Comprehending Atypical Anorexia Nervosa

Atypical Anorexia Nervosa (AAN) shares characteristics with traditional anorexia by exhibiting restrictive eating patterns and psychological distress. However, unlike standard anorexia, individuals with AAN may experience weight loss due to unhealthy eating behaviors while maintaining a Body Mass Index (BMI) within or above the “normal” range.

What is Atypical Anorexia Nervosa?

AAN is a recently recognized diagnosis classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, under “Other Specified Feeding or Eating Disorders (OSFED).” It shares criteria with anorexia nervosa (AN) excluding weight. Therefore, individuals suffering from AAN experience significant weight loss yet remain within a “normal” weight range, leading to potential underdiagnosis by healthcare providers.

Those with AAN can experience equally severe, if not more serious, medical and psychological complications compared to those with traditional AN. These can include conditions such as hypophosphatemia (low serum phosphorus levels) resulting from rapid weight loss linked to restrictive eating, purging, or other disordered eating habits.

Is Atypical Anorexia Nervosa Common?

Recently, there has been a noted increase in individuals with higher body weights seeking specialized care for eating disorders. A 2022 research review highlighted that 25–45% of those in inpatient medical stabilization are individuals with larger body types. Additionally, a 2021 review indicated that AAN may be more prevalent than low-weight anorexia but is less commonly recognized in clinical settings. In approximately 71% of 58 studies that examined eating disorder center admissions, at least 10% of individuals seeking treatment were diagnosed with AAN.

Moreover, some treatment facilities have reported a remarkable rise in AAN cases over certain periods, including evidence of a fivefold increase among adolescents over a span of six years.

Symptoms of Atypical Anorexia Nervosa

Individuals with AAN may exhibit a range of symptoms, including:

Significant Weight Loss: Risky weight loss through restrictive eating, excessive exercise, self-induced vomiting, or laxative use, despite being in or above a normal weight range.
Fear of Weight Gain: An intense obsession with body weight and appearance, coupled with an overwhelming fear of gaining weight.
Restrictive Eating Patterns: Severely limiting food intake, avoiding specific foods, or engaging in extreme dieting measures.
Body Image Disturbance: A skewed perception of one’s body shape or weight.
Physical Health Issues: Symptoms such as fatigue, dizziness, fainting, hair loss, gastrointestinal disturbances, irregular menstrual cycles in females, and intolerance to cold.
Psychological and Emotional Changes: Heightened anxiety, mood fluctuations, irritability, withdrawal from social interactions, and obsessive thoughts about food and body image.

Causes of Atypical Anorexia Nervosa

AAN, like other eating disorders, arises from a complex interplay of contributing factors:

Genetics: A family history of eating disorders may elevate the risk, with some studies indicating female relatives of those with anorexia being 11 times more likely to develop AN.
Psychological and Emotional Factors: Traits such as perfectionism, impulsivity, and high neuroticism are commonly associated with eating disorders, often coupled with decreased assertiveness.
Sociocultural Influences: Societal norms, cultural emphasis on thinness, and media representations can significantly impact body dissatisfaction and incite disordered eating behaviors.
Traumatic Events: Adverse experiences may instigate the onset of eating disorders in predisposed individuals, particularly relating sexual trauma to anorexia and binge eating disorders.
Sports and Athletics: Athletic environments can increase the likelihood of disordered eating behaviors, driven by the pursuit of an ideal athletic physique or performance outcomes.

Health Complications of Atypical Anorexia Nervosa

AAN can lead to numerous health complications comparable to those observed in traditional AN, including:

Nutritional Deficiencies: Limited food intake can result in critical nutrient shortages, causing fatigue and other health-related issues.
Electrolyte Imbalances: Severe dietary restrictions may disrupt electrolyte levels, leading to complications like irregular heart rhythms or, in severe cases, heart issues.
Gastrointestinal Problems: Prolonged food restriction can cause digestive concerns such as constipation, bloating, or abdominal pain.
Hormonal Disturbances: AAN can disrupt hormonal levels affecting menstrual cycles in women and lead to irregular periods.
Bone Density Loss: Inadequate nutrition can decrease bone density, increasing vulnerability to fractures and osteoporosis.
Cardiovascular Complications: Severe malnutrition can impact heart health, resulting in low blood pressure or fainting episodes.
Mental Health Complications: AAN can exacerbate or prompt mental health challenges such as anxiety, depression, and social isolation, stemming from food and body image preoccupations.

Treatment for Atypical Anorexia Nervosa

Addressing AAN generally involves a comprehensive, multidisciplinary strategy tailored to individual needs, potentially including:

Medical Supervision: Regular health evaluations and monitoring of vital statistics, including electrolyte levels, are crucial, especially if physical health issues arise.
Nutritional Counseling: Collaboration with a registered dietitian to create balanced eating habits and overcome food-related fears.
Therapy: Therapeutic interventions—such as cognitive behavioral therapy, dialectical behavior therapy, or group therapy—are effective in resolving underlying psychological issues related to body image and disordered eating.
Medication: In specific circumstances, medications like antidepressants or anti-anxiety medications may be utilized to manage coexisting mental health conditions, though medication efficacy for anorexia remains limited.
Family Involvement: Family therapy or support can be valuable, particularly in adolescent cases or when family dynamics play a role in the eating disorder.
Education and Support Groups: Participation in support networks or educational initiatives can help individuals connect with others facing similar struggles while learning coping mechanisms.

Conclusion

Atypical Anorexia Nervosa challenges the conventional understanding of anorexia, impacting individuals with normal or above-normal body weight. Despite this distinction, the consequences can be equally or more severe than traditional anorexia. If you or someone you know may be suffering from AAN, seeking assistance from a healthcare or eating disorder specialist is crucial. They can provide an accurate diagnosis, recommend treatment, and offer the necessary support and resources.