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Having been recovered from anorexia for over 10 years, I’d never heard of atypical anorexia until it recently came to my attention. I think it’s about time that it’s recognized that anorexia can just as serious in those who are not “underweight.”
According to the DSM-5 criteria, a clinical diagnosis of anorexia is based on criteria including:
- The persistent restriction of energy intake leading to significantly low body weight (in the context of what is minimally expected for age, sex, developmental trajectory, and physical health).
- Either an intense fear of gaining weight, becoming fat, or persistent behaviors that interfere with weight gain.
- A disturbance in the way an individual views their body, weight, or shape
Atypical anorexia nervosa is one of the five disorders known as “other specified feeding or eating disorder,” or OSFED, and meets all of the criteria for anorexia nervosa with the exception of low weight. Individuals with atypical anorexia nervosa engage in binging/purging and/or restricting behaviors, have an intense fear of gaining weight, and carry a disturbance in their self-image; however, they are of average weight as opposed to being underweight.
According to the Cleveland Clinic Journal of Medicine…:
“…compared with those who have anorexia nervosa, patients with atypical anorexia nervosa usually present for treatment after a longer duration of illness and are less likely to receive inpatient care, suggesting that the seriousness of their illness is not recognized because of their normal weight. Yet patients with atypical anorexia nervosa can be just as medically ill as their peers with anorexia nervosa and can have even greater eating disorder psychopathology.
“While it is well recognized that no body system is immune from the medical complications of restricting eating disorders, there is an emerging understanding that some of these same complications occur in patients with weight suppression (i.e., those who lose a lot of weight, regardless of whether they end up underweight). Specifically, from a cardiac standpoint, marked bradycardia, hypotension, and pulse nadir have been described. Although these cardiac findings resolve with nutritional rehabilitation and their long-term significance is not yet known, it is noteworthy that they can occur even when the absolute current weight is not low by traditional standards.”
I remember that during my last ED inpatient hospitalization in 2012, when an outpatient treatment program told me I was too sick for outpatient, I went inpatient, but the insurance company denied me after a couple of days due to my weight, which was low for me, but not low enough to meet the criteria for “anorexia.” Before I knew I had to leave, one of the other girls on the unit casually said to me, “Oh you’re here to maintain,” which devastated me, because I knew I was there to gain weight. Dr. Lev, my regular outpatient psychiatrist and therapist at the time, refused to see me until I had gained back the weight, which necessitated seeing a new therapist—an ED specialist, a stranger. But I did, and slowly I regained the weight, with starting back with Dr. Lev as the incentive.
I’m glad the “rules” have changed so that everyone can now get the help they need, regardless of weight.
Source: © Andrea Rosenhaft
