Why Atypical Anorexia Is A Problematic Diagnosis
“I’ve had a lot of messages from folks that are anorexic that are livid and angry because they feel like I’m lying. I am plus size, but advocating for diversity and larger bodies, and so I think for people hearing me say I’m anorexic was really jarring and hard and confusing.”—Tess Holliday
You may have heard the term “atypical anorexia” in the news recently, thanks to supermodel Tess Holliday bravely sharing her experience with this eating disorder on TV and social media. If you aren’t familiar with the diagnosis, we’re here to give you an overview and an explanation of why it really shouldn’t exist at all.
What does atypical anorexia mean?
Atypical anorexia means the exact same thing as anorexia nervosa. People who struggle with atypical anorexia use restrictive behaviors around food, have an intense fear of weight gain, are preoccupied with their body shape and size, and often have a distorted perception of their body.
What is the difference between anorexia nervosa and atypical anorexia nervosa?
The only difference between anorexia nervosa and atypical anorexia nervosa is that clients diagnosed with anorexia nervosa are medically underweight according to the BMI. Those with atypical anorexia nervosa are at or above what is considered a normal weight. Anorexia is the only eating disorder that mentions weight in the diagnostic criteria. Clients with atypical anorexia often do have significant weight loss, but still remain outside the BMI range specified in the criteria for anorexia nervosa. Not only does this weight criteria create stigma around atypical anorexia, but the BMI is not a good measure of health and also has a racist history.
What is it like to have atypical anorexia?
Atypical anorexia presents just like anorexia nervosa: your mind is preoccupied with concerns about your food intake and the size and shape of your body. You might obsessively count calories, cut out certain foods, engage in frequent body checking, compulsively exercise and starve yourself.
However, people dealing with atypical anorexia often face weight stigma and shame around their eating disorder and feel that their struggles are invalid because they aren’t underweight. Some clients may feel they have “failed” at having an eating disorder. Tess Holliday, who labeled her eating disorder as “anorexia,” has been criticized after revealing her struggle because she isn’t underweight.
Is atypical anorexia more common?
According to an Australian study in the Journal Of Eating Disorders, atypical anorexia has been reported to be five times more common than anorexia nervosa, but many cases are not accounted for in reports. It’s often an invisible illness that goes undiagnosed. Those who do receive a diagnosis are often misdiagnosed with binge eating disorder and less likely to seek treatment due to weight bias. And if they get treatment, they are often treated differently from patients in smaller bodies with anorexia by treatment providers.
Having the weight criteria in the diagnosis of anorexia nervosa prevents clients who struggle with the same symptoms and medical conditions from receiving equal and adequate care. Since many medical professionals are trained to take a weight-based approach to health, treatment providers may not use weight-restoring meal plans for atypical anorexia patients and might even prescribe exercise too early in their recovery, which can slow or derail their progress.
Weight and health are not correlated, so even if a client is at or above a “normal” weight, they can still be malnourished and suffer from physical complications, including cardiac complications (ranging from irregular heart rhythms to heart failure), heart, kidney and liver failure and bone loss/osteoporosis.
Eating disorders are life-threatening mental illnesses that may or may not affect someone’s weight. The thoughts, feelings, and behaviors around food, exercise, and body image are what drive the disorder.
Among eating disorder patients, there is already competitiveness around being “sick enough.” The diagnosis of atypical anorexia perpetuates that unhealthy comparison and minimizes the devastating impacts of the eating disorder. Every eating disorder is harmful, no matter how it affects body size.
At Kindful Body, we treat every eating disorder equally and take a weight-neutral, Health At Every Size approach to therapy and nutrition counseling. If you or someone you know may be suffering from atypical anorexia, contact us for a consultation.