What is Atypical Anorexia Nervosa?
Atypical anorexia nervosa (A-AN) is an eating disorder characterized by an intense fear of gaining weight and a distorted perception of weight. People with A-AN use extreme efforts that often interfere with their lives to control their weight and shape. With support from expert clinicians, people with atypical anorexia nervosa – regardless of how long they have been living with the condition – can recover.
Atypical anorexia nervosa v. anorexia nervosa
Atypical anorexia nervosa and anorexia nervosa are very similar, with the only difference being that those with A-AN, despite significant weight loss, have a weight that is within or above the normal range.
Signs of atypical anorexia nervosa
There are some common behaviors associated with atypical anorexia nervosa. Friends and family can look out for the warning signs below.
Significant or rapid weight loss
While those with A-AN are at or above their ideal body weight, significant or rapid weight loss is a common warning sign.
Overvaluation of weight & shape
Individuals with atypical anorexia nervosa may define their self-worth primarily by their body shape and/or weight.
Fear of weight gain
An extreme fear of gaining weight is also a common sign of A-AN. Individuals with A-AN might weigh themselves daily and get upset if they’ve gained or haven’t lost weight. For those with a history of being overweight, they may express excessive fear of regaining weight. These concerns are often experienced to an even greater degree than seen in those with anorexia nervosa.
Skipping meals or eating alone
Someone with A-AN may skip meals or frequently eat alone. They might refuse food, say they aren’t hungry or say that they have already eaten. This might expand to skipping whole meals, like frequently skipping lunch or breakfast.
Frequent body checking
Another warning sign is frequent body checking or weight tracking. They might weigh themselves daily or constantly check their body in the mirror.
Obsession with dieting & nutrition labels
Those with atypical anorexia nervosa may be preoccupied with food, dieting or nutrition labels. They might be overly concerned with calories or nutrition labels. They might diet on and off or try new diets regularly.
Atypical anorexia symptoms
While severe anorexia nervosa involves many behavioral symptoms, it can also have serious health consequences. Rapid and significant weight loss commonly associated with A-AN can pose serious health risks, including:
- Abnormal vital signs
- Osteoporosis and osteopenia
- Hormone dysregulation
- Refeeding hypophosphatemia
Medical complications of atypical anorexia nervosa
While atypical anorexia nervosa and other eating disorders are mental illnesses, they are also one of the few conditions that are regularly accompanied by severe medical complications. Unlike with anorexia nervosa, which has been studied for decades, the medical complications of A-AN are less understood.
Bradycardia
Bradycardia (heart rate under 60 beats per minute) is often encountered in those with atypical anorexia nervosa, especially young people.
Hypotension
A-AN is also associated with hypotension.
Amenorrhea
It is common for adolescents and adults with A-AN to experience amenorrhea (loss of menses) and oligomenorrhea (irregular menses). Osteopenia & osteoporosis
Although the cause is not clear, A-AN can increase the risk of osteopenia and osteoporosis due to decreased bone mineral density as a result of either a directly related to weight loss or reduced estrogen levels due to menstrual abnormalities.
Refeeding hypophosphatemia
Although the research is not clear, there is likely a relationship between weight loss and development of this electrolyte abnormality.
Psychiatric Comorbidities of Atypical Anorexia Nervosa
Research demonstrates that 55-95% of people diagnosed with an eating disorder also receive a diagnosis for another disorder. A-AN shares many traits with other mental illnesses, so it is common to see individuals with atypical anorexia nervosa living with multiple conditions.
Obsessive-compulsive disorder
The prevalence of obsessive-compulsive disorder (OCD) is higher in patients with A-AN, with many of the characteristics of OCD bring mirrored in A-AN pathology.
Generalized anxiety disorder
Many individuals with atypical anorexia nervosa have generalized anxiety disorder (GAD). Anxiety can exacerbate eating disorders due to the intense fear or anxiety surrounding body image and food.
Major depression
Eating disorders and major depressive disorder have significant overlap in emotional presentation, sharing traits like low self-esteem and body dissatisfaction.
What Causes Atypical Anorexia Nervosa?
There is no one cause of anorexia nervosa. We know that anorexia nervosa develops through a variety of means. Genetics, personality, co-occurring psychiatric disorders and sociocultural environment can all contribute to the development of an eating disorder.
Genetics
Although the clinical presentation of anorexia nervosa and A-AN are quite similar, the genetics of A-AN is currently understudied, although a recent study suggests that A-AN may have different underlying genetics than anorexia nervosa.
Personality Traits
Perfectionism
Many studies have demonstrated that patients with anorexia nervosa self-report higher levels of perfectionism and score higher on perfectionism scales. Perfectionism is also elevated in individuals with A-AN.
Low self-esteem
Lower self-esteem correlates with greater eating disorder symptoms in both anorexia nervosa and A-AN.
Sociocultural Environment
The thin ideal
The cultural pressure to achieve the thin ideal has been linked to increased body dissatisfaction and weight concerns, which may contribute to the development of atypical anorexia nervosa.
Weight stigma & body shame
Those with A-AN were also more likely to be teased for their weight growing up. Across different media there is also a tendency to praise weight loss, particularly dramatic weight loss, which can push those who feel stigmatized for their size to lose weight at any cost, often with encouragement from friends and family.
Atypical anorexia nervosa treatment
We believe lasting recovery from atypical anorexia nervosa is possible. Sustained recovery from atypical anorexia nervosa is always the goal, and for many the first steps are medical stabilization and nutritional rehabilitation.
ACUTE aims to support patients in their eating disorder recovery by helping them achieve medical stabilization and nutritional rehabilitation. Once these are achieved, patients can continue their journey and embrace recovery at lower levels of care.
To achieve these goals, we support patients with:
- World leading medical expertise in the medical treatment of eating disorders
- Evidence-based multidisciplinary care across internal medicine, dietetics, nursing, behavioral health, physical therapy, occupational therapy and speech therapy
- Around-the-clock 1:1 nursing supervision
- Blood chemistry, vitals monitoring and treatments for other medical and/or surgical comorbidities
- Air ambulance transfer when necessary
How is inpatient medical hospitalization different?
Unlike other treatment programs, ACUTE is a medical hospitalization unit. Inpatient medical hospitalization is the highest level of eating disorder care, delivered in a hospital setting and primarily focused on treating severe medical complications. Patients at an inpatient medical hospitalization level require monitoring of vitals, intravenous fluids, daily lab monitoring and/or medications that aren't available at lower levels of care.
Who does ACUTE treat?
ACUTE accepts patients who are too medically complex for lower levels of care.
- 15+ years of age
- All gender expressions
- Severe medical complications associated with atypical anorexia nervosa
Get connected to care
Our admissions specialist can help assess your needs and determine the appropriate level of care.
Even if ACUTE isn’t right for you, our experienced admissions team can connect you with other programs that meet your needs.
Living a Life Recovering from Anorexia Nervosa
“ACUTE completely changed my life. If it wasn’t for ACUTE, I wouldn’t have my life back. I might not even be here to share my story. ACUTE saved me. They showed me that recovery was possible. They were with me on every good and bad day and shaped me into the person I am today."Rachel