Atypical Anorexia: How to Deal With the Mental and Physical Health Risks and Why There are Controversies About the Term

by Dr. Marianne Miller, Eating Disorder Therapist Who Specializes in Atypical Anorexia

Atypical anorexia has been in the news a lot in the past couple of years. Whether you’re living in Texas, California, or D.C., atypical anorexia is more common than you might think. Even though it’s considered “atypical,” it is still anorexia, and with it comes many mental and physical health risks. I have my own experiences having atypical anorexia, and the only differences were that (a) I didn’t “look” like I had anorexia in that I wasn’t unusually thin, and (b) NO ONE thought that I had anorexia, even though I demonstrated most of the symptoms. Let’s dive into the mental and physical health risks of atypical anorexia, and I’ll share more about my story of having it in middle school growing up in Denver, Colorado.

My Story of Atypical Anorexia Growing Up in Colorado

I had atypical anorexia when I was in middle school in Colorado, and no one knew it. I counted calories and severely restricted food. It got to the point at which I had regular stomachaches and lost my period (amenorrhea), and no one realized that I was so sick because (a) I didn’t look like a “typical anorexic,” and (b) It was the 1980s, and mental health disorders, and ESPECIALLY eating disorders, weren’t really understood or talked about.

I feel sad when I think of myself as a young girl, suffering all alone. During that time, I truly felt as though that was what I was supposed to be doing, so I could be thin and pretty and so others would approve of me, especially my family. I received so much positive feedback for losing weight, and I didn’t lose so much weight that I was put into the hospital, yet I was really, really ill.

I honestly didn’t realize that I had anorexia until I bean listing off all of the symptoms I had. I remember the “high” I got from restricting food. I thought that feeling hungry all of the time—especially when I went to bed—was a good sign. I read teen magazines that talked about losing weight and had articles of girls going on diets, and it affirmed that I was doing the right thing.

Yet I was suffering so much.

Mental Health Risks of Atypical Anorexia

There are a surprising number of mental health risks of atypical anorexia. Some of them have to do with mood. Others have to do with how you think and how you feel about yourself. Researchers have found that humans with atypical anorexia have as high or higher amounts of eating disorder-related mental health issues when compared to folks with anorexia.

So let’s talk about mood. Depression and anxiety often occur in people with atypical anorexia. Individuals may feel anxious about food, eating, and body image issues, or they may have more generalized anxiety about everything! Feeling sad, lonely, and isolated are also common experiences. Like many folks with atypical anorexia in San Diego, Dallas, Denver, and D.C., I hyperfixated on food and on my body. I was constantly running totals of calories in my head. Obsessive thinking and compulsive body checking happened most of the time. It was miserable.

Difficulty thinking and concentrating can also show up with atypical anorexia. So can mood swings and irritability. I was going through puberty at the time, so the mood swings and irritability were often attributed to hormonal changes. Now I wonder how much of those mental health symptoms were because of puberty, and how much of them occurred because I was so undernourished.

Physical Health Risks of Atypical Anorexia

Physical health risks of atypical anorexia include hair loss, amenorrhea (loss of periods). Amenorrhea can have long-term effects on the reproductive system. Other risks may include lightheadedness, dizziness, fatigue, and muscle damage.

Rapid and/or significant weight loss is another physical health risk of anorexia. Sometimes it’s a large amount of weight that is dropped. In some cases, there isn’t much weight loss—yet the person is still restricting their food and demonstrating other symptoms.

Here’s the thing: if the person doesn’t drop below a certain BMI, physicians don’t look at the weight loss as a problem. Children, teens, and adults can be really ill with an eating disorder, and medical providers will applaud them from getting out of the “obese” and “overweight” categories of the BMI (the BMI is total crap, btw—more on that a future blog post). It’s so frustrating.

Gastrointestinal (G.I.) issues are prevalent in folks with atypical anorexia. Bloating, constipation, stomach pain (like me), acid reflux, and GERD, are all symptoms people may experience. It often feels counterintuitive when eating disorder therapists and dietitians convince you to eat more as part of your atypical anorexia recovery journey. A main reason is because you may feel so bloated and full because of the G.I. issues, you can’t imagine eating more food.

Controversies With Atypical Anorexia

There are many controversies involving atypical anorexia. Researchers have discovered that individuals with atypical anorexia often face weight discrimination. It’s so difficult to become vulnerable and disclose to medical providers that you may have a restrictive eating disorder and have them respond with, “You don’t look anorexic.” These experiences not only delay the sufferer in getting eating disorder treatment, it also can foster medical care avoidance and phobias.

Such dismissal and invalidation lead to further oppression, as the individual feels isolated and experiences self-doubt, often saying to themselves, “I don’t look like I have an eating disorder, so I must not have one." It’s vital to remember that eating disorders don’t have a look.

Another controversy is that the word “atypical” suggests two things: (a) there is a “typical” or “normal” type of anorexia, and (b) it sounds less severe. The reality is that there are more people (4.9% of the population) with atypical anorexia than “classic” anorexia (0.6%). It also can be more difficult for insurance to cover eating disorder treatment for people with atypical anorexia, as they often qualify treatment based on BMI.

It’s important for us to keep the notion of atypical anorexia in the spotlight and move toward a more inclusive definition of anorexia that encompasses all genders, ages, and body types.

Struggling With Atypical Anorexia in California, Texas, or Washington D.C.? A San Diego Eating Disorder Therapist Can Help!

Work with me in person in San Diego, California, or virtually throughout California and Texas.

Find Resources on Atypical Anorexia on Dr. Marianne-Land: An Eating Disorder Recovery Podcast

Check out this episode, when San Diego eating disorder dietitian Amy Ornelas and I discussed all things atypical anorexia.

Follow Me on Instagram @drmariannemiller for Information on Atypical Anorexia

Coming to you from San Diego, California, I’m an eating disorder therapist and binge eating coach who offers education and encouragement on all types of eating disorders, including atypical anorexia, on my instagram account @drmariannemiller.