Signs, Symptoms, and Treatment for Atypical Anorexia

Anorexia can impact people of all body sizes. While it is often associated with underweight individuals, many people struggling with this life-threatening illness may have average or above-average-sized bodies. It is essential to recognize that anorexia does not discriminate and can affect anyone, regardless of their appearance.

What is Atypical Anorexia Nervosa (AAN)?

Atypical anorexia nervosa (AAN) is an eating disorder characterized by restricted calorie intake and significant weight loss — similar to anorexia nervosa — but without the low body weight typically associated with the condition.

People with atypical anorexia often live in larger bodies and may be classified as “healthy,” “overweight,” or “obese” by medical standards. Despite experiencing substantial weight loss and employing unhealthy methods to control their weight, their body size can lead to confusion about their health and eating behaviors.

Because anorexia is commonly associated with thinner bodies, atypical anorexia frequently goes undiagnosed. Many healthcare providers may mistakenly recommend weight loss for those with atypical anorexia, overlooking the underlying eating disorder and potentially worsening symptoms.

Atypical anorexia is a newer diagnosis from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It falls under the “Other Specified Feeding or Eating Disorders” (OSFED) category.

This diagnosis acknowledges that eating disorders can affect individuals outside the typical underweight profile, highlighting the need for broader awareness and understanding of these conditions.¹

Symptoms and Signs of Atypical Anorexia

Atypical anorexia presents symptoms that closely resemble those of anorexia nervosa. Malnutrition can impact every system in the body, leading to various concerning signs. Here are the critical physical symptoms to watch for:

Physical symptoms of atypical anorexia

Significant weight loss: Noticeable reduction in body weight, often through restrictive eating
Dizziness or fainting: Frequent feelings of lightheadedness or loss of consciousness
Heart palpitations: Irregular or racing heartbeat
Hair loss: Thinning or loss of hair due to nutritional deficiencies
Frequent dental cavities: Increased risk of dental issues related to dietary habits
Gastrointestinal issues: Nausea, vomiting, abdominal pain, bloating, and constipation
Amenorrhea: Loss of menstrual periods in those who menstruate
Cold intolerance: Increased sensitivity to cold temperatures
Low blood pressure or heart rate: Bradycardia (slow heart rate) or hypotension (low blood pressure)
Lanugo: Development of fine, soft body hair as the body attempts to retain heat

Recognizing these symptoms is essential for early diagnosis and treatment, as atypical anorexia can have serious health consequences.

Behavioral symptoms of atypical anorexia

Loved ones may notice distinct behavioral changes in individuals with atypical anorexia, often centered around the need to control body size. These behaviors can also reflect the psychological and social impacts of rigid, disordered eating patterns. Common behavioral signs include:

Fear of gaining weight: Intense anxiety surrounding the prospect of weight gain
Wearing oversized, baggy clothing: Choosing loose-fitting clothes to hide body shape
Social isolation: Withdrawing from social situations, especially those involving food
Fear of high-calorie foods: Avoiding foods high in calories, sugar, or fat
Increased anxiety and depression: Heightened emotional distress related to eating and body image
Frequent bathroom trips after meals: Going to the bathroom soon after eating, possibly to purge or hide behaviors
Lack of flexibility around food choices: Rigid adherence to specific eating rules or routines
Dishonesty about food intake: Concealing what or how much has been eaten
Obsessively tracking calories: Constantly counting and monitoring caloric intake
Excessive exercise: Engaging in intense physical activity to compensate for food intake
Use of diet pills or laxatives: Relying on substances to control weight or manage eating
Frequent weighing: Checking weight multiple times a day, often obsessively
Avoiding food-related social settings: Steering clear of gatherings or events where food is present.

Recognizing these behavioral symptoms can be crucial for intervention and support, as they often indicate underlying struggles with body image and self-worth.

Medical Complications of Atypical Anorexia

Individuals with atypical anorexia face similar medical complications as those with anorexia nervosa. These can be serious and life-threatening.

Cardiovascular complications

Atypical anorexia can result in heart problems. Long-term restriction can cause the heart muscle to weaken over time. Restriction and purging can also lead to electrolyte imbalances that can cause abnormal heart rhythms.

Electrolyte shifts can occur for two main reasons:

Severe restriction: Leads to dangerously low levels of electrolytes in the bloodstream
Rapid increase in calorie intake: When calories are reintroduced too quickly, electrolytes like potassium, magnesium, and phosphorus can shift from the bloodstream into cells, potentially causing life-threatening heart rhythms.¹

Gastrointestinal complications

Malnutrition from atypical anorexia can severely impact gastrointestinal health. The body may struggle to digest food properly, leading to nausea, vomiting, constipation, abdominal pain, and bloating symptoms.

Long-term restriction can result in gastroparesis, a condition in which the stomach empties more slowly than usual, causing persistent nausea, early satiety, and vomiting. This condition may not always be reversible. Additionally, laxative misuse can alter gut function and create a dependency on laxatives for bowel movements.

Atypical anorexia can also contribute to other serious health issues, including poor kidney function, seizures, anemia, delayed wound healing, and a weakened immune system.¹

Treatment for Atypical Anorexia

Psychotherapy

Working individually with a mental health provider who specializes in eating disorders is essential for recovery. Your therapist will use a variety of therapeutic approaches to help you reshape your beliefs about food and yourself.

Family therapy can be an invaluable resource. Involving family members or significant others allows everyone to receive support from a mental health professional, foster healthy communication, and teach you how best to support you in your recovery journey.

Group therapy can also play a crucial role in treatment. Led by a licensed mental health provider, these sessions offer education and therapeutic activities that help you process emotions and develop effective coping strategies. Additionally, group settings provide peer support, connecting you with others who have similar experiences.

Nutrition therapy

A vital component of eating disorder treatment is learning how to nourish your body. A registered dietitian will work with you to set realistic, personalized goals and may provide a structured meal plan during the initial recovery phases. This plan will be adjusted as you progress toward intuitive eating.

Nutrition therapy also creates a space to explore your relationship with food and develop healthier habits. Your dietitian may help you:

Understand how your unhealthy relationship with food developed
Recognize the impact of your eating disorder on various aspects of your life
Learn about nutrition research and its practical applications
Practice flexibility with meals and snacks
Create strategies for navigating challenging eating situations, such as dining out or attending events
Challenge harmful thoughts about food, fostering a more neutral and positive perspective

Medication management

For many individuals, therapy and nutrition alone may not be sufficient. Medication can be an effective tool in the recovery process, particularly for those with co-occurring mental health conditions like anxiety, depression, obsessive-compulsive disorder (OCD), or bipolar disorder.

Psychiatrists — medical doctors specializing in mental health — can prescribe medications tailored to your needs. They will assess your symptoms, medical history, and other factors to develop a personalized treatment plan.

Moving toward recovery: embracing hope and healing

By integrating psychotherapy, nutrition therapy, and medication management, individuals with atypical anorexia can find a comprehensive approach to recovery that addresses both their physical and emotional needs.

If you or a loved one is struggling with anorexia, seeking treatment is crucial. Complete our contact form or call us to learn more about Toledo Center’s eating disorder recovery options.

Atypical Anorexia Nervosa: Signs, Symptoms, and Treatments