What Is Atypical Anorexia

Atypical anorexia nervosa (A-AN) is an eating disorder (ED) that shares nearly all the same psychological and behavioral features as anorexia nervosa: fear of weight gain, body image distress, and rigid food beliefs. The one major difference? People with atypical anorexia do not fall below a normal weight range. 

History Of The Diagnostic Criteria of A-AN

A-AN was officially added into the The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM5) in 2013 which falls under the Other Specified Feeding and Eating Disorders (OSFED). This change in diagnostic criteria was due to reduce individuals being categorized into an umbrella diagnosis, and ideally better outcomes to reach more folks needing specialised ED care. 

Understanding eating disorders more inclusively and expanding the understanding of diagnostic criteria has led to a shift with more folx getting care they need, however this system is far from perfect. With far too many individuals still unable to get the care they need due to the untangling of weight centric care and fat bias in health care, this continues to be an area for change. 

That means someone can lose a significant amount of weight, be deeply consumed by food rules, or engage in compulsive exercise, and still be told they’re “fine” or “healthy” because their weight range falls in normal, overweight, or obese categories. Unfortunately, this misunderstanding is why A-AN is so often underdiagnosed and undertreated.

Weight Bias in Healthcare

 A Critical Look at BMI and Weight-Based Healthcare 

As previously discussed, the diagnostic criteria of AN and A-AN are nearly identical, including significant restriction, intense fear of gaining weight, and high body image distress. But individuals with A-AN haven’t dropped below the "underweight" threshold. Our healthcare system often uses BMI as a gatekeeper for diagnosis and care, even though weight is not synonymous with health. As a result, many people with A-AN don’t receive the same urgency or support, even when they’re medically or emotionally just as compromised as someone with AN. 

This is an important moment to reflect on how deeply weight bias can affect access to care specifically in the context of this discussion, with individuals needing care for A-AN. Even when someone is experiencing intense restriction, medical instability, and psychological distress, their body may still fall within or above what is labeled a "normal" or "overweight" BMI range. I encourage you to pause and breathe deeply if this has affected you. I am sorry and you deserve care. This does not mean individuals in these weight ranges are without need for specialized ED care. Many individuals with A-AN are living in bodies close to their natural set point weight, a biologically regulated range that the body works hard to maintain. The presence of ED behaviors and medical risk may not be determined by BMI. Yet due to continued weight-centric frameworks and the challenge with providers using BMI as an individualised clinical tool, these individuals are often overlooked, invalidated, or delayed in receiving treatment. 

Rather than pathologizing weight, it’s important to challenge the pervasive anti-fat bias in our culture which does fall into our health care systems, and affirm that bodies come in many shapes and sizes, all of which deserve respect and care.

Atypical Anorexia Behaviors

A non-weight-focused approach can help us better recognize when someone is in need of focused care. Individuals may engage in the following: 

  • Preoccupation over calories, macronutrients, and/or ingredients

  • Fear or guilt around eating too much or eating “bad” foods (check out All Foods Fit for more on “good” vs “bad” food labeling)

  • Skipping meals or limiting food groups
    Intense fear of gaining weight
    Frequent body checking
    Exercising to “earn” or “make up for” food
    Withdrawing from social events, connections and increased isolation

Medical Risks Of Atypical Anorexia

  • Slowed heart rate (bradycardia)

  • Low blood pressure

  • Electrolyte imbalances

  • GI complications

  • Irregular, delayed or missed menstruation

  • Low bone density

ED Dietitian Nutrition Tips on How to Advocate for Inclusive Healthcare

Individuals may delay or dismiss seeking help because they believe they’re “not sick enough.” I’ve been told directly, “but my body doesn’t look like I have an eating disorder.” In the wise and compassionate words of https://www.sonyareneetaylor.com/ Sonya Renee Taylor, author of The Body Is Not an Apology, let’s shift the narrative and “turn body blame into accountability for people, systems, and structures that fail to treat all bodies with compassion, equity, and justice.” Weight-stigmatizing healthcare continues to be a major barrier to truly inclusive and accessible care.

If that’s something you’ve felt, please hear this:
You are valid. Your symptoms are real. And you compassionate deserve care.

When talking to a healthcare provider, it might help to:

  • Describe your behaviors and how they’re affecting your life outside of weight 

  • Mention physical symptoms (fatigue, GI issues, missed periods, dizziness)

  • Ask directly for vitals and labs assessing for malnutrition and orthostasis 

  • Bring a list of concerns or a support person to advocate with you

  • Ask for a second opinion from someone specialized in eating disorders

If a provider dismisses your experience, that’s not a reflection of your worth or need for care, it’s a sign you deserve someone more informed in your corner. The Side By Side team specializes in eating disorder recovery, intuitive eating, body image, weight-inclusive, Health at Every Size® nutrition counseling for both adolescents and adults. Together, through your grit and innate wisdom partnered with our experience and expertise, we support you in reaching your health goals so you can start living a life that empowers you.

Eating Disorder Awareness Trainings for Therapists, Dietitians, and Healthcare Providers

Join Us in Building Compassionate Care for Eating Disorders

We invite therapists, coaches, educators, and healthcare providers to take part in our online and in-person training sessions designed to deepen your understanding of anorexia, bulimia, BED, ARFID, OSFED, orthorexia, and disordered eating.

Led by our certified dietitians specializing in medical nutrition therapy, these trainings offer practical, evidence-based tools to help you recognize, assess, and support those struggling with eating disorders.

Together, we can create more compassionate, informed spaces for healing. 

References

Jamie MagdicSide By Side NutritionComment