You are struggling to nourish yourself. You obsess over food from sunrise to sundown. You exercise compulsively. The thought of weight going any direction but down consumes your consciousness, stirs rage and remorse. You are losing touch with friends and family, missing out on important events, and feeling lost in your own skin. Your body tries to cope. It struggles to maintain levels of potassium, magnesium, and to use what little energy it receives to function. Your heart, literally and metaphorically, doesn’t beat the same. Your body’s on the brink. Perhaps even more concerning, your mind’s acuity fades. You feel foggy, disconnected, and estranged from reality, your world getting smaller and smaller, until hope shrinks from a flood light to a distant candle flame.
In a word, you are experiencing the brutal blend of symptoms called anorexia nervosa. However, if your body mass index falls above a certain line, you would receive a diagnosis of “atypical anorexia nervosa,” a diagnosis we will criticize here as, at best, misleading and, at worst, stigmatizing beyond the intense stigma many people with eating disorders already face.
What is Atypical Anorexia?
Atypical anorexia was included in the DSM-V (psychiatrists’ diagnostic handbook) to describe a segment of the population who experience the debilitating symptoms of anorexia without being classified as “medically underweight” based on BMI, a measure that has come under justified scrutiny (as it gives no data, unhelpful data, or untrue data on a person’s health). These criteria were set before mental health professionals knew if there were differences between the risks and experiences of clients with anorexia based on weight status. Spoiler alert: so far, there aren’t. But the designation of one type of anorexic client as “atypical” has served to disadvantage, stigmatize, and alienate many people with this illness.
How Common Is Atypical Anorexia?
Atypical anorexia is the most common type of anorexia. Let that sink in. Names have consequences. Funding for the research and treatment of anorexia in average size or larger bodies lags far behind funding to treat anorexia in smaller bodies, despite atypical anorexia affecting more people and posing serious health risks. Many insurance companies deny reimbursement for treating atypical anorexia on the ground that it is less severe and less urgent. But if you are experiencing the nightmare of food restriction, obsessive thoughts about your body, or compulsions to purge or exercise, believe us when we tell you that your symptoms are serious and you deserve care, no matter what the scale–or a medical field mired in diet culture–says.
How Severe is Atypical Anorexia?
Atypical anorexia carries the same risks as anorexia, and in some ways carries a greater risk due to the increased likelihood of clients’ concerns, need for weight restoration, and need to discontinue exercise going overlooked by even trained professionals. In other words, eating disorder symptoms are more likely to slide under the radar for clients who meet criteria for atypical anorexia. This leaves those struggling with this disorder more vulnerable for more time and likely to suffer longer. Since eating disorders progress in severity, poor screening and missed diagnoses contribute to a worse prognosis for this population.
No matter what body you’re in, disordered eating , purging, and compulsive exercise wreak havoc physically and psychologically. And yet we have practically never seen an eating disorder client who did not at some point voice a concern that they were not sick enough (which is a sick thought). In many cases, “not sick enough” is code for not being thin enough or not appearing as sick as the stereotypical person with an eating disorder. There is no evidence, however, that key markers of morbidity (mortality risk, cognitive decline, physical damage) differ between people diagnosed with anorexia or atypical anorexia. The charitable interpretation is that the psychiatric community made an honest mistake when researching for and drafting the criteria for eating disorders. The very existence of atypical anorexia in our diagnostic manual evinces the long and pervasive reach of anti-fat bias in medicine, a bias at the root of mountains of modern injustice.
Let this be clear: if you are sick at all, you’re sick enough. If you broke your arm, you would deserve to have the bone set and cast, even if it would have felt worse to break your femur. If you have been diagnosed with or meet the criteria for atypical anorexia, please know that you are not alone. Your experience reflects the majority of those afflicted with anorexia, and it is far from atypical. While it should not be your responsibility to advocate for adequate and ethical care, we encourage you to persist in your pursuit of healing even if medical providers dismiss or minimize your pain.
Some Tips for Navigating The Medical System
To procure better healthcare for so-called atypical anorexia, look for providers who demonstrate that they are Health at Every Size® (HAES®)-aligned. These providers will be more aware of the challenges that face people living in larger bodies, and they are more likely to screen for and treat eating disorder symptoms equally across the spectrum of body diversity.
Full Color Psychology offers specialized services in eating disorders and related issues. Drs. Corinne Hannan and Eric Ghelfi are both HAES®-aligned psychologists who can help you find food freedom and liberation from atypical anorexia as well as other eating disorders. Reach out today if you’re interested in getting help. We’d love to meet you.
