What is atypical anorexia?
Atypical anorexia occurs when all criteria are met for anorexia nervosa such as restricting food and fluid, purging, and fear of gaining weight (read more about the symptoms of anorexia here). The defining feature of atypical anorexia is that the person affected is not underweight according to their body mass index (BMI), and they may even be in a higher weight body.
Despite restricting and/or purging, people with atypical anorexia do not lose a significant amount of weight. However, they still experience all of the serious health risks as people with anorexia.
Atypical anorexia diagnostic criteria
Atypical anorexia is not recognized as a separate diagnosis in the Diagnostic and Statistical Manual 5 (DSM-5), but falls under the category of “Other Specified Feeding or Eating Disorder” (OSFED). Atypical anorexia is diagnosed when a person meets the DSM-5 symptoms of anorexia except the low weight. It is important to note that a person with atypical anorexia can experience weight loss (and thus weight gain upon treatment), but the weight loss never falls below what is considered unhealthy on the BMI scale (this cut off is typically a BMI of 18.5)
Who is affected by atypical anorexia?
Just like anorexia, atypical anorexia does not discriminate and can affect both sexes, all gender identities, age groups, demographics and socioeconomic statuses. Because of the recent recognition of atypical anorexia, there are very few studies that assess who and how many people are affected by atypical anorexia.
One review of the research literature spanning 2007 to 2020, found that atypical anorexia occurs more frequently than anorexia with a prevalence of up to 13% (Harrop et al., 2021). In the same review, the authors found that the majority of people with atypical anorexia were adolescent females. Thus, despite its name, research suggests that atypical anorexia is not that atypical among the general population.
However, similar to anorexia, there are several reasons why this prevalence rate may not be reliable, including underdiagnosis of anorexia in males, older adults, people of color and LGBTQIA+ groups. Anorexia is underdiagnosed among all ages, sexes and genders but some groups are more affected. This underreporting is in large part attributed to the incorrect belief that anorexia is a disease that belongs to “young, white, wealthy, cis-females”.
Some of the groups that are affected by anorexia, but often go undiagnosed are:
- Males: Healthcare providers often overlook symptoms of anorexia in males and studies often do not include male participants.
- Older adults: Although anorexia typically emerges during adolescence, recent research shows that anorexia is also prevalent among older people. While this prevalence can often be attributed to chronic, untreated anorexia, new research also finds that anorexia can emerge in adulthood. However, these patients often go undiagnosed simply because of their age.
- Minority groups: People of color and LGBTQIA+ groups are also underdiagnosed, despite being at higher risk for eating disorders due to their higher load of trauma exposure.
In addition, atypical anorexia is often overlooked by researchers and healthcare providers because:
- It is a newer diagnosis and they lack awareness.
- They carry a weight stigma that leads them to think that only underweight people can have anorexia.
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Harrop EN, Mensinger JL, Moore M, Lindhorst T. Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. Int J Eat Disord. 2021 Aug;54(8):1328-1357. doi: 10.1002/eat.23519. Epub 2021 Apr 17. PMID: 33864277; PMCID: PMC9035356.
Vo M, Golden N. Medical complications and management of atypical anorexia nervosa. J Eat Disord. 2022 Dec 16;10(1):196. doi: 10.1186/s40337-022-00720-9. PMID: 36522787; PMCID: PMC9756584.
Sawyer SM, Whitelaw M, Le Grange D, Yeo M, Hughes EK. Physical and Psychological Morbidity in Adolescents With Atypical Anorexia Nervosa. Pediatrics. 2016 Apr;137(4):e20154080. doi: 10.1542/peds.2015-4080. Epub 2016 Mar 29. PMID: 27025958.
Walsh BT, Hagan KE, Lockwood C. A systematic review comparing atypical anorexia nervosa and anorexia nervosa. Int J Eat Disord. 2023 Apr;56(4):798-820. doi: 10.1002/eat.23856. Epub 2022 Dec 12. PMID: 36508318.