Teryn Franzen RDN, LDN

Nothing Atypical about Atypical Anorexia

May 25, 2023

Only 20% of those with eating disorders fit the “emaciated body” stereotype. OSFED (Other Specified Feeding and Eating Disorder) is now the most commonly diagnosed eating disorder, encompassing an estimated 70 percent of all diagnoses. It’s characterized by abnormal eating patterns, distorted body image and extreme consciousness of weight/shape. Heightened anxiety around meal times and compulsive exercise are common symptoms. OSFED consists of (but is not limited to) five primary presentations including atypical anorexia.

According to the American Psychiatric Association, atypical anorexia is used when an individual meets “all of the criteria for anorexia nervosa…except that despite significant weight loss, the individual’s weight is within or above the normal range.”
Atypical anorexia nervosa is researched a great deal less than anorexia nervosa, however, as it becomes more prevalent, researchers are increasing their awareness of this disorder.
Atypical anorexia nervosa hospitalizations comprise nearly one-third of hospital inpatient eating disorder treatment program.
1 in 4 adolescents with atypical anorexia present with Bradycardia, or slow heart rate.
1 in 3 adolescents with atypical anorexia have amenorrhea, an absence of menstrual periods.
At least 40% of those struggling with atypical anorexia nervosa warrant admission to a hospital.
Research indicates that psychological distress related to eating and body image is worse in atypical anorexia than anorexia nervosa.

Individuals in larger bodies are 2.5x more likely to engage in disordered eating behaviors than individuals with a “normal” BMI, but are only half as likely to be clinically diagnosed. Unfortunately, it’s common for these individuals to fall through the cracks and going without evidence-based treatment they deserve.

What are better markers of severity of disease?

Weight suppression
Functional impairment
Emotional, mental, and/or physical distress
ED psychopathology

The symptoms of atypical anorexia are the same for anorexia nervosa, including:

Significant weight loss yet being of a weight within normal limits.
Yellowing/drying skin.
Abdominal pain.
Gastrointestinal issues.
Reduced immune system.
Constipation.
Hyperfocus on body weight, size, and shape.
Low self-worth or distorted body image.
Intense fear of being overweight or having fat.
Hyperfocus on food, nutritional content, and/or bodily impact of food.
Refusing to eat or be seen eating by others.
Increased emotional dysregulation (irritability, mood swings, etc).
Difficulty thinking and focusing.

The long-term medical complications of atypical anorexia are the same as anorexia nervosa, including:

Damage to vital organs.
Bone and muscle loss/damage.
Reduced daily life functioning.
Cardiovascular complications.
GI complications.
Increased depressive symptoms and suicidal ideation.
Death.

It is our ethical responsibility as dietitians to treat our clients with compassion, respect for body diversity and autonomy, and to work to dismantle the many systems that disadvantage them. We focus on all the determinants of health in our work including: social, individual, and biological. If you are struggling and want to work towards healing, our compassionate dietitians are here to help. It’s important to note that all levels of eating disorders and disordered eating deserve treatment and support, and Nourish Family Nutrition’s Food Peace team is here to help.