Anorexia Nervosa Does Not Have One Look

There are many silent voices of pain in the eating disorder community, and some individuals don’t “look like” what a person with anorexia nervosa is assumed to look like.

The sad and honest truth is, there is no limit to who can be challenged with an eating disorder. From gender, ethnicity, socioeconomic status, and, yes, appearance, anorexia nervosa can infect the lives and minds of anyone.

The assumption that individuals with anorexia nervosa look a certain way is as dangerous as it is unfair. From loved ones to mental health professionals to doctors, many place the “look” of anorexia in a box, resulting in individuals not being believed, support being denied, diagnosis being postponed, and treatment being withheld.

“Atypical”

The Fifth Edition of the Diagnostic and Statistical Manual of Mental Illness (DSM-5) categorizes those that experience symptomatology of Anorexia Nervosa that are at “normal” weight or above as struggling with “atypical anorexia.”

This term, in-and-of-itself, lends to the assumption that there is a “typical” appearance of anorexia.” Atypical is defined as “not representative of a type, group, or class.” Despite this distinction, “one-third of eating disorder admissions are patients with atypical anorexia [1].”

Now, one third is not a majority, but it is enough to consider that, as is typical with eating disorders, there is more at play here than weight.

Same Symptoms, Same Consequences

The truth of a diagnosis of Anorexia Nervosa versus Atypical Anorexia Nervosa is that the primary difference truly is only the individual’s weight. This has never been more clear than when study results show the dire health consequences faced by those with an atypical anorexia diagnosis.

One study looked into the numerous health and psychological aspects of these disorders and found that, in many ways, individuals with atypical anorexia nervosa experience the same consequences, or worse, due to their disorder.

One result indicated that those with atypical anorexia were just as likely as those with anorexia to stop menstruating, noting this as “a hallmark of hormone suppression due to poor nutrition that impacts fertility and bone density [1].”

Additionally, both groups were “susceptible to electrolyte imbalances from inadequate sodium, potassium, calcium, and chloride intake, which can impact the brain, muscles, and heart functioning [1].”

Finally, “patients with atypical anorexia nervosa are as likely as underweight patients to suffer from bradycardia, or slow heart rate, a key sign of medical instability that can lead to irregular heartbeat and other complications [1].”

The study also noted that those with atypical anorexia scored higher in eating disorder psychopathology, such as “avoidance of food and eating, preoccupation with calories and eating in secret, feelings of fatness and discomfort seeing one’s body, dissatisfaction with weight and reaction to being weighed [1].”

Letting go of Assumptions in Diagnosis

Essentially, assuming that atypical anorexia nervosa is a less severe form of anorexia nervosa due to the lack of emaciation is unfounded and hazardous.

It is predicted that many individuals with atypical anorexia nervosa began living in a larger body. As such, their restrictive and harmful disordered thoughts and behaviors likely resulted in severe weight loss that is ignored because they do not appear dangerously gaunt or thin.

Medical and mental health professionals can be a reflection of the community as well as models for how to view eating disorders. If these individuals focus more on weight than behavior and assume that having weight means an individual is less at-risk, they are engaging in negligent assumptions that could result in harm.

It is instead incumbent upon all of them to acknowledge that appearance does not create criteria for diagnosis. Instead, metabolic measurements, psychological processes, and food and weight-related behaviors all need to be considered when looking at eating disorder diagnosis and severity.

If there is one thing we can always assume, it is that nothing is as it appears. As a result, we must look beyond the external and dig deeper to ensure early diagnosis and appropriate treatment.

---

Resources:

[1] Leigh, S. (2019). Anorexia nervosa comes in all sizes, including plus size. Retrieved from https://www.ucsf.edu/news/2019/11/415871/anorexia-nervosa-comes-all-sizes-including-plus-size.

---

About the Author:

Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

---

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published April 13, 2020, on EatingDisorderHope.com
Reviewed & Approved on April 13, 2020, by Jacquelyn Ekern MS, LPC