The Unique Challenges of Atypical AnorexiaWhy Recognition, Treatment, and Compassion Matter — Regardless of Body Size
Here’s a thoughtful and evidence-based blog post on:
The Unique Challenges of Atypical Anorexia
Why Recognition, Treatment, and Compassion Matter — Regardless of Body Size
When most people hear the term “anorexia,” they picture someone who is extremely thin, visibly malnourished, or wasting away. But there’s another form of this serious eating disorder — one that often flies under the radar:
Atypical Anorexia Nervosa.
Despite the name, there’s nothing “less serious” about atypical anorexia. In fact, the symptoms, medical complications, and psychological distress are often just as severe — but because it doesn’t look like the stereotype, many individuals go undiagnosed, invalidated, and untreated.
What Is Atypical Anorexia?
Atypical Anorexia Nervosa (AAN) is a diagnosis under the DSM-5 category Other Specified Feeding or Eating Disorder (OSFED). It includes all the features of anorexia nervosa — intense food restriction, fear of weight gain, distorted body image — except one:
The individual is not underweight according to standard weight charts or BMI.
Often, individuals with AAN have lost a significant amount of weight, but remain in a “normal” or higher body size — and that’s where many of the challenges begin.
Unique Challenges of Atypical Anorexia
1. Delayed Diagnosis Due to Weight Bias
Many individuals with atypical anorexia are praised for their weight loss — even when that weight loss is the result of extreme restriction, disordered behaviors, and emotional suffering.
Medical professionals may overlook or dismiss symptoms if the patient doesn’t appear “sick enough”
Teens may be told their weight is “finally healthy,” even if they’re restricting, fainting, or obsessing over food
This leads to underdiagnosis and under-treatment
Research shows people with AAN often experience greater weight suppression and longer delays in treatment than those with typical anorexia (Sawyer et al., 2016).
2. High Psychological Distress in a Body That’s Invalidated
People with AAN often experience:
Intense body dissatisfaction
Obsessive thoughts about food, exercise, and weight
Perfectionism, anxiety, or trauma history
But because they don’t “look the part,” they may be:
Disbelieved or minimized
Denied access to treatment
Struggling with internalized shame — “I don’t deserve help.”
“The body may not be underweight — but the brain is still starving.”
3. Fear of Weight Gain During Recovery
Weight restoration is often needed in both anorexia and atypical anorexia. But for those in larger bodies, this can trigger:
Intense fear of becoming “too big”
Social stigma or fatphobia
Shame around being asked to eat more when the world tells them to eat less
This makes nutritional rehabilitation and weight acceptance uniquely challenging in AAN.
4. Overlooked Medical Risks
Despite being at a “normal” weight, individuals with AAN may still experience:
Bradycardia (low heart rate)
Electrolyte imbalances
Amenorrhea (loss of periods)
Bone loss or delayed puberty
GI complications, dizziness, fatigue
A 2019 study found that medical complications in AAN are just as severe as in low-weight anorexia nervosa (Garber et al., 2019).
5. Fewer Treatment Options That Address Weight Bias
Some eating disorder programs:
Have BMI cutoffs for admission
Don’t provide weight-inclusive care
May reinforce fatphobia or push “healthy weight loss” goals
This can lead to re-traumatization and limited access to safe, affirming care.
Final Thought
Atypical anorexia is not “milder,” “better,” or “less deserving of care.” It is real, dangerous, and absolutely worthy of early intervention and compassionate treatment.
If your child, patient, or loved one is restricting food, showing signs of anxiety around eating, or has lost weight — regardless of body size — they deserve full support.
“The severity of an eating disorder is not measured by weight, but by suffering.”
References
Sawyer, S. M., Whitelaw, M., Le Grange, D., Yeo, M., & Hughes, E. K. (2016). Physical and psychological morbidity in adolescents with atypical anorexia nervosa. Pediatrics, 137(4), e20154080.
Garber, A. K., Sawyer, S. M., Golden, N. H., et al. (2019). Atypical anorexia nervosa: Implications for medical risk and diagnosis. Pediatrics, 143(5), e20194008.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
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