"Atypical" Anorexia? Not so much.
Let's talk about stereotypes.
When you think of a person with anorexia, do you think about thin, young, woman? If you answered yes, I wouldn't be surprised. There is a deeply engrained stereotype about anorexia which stems from a long history of systemic bias.
The definition of anorexia nervosa has a focus on weight and the appearance of thinness as part of it's diagnostic criteria in the DSM-5. The DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders) is a book published by the American Psychiatric Association. It includes all of the mental health diagnoses that you might have heard of — autism spectrum disorder, major depressive disorder, personality disorders, eating disorders, and more.
The DSM-5 states that a person must have lost significant weight, or appear to be underweight, in order to receive a diagnosis of anorexia. People with all the symptoms of anorexia who do not show low weight are sometimes given the diagnosis 'atypical anorexia'.
A Call to Action: Challenge Stereotypes
Eating disorders don’t have a 'look' and it’s time we move beyond outdated perceptions to create a more inclusive and compassionate understanding of these complex illnesses.
By challenging stereotypes, addressing biases, and advocating for inclusive treatment approaches, we can ensure that individuals with atypical anorexia receive the support they need to recover.
But here's the thing...
Atypical anorexia is actually not that atypical. It is quite common for people with normal or larger bodies to exhibit anorexia symptoms such as food restriction and an overevaluation of shape and weight. This can be just as severe and distressing for sufferers, yet it sometimes goes underdiagnosed and misunderstood.
Why Weight Shouldn’t Define Severity, or Be a Barrier to Treatment
The reliance on weight as a diagnostic criterion has led to significant barriers in recognizing and treating people with anorexia who live in bigger bodies. Research shows that individuals with atypical anorexia face many of the same psychological and physical risks as those with anorexia, including bradycardia, hypotension, and severe food-related anxiety. But people in larger bodies might be overlooked by healthcare providers because they don’t 'look sick enough'. This might leave them feeling undeserving of treatment, invalidated, and feeling like they need to prove how sick they are. These biases can delay treatment, and may even suggest to sufferers that they should keep suffering in silence. They may even think that getting sicker would make someone take them seriously.
How Can We Improve Awareness and Treatment?
Challenge Stereotypes
Eating disorders affect people of all body sizes, races, genders, and ages. It’s crucial to educate the public and healthcare providers about the diverse presentations of these disorders.
Whether you are a clinician or a client who is looking for support to breakdown your implicit biases, I am here to support you. Please feel free to reach out for more information, suggested readings, and to discuss counselling or clinical consultatio.
Focus on Symptoms, Not Weight
Healthcare professionals should prioritize psychological and behavioral symptoms over weight when diagnosing and treating eating disorders. And even when behaviours change, people may still experience distressing and all-consuming thoughts about their bodies. These are part of the disorder, and they need to be paid attention to and challenged as part of treatment.
Increase Research Funding
Atypical anorexia remains underexplored in the literature, and more studies are needed to develop evidence-based treatments tailored to this population.
Leverage Technology
Emerging tools like generative AI (GenAI) may offer innovative ways to improve diagnosis and personalize treatment for individuals with atypical anorexia. For example, machine learning algorithms have shown promise in identifying anorexia symptoms and pathology without relying on weight as a data point.
If you or someone you know is struggling with an eating disorder, remember that help is available. Reach out to a healthcare provider or a trusted organization for support. Together, we can break the stigma and barriers surrounding atypical anorexia.
Share Your Thoughts
What are your thoughts on the current state of anorexia nervosa treatment? How can we work together to reduce stigma and improve access to care? Share your thoughts in the comments below!
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Moreno, R., Buckelew, S. M., Accurso, E. C., & Raymond-Flesch, M. (2023). Disparities in access to eating disorders treatment for publicly-insured youth and youth of color: A retrospective cohort study. Journal of Eating Disorders, 11(1), 10. https://doi.org/10.1186/s40337-022-00730-7
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Walsh, B. T., Hagan, K. E., & Lockwood, C. (2023). A systematic review comparing atypical anorexia nervosa and anorexia nervosa. International Journal of Eating Disorders, 56(4), 798–820. https://doi.org/10.1002/eat.23856