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What Is Atypical Anorexia Nervosa?

Anorexia nervosa is a well-known eating disorder affecting, in large part but not entirely, teenagers and young adults who restrict caloric intake, often causing weight loss and a medically underweight condition.When most people think of someone with symptoms of anorexia nervosa, they think of a person who is thin, frail, and malnourished. However, there is evidence of another type of anorexia nervosa affecting people who have lost a significant amount of weight but are not considered clinically underweight.

Although atypical anorexia nervosa is indeed an eating disorder, people in anorexia nervosa recovery often do not show outward signs of serious medical complications associated with other eating disorders. This is not to say the health risks are reduced, only that the individual has not been deemed underweight by their doctors. Professionals in the eating disorder treatment sphere are aware of this variant, however. Consequently, anorexia nervosa treatment centers often perform blood and urine tests to determine if underlying health problems need to be addressed before beginning psychological therapy.

Atypical anorexia nervosa (AAN) is not listed as its own entry in the DSM-V Instead it is an Other Specified Feeding or Eating Disorder (OSFED). The DSM-V lists atypical anorexia nervosa, bulimia nervosa of limited duration/low frequency, binge eating disorder of limited duration and/or low frequency, purging disorder, and night eating syndrome as Other Specified Feeding or Eating Disorders as well.It may seem that these disorders, not having separate entries in the psychiatric manual, are not as dangerous or require less treatment than others, but don’t be fooled. They are serious mental health conditions in their own right.

Symptoms of Atypical Anorexia Nervosa

The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders defines atypical anorexia nervosa (AAN) as an eating disorder that meets all criteria for AN except that significant weight loss seen in people with atypical anorexia nervosa does not put that person out of their normal weight range. In addition, people with atypical anorexia nervosa presented the same assortment of cognitive distortions and abnormal eating behaviors characteristic of anorexia nervosa. Physical complications experienced by people with atypical anorexia nervosa are similar to complications diagnosed in anorexia nervosa, except for being clinically underweight.

In some cases, teens and young adults with atypical anorexia nervosa may even be above their normal weight range. This is one of the unexpected characteristics of this eating disorder that has led psychiatrists to name it “atypical” anorexia nervosa. Despite this, severe weight loss is often encountered in atypical anorexia nervosa cases, and similar medical complications, such as malnutrition, anemia, and bone density loss.

People with anorexia nervosa may emphatically deny they are severely underweight or even have an eating disorder. In most cases, people with atypical anorexia nervosa also deny they have an eating disorder or that their eating habits are negatively affecting their lives. When confronted with their eating disorder, individuals with atypical anorexia nervosa may try to minimize the impact of their eating disorder on their health, criticize family and friends for “picking” on them about a nonexistent problem, or blame others/situations for their eating disorder (i.e. relationship, job stress). Disordered thinking patterns have a way of causing their sufferers to defend them – this is often addressed by behavioral therapy such as CBT or DBT.

When constantly questioned about their eating habits, atypical anorexia nervosamay cause people to go to great lengths to conceal their eating disorder or claim they no longer restrict their food intake. This denial is also often exacerbated by mental health conditions like depression, anxiety, or OCD. People with one of these are much more likely to have an eating disorder; co-occurring disorders are very common in conjunction with eating disorders. Thus, the staff at eating disorder treatment centers usually perform extensive questionnaires and consult with psychiatrists when admitting new clients. Comprehensive care means treating every disorder simultaneously to achieve the best outcome.

Anorexia Nervosa Diagnosis Provided by Anorexia Nervosa Treatment Centers

People with atypical anorexia nervosa and their families often do not realize they have a serious eating disorder because of the weight-loss misconceptions clouding awareness of this disease. Because they are not necessarily extremely thin, they may not think they are sick enough to suffer from an eating disorder.In fact, the idea of being “sick enough” for treatment can prevent a person from seeking out help – or can even become a kind of competition among fellow eating disorder sufferers. The staff at any atypical anorexia nervosa treatment center should be aware of this and take steps to ensure every individual receives the care they need. When scouting a treatment center for yourself or a loved one, make sure to speak to the staff members before admitting to make sure of this.

Like other disorders like bulimia nervosa, binge eating disorder, and ARFID, anorexia nervosa in all forms is usually treated with a combination of nutrition planning and education, therapy, and behavioral modification techniques. The latter are largely Cognitive Behavioral therapy and its offshoots like Dialectical Behavioral Therapy and Cognitive Processing Therapy. These all have a slightly different focus but rely on the same core techniques. Namely, they each help individuals understand how emotion affects thinking, which affects behavior, which in turn affects emotion.

When an individual can objectively identify flawed thinking patterns or distorted emotion without acting on it and without judgment, they can begin to replace it. Thus CBT helps individuals do this through a back and forth series of conversations between the person and their therapist, asking them to consider their deepest feelings mindfully. Normally these sessions take place over months and can continue after residential treatment.

The Bottom line on Atypical Anorexia Nervosa

Lack of knowledge about atypical anorexia nervosa can prevent parents and teens from entering anorexia recovery programs. Weight loss is not the defining criterion for atypical anorexia nervosa, but the symptoms of anorexia nervosa are otherwise largely the same. There is much overlap between the two eating disorders and care should be taken when receiving a diagnosis for either eating disorder.

Treatment should not be ignored simply because a person does not become medically underweight. This is a good rule of thumb for all eating disorders. BMI and other measures of weight are not an indication of a person’s mental or (necessarily) physical health. Instead of focusing on a person’s weight, eating disorder recovery centers place their attention on mindfulness, nutritional and intuitive eating, and restoring a person’s body image.

Anorexia nervosa treatment centers specialize in diagnosing all eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and nighttime eating disorder. If a person is engaging in obsessive-compulsive behaviors involving food restriction, counting calories, counting fat grams, or performing ritualistic food activities during meals but is not underweight, they should be evaluated by professionals trained to recognize symptoms of an eating disorder. This is the first step to a full recovery – and it’s best to get started as soon as you can.

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.
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