Because we usually associate anorexia with a person being underweight, atypical anorexia nervosa often goes underdiagnosed and undertreated.
What is Anorexia Nervosa?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the manual medical professionals generally use to diagnose mental health disorders. Created with the contributions of over 200 experts, it represents the official record of all currently recognized mental health disorders, including a number of different eating disorders.
According to the DSM-5, the most recent version of the manual, diagnostic criteria for anorexia nervosa consists of three distinct elements: [1]
People with anorexia nervosa generally have a distorted sense of their own body, often perceiving their weight, shape, and body size to be much different than it actually is.
Generally, this is coupled with negative body image and low self-esteem, with the person viewing themselves in an unfairly harsh light. People with AN also tend to fixate on this topic, with outsized concern over body weight, shape, and size, as well as food, marking another common sign of the condition.
People with anorexia nervosa commonly have intense anxiety around weight gain, far beyond what might be considered a health concern for one’s health and appearance.
People with this condition may take weight gain personally, perceiving it as a major failing, or seek to lose as much weight as possible, often setting unsafe weight loss goals or attempting to lose weight indefinitely.
This anxiety will frequently manifest as something called persistent weight gain interference. This symptom describes someone who will actively try to avoid weight gain by almost any means.
Anorexia nervosa is, in large part, driven by energy intake restriction, although many people engaging in this behavior may not be familiar with the term.
The concept refers to limiting caloric intake relative to what is otherwise understood as the required levels for someone’s specific age, height, sex, developmental trajectory, physical health, and other factors.
In other words, someone who struggles with AN will be ingesting fewer calories on a regular basis than their body needs to continue functioning in a healthy way. This behavior is often combined with a significant level of exercise, further burning off energy and leading to dangerous and rapid weight loss.
Being Anorexic and Overweight
Many aspects of anorexia nervosa commonly lead to becoming underweight. However, that is not always the case when it comes to this condition.
Atypical anorexia nervosa can impact people who present as at or above a normal weight range, yet who still struggle with the common signs and symptoms of AN.
Shared Physical Signs & Symptoms
Significant weight loss can still take place in individuals with atypical AN, though they will remain in a “normal” or “above-normal” weight range. This may be due to the person starting off at a higher weight, making it more difficult to detect the effects of atypical eating behaviors.
Researchers are also split on how “significant weight loss” should be defined. Some argue that as little as 5% weight loss could be indicative of anorexia nervosa, when combined with other aspects of the condition. [2]
Regardless, the disordered eating patterns of someone struggling with atypical AN can still lead to malnutrition. Cisgender women may stop menstruating, and a loss in bone density may also be detected, among other signs. [3]
Shared Psychological Signs & Symptoms
Many of the psychological effects of anorexia nervosa also carry through for those with atypical AN.
People struggling with this condition are equally as likely to experience intense fear and anxiety, negative body image, and a distorted perception of their body shape, weight, and size. And people with atypical AN also frequently fixate on the subjects of weight, body image, and food. [3]
Unfortunately, people who present as overweight but struggle with anorexia nervosa are often misunderstood—and sometimes misdiagnosed.
Many practitioners may focus too much or exclusively on weight barometers, missing the psychological symptoms or even the signs of malnutrition in someone in a larger body. But if you or a loved one are showcasing signs or symptoms of disordered eating, asking some questions may help you better understand what’s going on.
Warning Signs that Someone May Have Anorexia While Overweight
Along with the shared signs and symptoms of anorexia nervosa and atypical AN, there are a number of other factors that may point to someone struggling with the condition, including: [4]
- Unusual eating habits, such as cutting food into small pieces and moving it around their plate instead of actually eating it
- Going to the bathroom immediately after meals
- Refusing to eat around other people
- Using diuretics or laxatives excessively
- Blotchy skin
- Dry mouth
- Extreme sensitivity to cold
- Osteoporosis
- Depression
- Confusion or difficulty thinking clearly
- Poor memory
People who experience atypical anorexia nervosa may also turn to unhealthy exercise habits in an attempt to control weight. This could look like overexercising, exercising in secret, or failing to adjust their diet to their level of activity. [5]
While we typically associate exercise with improving health, there can be too much of a good thing. Unhealthy exercise habits can have a negative impact on someone’s physical health, mental health, and/or life balance, and actually damage a person’s body under the wrong circumstances.
Talking to a Loved One About Anorexia
Talking to a loved one about any disordered eating behavior is difficult. But this can be especially hard when discussing atypical AN, as the condition is less commonly recognized.
Before talking to your loved one, you may want to research the subject, so you can come into the conversation more well-informed. Many people with atypical anorexia nervosa may struggle to understand that it’s possible to have an eating disorder while presenting in a larger body.
What to Expect
It may take multiple conversations to get a person to understand and admit that they have an eating disorder.
Generally, it’s advised to have these conversations in a place that is private, and comfortable for your loved one. Their home—or their room, if you live together—may be a good setting to help ensure they’re as relaxed as possible during this difficult discussion.
In fact, the stress of the situation could lead to your loved one reacting negatively. Many people grow angry and defensive when approached about disordered eating behavior.
It’s important that you don’t respond with anger if this occurs, and to stay away from using judgemental language. Instead, focus on how you care about your loved one, and let them know you’re concerned about their mental and physical health.
Finding Help
It may also be beneficial to come to the conversation with some ideas about how to help.
As a non-professional, you may be limited in how much you can personally do. Instead, you can work on having your loved one agree to speak with a reputable medical worker, or go to a treatment facility where they can get expert help.
Options can be researched online. Make sure to keep in mind several potential priorities, including where the professionals or centers are located, their cost, the insurance they accept, and the type of therapy they utilize.
While recovering from anorexia can be a long process, choosing to seek professional help is a huge milestone, and in fact, is one of the most critical parts of recovery. It is the first step on a journey to a healthier, happier future.
Resources
- Diagnostic Criteria for Anorexia Nervosa (DSM-V). (2020, April 16). MedicalCriteria.com. Retrieved July 6, 2022.
- Forney, K. J., Brown, T. A., Holland-Carter, L.A., Kennedy, G. A., Keel, P.K. (2017, April 24). Defining “significant weight loss” in atypical anorexia nervosa. International Journal of Eating Disorders; 50(8):952-962.
- Leigh, S. (2019, November 6). Anorexia Nervosa Comes in All Sizes, Including Plus Size. University of California San Francisco. (2019, November 6). Retrieved July 6, 2022.
- Anorexia. (2020, May 10). National Library of Medicine. Retrieved July 6, 2022.
- Unhealthy Exercise. (2018, January 25). Center for Clinical Interventions. Retrieved July 6, 2022.