Atypical Bulimia Nervosa: Signs and Symptoms

Contributor: Courtney Howard, BA, writer for Eating Disorder Hope

Eating disorders come in all shapes and sizes, often deviating from the idea people have in their minds of what an eating disorder must look like. Conditions that do not meet the diagnostic criteria for a traditional diagnosis are labeled atypical, though many of the qualifying symptoms for said diagnosis might be present.

Atypical eating disorders fall under the umbrella of Other Specified Feeding and Eating Disorder (OSFED) in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), formerly known as Eating Disorder Not Otherwise Specified (EDNOS).

What is Atypical Bulimia nervosa?

Atypical bulimia nervosa is diagnosed when an individual’s disorder most closely corresponds with bulimia nervosa, yet does not fit all of the specified criteria.

According to the American Psychiatric Association, “DSM-5 criteria reduce the frequency of binge eating and compensatory behaviors that people with bulimia nervosa must exhibit, to once a week from twice weekly as specified in DSM-IV.” So, for example, if an individual has some behaviors consistent with bulimia nervosa but only engages in bingeing and purging cycles once per month, this would constitute as atypical bulimia nervosa.

Binge eating disorder (BED) now has its own diagnosis in the DSM-5, though this was once classified as an atypical eating disorder. Since BED is characterized by binges without engaging in compensatory behaviors, the overlap in symptoms often made it linked to atypical bulimia nervosa.

Signs and Red Flags

The signs of atypical bulimia nervosa are similar to those of bulimia nervosa, though their frequency and severity can vary.

Signs that an individual might be bingeing include spending an unusual amount of money on groceries, hiding or hoarding food, the presence of empty food wrappers, and eating large quantities in the middle of the night. If he or she goes to the restroom directly following a binge episode, this is a likely indication that the individual is also purging.

Those with bulimia nervosa, whether atypical or not, typically engage in compensatory behaviors following a binge. While purging can be done to reduce caloric intake, many also engage in these behaviors in an attempt to relieve anxiety and regain control after a binge.

If an individual spends inordinate amounts of time at the gym, particularly following large meals, this is a red flag that gym time is being used as a compensatory behavior. There is a fine line between a healthy exercise routine and compulsive exercise, which is continually blurred by society’s obsession with Fitbits and Crossfit.

Though some amount of bingeing and purging is typically necessary for an atypical bulimia nervosa diagnosis to be made, other behaviors might be minimal. For instance, the presence of these behaviors without preoccupation over weight or body image can signify an atypical disorder.

Physical Symptoms

Effects of bingeing and purging behaviors on the digestive tract include tooth decay, ulcers, gastrointestinal difficulties, and hemorrhoids. Compensatory behaviors, namely self-induced vomiting and laxative abuse, can also lead to dehydration and electrolyte imbalances.

Atypical bulimia nervosa can cause damage to the reproductive system. In women, this can lead to cessation of menstruation and infertility.

The thoughts and behaviors associated with atypical bulimia nervosa can also contribute to the development of other mental health conditions, or exacerbate those that were pre-existing. This can lead to an increase in substance abuse, self-harm, and suicidal ideation.

Treatment for Atypical Eating Disorders

Some people incorrectly assume that the word “atypical” denotes a less severe disorder. This can contribute to an individual’s feelings that his or her disorder is unworthy of treatment, or that professional help is not needed.

Rather, as a 2002 scholarly article [1] on the subject explains, “It is… important to stress that atypical eating disorders should not be viewed as mild or ‘subclinical’ in severity (in fact, a misuse of this particular term), since by definition they are associated with a clinical level of impairment.”

There are many treatment options available to those coping with atypical bulimia nervosa and co-occurring disorders. These range from outpatient services to inpatient hospitalization, depending on the severity of the disorder.

Community Discussion – Share your thoughts here!

What has been your experience with Atypical Bulimia Nervosa? What type of treatment helped lead you to recovery?

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About the Author: Courtney Howard is a Certified Life Coach specializing in eating disorders through Lionheart Eating Disorder Recovery Coaching. As a content writer at the Sovereign Health Group while writing freelance through Eating Disorder Hope, Courtney is a passionate advocate for recovery and works to fight the stigma surrounding all mental health disorders. She graduated summa cum laude with a Bachelor of Arts (B.A.) from San Diego State University, holds a paralegal certificate in Family Law, and is a Certified Domestic Violence Advocate.

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References:

[1]: Fairburn, C.G., Walse, B.T. (2002). “Atypical Eating Disorders (Eating Disorder Not Otherwise Specified.” Eating Disorders and Obesity: A Comprehensive Handbook. New York: The Guilford Press.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer 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.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on February 16, 2016
Published on EatingDisorderHope.com