotyped images portrayed in the media.

Eating disorders are mental health conditions marked by a variety of behaviors including, but not limited to, preoccupation with food and weight, excessive restriction of food intake, binge eating, compulsive exercise, and use of inappropriate compensatory methods for weight control (i.e., self-induced vomiting, laxative abuse, diet pill use), causing clinically significant levels of impairment or distress.  Though there are a lot of misconceptions about who has eating disorders, the fact is that these are mental health disorders, meaning we cannot see them.  These disorders do not discriminate based on body size, race, ethnicity, gender, sexuality, or anything else.

There are several diagnoses under the umbrella of eating disorders, but a commonly misunderstood diagnosis is “Atypical Anorexia.”  Below, you can see the criteria used to diagnose Anorexia Nervosa and its counterpart, Atypical Anorexia Nervosa.  Per the DSM-V, the behaviors and thought patterns described in the diagnostic criteria for Anorexia Nervosa must lead to a “significantly low body weight in the context of age, sex, developmental trajectory, and physical health.”  Though there is not a specific cut-off for the body size one must be to receive this diagnosis, the person must be at a lower weight than their body should be – this is because of the specific psychological impact of malnutrition.  This may or may not mean that the person is considered medically underweight.  To receive a diagnosis of Atypical Anorexia Nervosa, according to the DSM-V “all of the criteria for Anorexia Nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range” AKA it’s the same exact disorder but the person is not “medically underweight.”

Atypical Anorexia is not that atypical, though.  This presentation is actually 3 times more common than a “typical” presentation of Anorexia, and is associated with identical medical risks.  To be explicit, Atypical Anorexia is not a “less severe” disorder.  People with Atypical Anorexia actually tend to have more severe symptoms, are less likely to receive adequate treatment, more likely to delay treatment, and have a longer duration of illness on average.

A recent New York Times article, “You Don’t Look Anorexic”, shared several stories of Atypical Anorexia, highlighting the harm caused by misconceptions that eating disorders only affect impossibly thin women.  In one story, a woman with Atypical Anorexia described consuming an extremely low-calorie diet, misusing medications that cause weight loss, engaging in hours of high-intensity exercise per day, and regularly fasting.  She reported fainting on several occasions, experiencing “mysterious” health problems, and visiting multiple doctors and psychotherapists who either ignored, minimized, or encouraged her pursuit of weight loss.  She recalled one doctor telling her to do “anything to make the scale go down.”

In my experiences with clients who have Atypical Anorexia, I have heard countless stories like this one.  Even my thinner clients who are not quite “medically underweight” note experiences of their eating disorders being reinforced by therapists and doctors who, solely because of their body size, believe them to be “fine” or “not sick enough.”

Atypical Anorexia being deemed a separate disorder from “typical” Anorexia is plain fatphobia.  When we fail to adequately diagnose and treat eating disorders in 94% of cases, we allow people to suffer – and even die – meaninglessly.  Of course, people with “typical” anorexia struggle in recovery and often face significant barriers to receiving adequate treatment.  The U.S. healthcare system often values profits over patients, and fails us all.  For those with “atypical” anorexia, though, these barriers are multiplied.

Check out the resources below to help fight fatphobia in eating disorder treatment and see those leading the fight:

f you think you might benefit from improving your relationship with food/body image, click here to learn more about working with me.  Check out my social media below for free resources and updated information on my services!

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