Written by: Samantha DeCaro, PsyD
Director of Clinical Outreach and Education at The Renfrew Center
What is “Atypical” Anorexia (AA)?
The word “atypical” is at best misleading – and at worst – dangerous and stigmatizing in the context of restrictive eating disorders. There’s nothing unusual or uncommon about the symptoms of “atypical” anorexia, yet the word “atypical’ suggests otherwise. It implies a difference significant enough from anorexia nervosa (AN) to warrant a separate diagnostic code under the Other Specified Feeding and Eating Disorder (OSFED) category in the DSM-5, an umbrella diagnosis that lumps together a wide range of eating-related conditions.
The truth is this: someone diagnosed with “atypical” anorexia experiences the exact same symptoms as someone with anorexia; the only difference in criteria is that, despite “significant weight loss,” weight remains in the “normal” or “above normal” range (American Psychiatric Association, 2013). As any qualified eating disorder professional knows, weight does not protect the brain and body from the serious medical and psychological effects of restriction. Since many people believe that only underweight bodies can suffer from restricted intake, it often comes as a surprise that malnourishment, severe medical complications, and psychiatric issues can occur at all weights, shapes, and sizes.
Restrictive eating disorders are mental and emotional disorders; weight-centric diagnostic criteria, weight stigma, and longstanding stereotypes contribute to internalized shame and interfere with timely screenings, assessments, diagnoses, and referrals to specialized treatment. Despite the fact that “atypical” anorexia is more prevalent than anorexia nervosa – and affects more men and more people of color than AN – it continues to be under-studied and under-represented in clinical settings (Harrop et al., 2021).
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Is “Atypical” Anorexia Less Serious than Anorexia Nervosa?
No, “atypical” anorexia is not less serious than anorexia, and there are studies that suggest that certain symptoms may be more severe. There is mounting evidence that both disorders, regardless of weight, are associated with serious medical and psychological complications, many of which may require inpatient hospitalization. Various studies have found that these disorders are nearly identical, showing similar medical complications, eating disorder symptom severity, depression, vitamin and nutrient deficiencies, low bone mineral density, abnormal lab results, and even decreased gray matter in the brain – yet research suggests those with “atypical” anorexia often experience more severe psychiatric impairment, including greater body dissatisfaction, greater concerns about weight and shape, and stronger drives to pursue thinness compared to subjects with anorexia (Jablonski, et al., 2024; Fitterman-Harris et al., 2024; Johnson-Munguia et al., 2024; Nagata et al., 2024; Davis et al., 2024; Lyall et al., 2024).
Some may be shocked to learn about these findings, as many people mistakenly believe that fat stores on the body can protect our brains and bodies against starvation. These beliefs fuel the false notion that restriction is only harmful for thin bodies, while the dangers of restrictive eating in larger bodies continue to be minimized or completely dismissed. Simply put, human beings cannot survive on fat stores alone. While fat provides energy, it cannot supply the essential amino acids, nutrients, vitamins, and minerals, and glucose required for a variety of critical bodily functions. Certain micronutrients in the brain can deplete long before weight loss occurs, many of which play key roles in our mood, sleep, cognition, and overall physical and mental health. Moreover, the brain alone is responsible for about 20% of resting metabolic energy needs, and relies on a continuous supply of glucose, which cannot be fully provided by fat breakdown alone (Brady et al., 2011). Ultimately, the body’s need for nourishment is universal, and the harm caused by restriction is profound regardless of size. When we see the symptoms of anorexia through this lens, we can respond with the urgency and clinical seriousness every person deserves.
Why “Atypical” Anorexia is Minimized, Missed & Misdiagnosed
Many people, including medical providers, hold stigmatizing beliefs about weight and unconscious assumptions about what an eating disorder “looks like.” These assumptions often align with the stereotypical image of anorexia: a skinny, white, affluent girl (the so-called “SWAG” stereotype). For higher-weight individuals, restrictive eating is often praised by family and friends, and medical providers may even prescribe dieting and continued weight loss. To complicate matters, the multi-billion-dollar diet and fitness industries normalize and encourage restriction – it is often branded and sold as a morally righteous form of self-care, further obscuring the seriousness of what may be a clinical eating disorder. When someone does not “look the part” of someone with anorexia, symptoms of restriction may be minimized or dismissed entirely, even by seemingly experienced professionals.
Feeling seen and understood is a cornerstone of effective healthcare; weight stigma in medical and mental health settings can leave patients feeling invalidated and reluctant to seek help or disclose eating disorder symptoms. Patients may experience immense confusion and begin to question whether they are truly struggling or even deserve help. Many may find themselves working harder to prove that their eating disorder is severe enough to warrant professional attention. This “not sick enough” mentality can delay treatment, contribute to symptom escalation, and increase the risk of relapse.
Weight stigma and biases can also interfere with treatment access. One study found that healthcare providers are more likely to recognize an eating disorder, refer to specialized treatment, and recommend medical follow-up when a patient is “low weight” (Silbiger, 2024). When funding for eating disorder care uses weight-centric criteria, higher-weight patients may be denied necessary treatment or given shorter lengths of stay under the false assumption that they are less vulnerable. Misdiagnoses are also common; individuals in larger bodies may be incorrectly diagnosed with binge eating disorder or another eating disorder that doesn’t match their actual symptoms.
The language and diagnostic framework surrounding “atypical” anorexia also contribute to misconceptions and minimization. Because the word “atypical” may be interpreted as a milder form of anorexia nervosa, both patients and providers may underestimate the severity of the disorder. Additionally, healthcare providers may simply be less familiar with “atypical” anorexia compared to more traditional eating disorders. They may not even realize their patient is experiencing a psychiatric condition that can – and should – be assessed and treated.
LEARN MORE: “They Don’t Look Like They Have an Eating Disorder”
Treatment & Support
Treatment for eating disorder symptoms and body dissatisfaction goes far beyond weight or food. Eating disorders are emotional disorders at their core. In treatment, the focus is not on the label of the diagnosis, but rather the eating disorder symptoms and behavioral cycles that are causing physical, mental, and emotional harm. We work with clients to understand what is fueling their patterns, develop skills to tolerate and respond to distressing emotions, and gradually shift the role that restriction plays in managing distress or meeting deeper needs.
Recovery involves significant emotional work, which may include healing relationships with oneself and with others, while reconnecting with one’s authentic identity, core values, and passions outside of societal expectations or body ideals. Clients learn that improving their relationship with food and their body is not about the number on the scale, but about restoring the body’s natural signals, meeting metabolic needs, and reclaiming a feeling of emotional safety and trust in the body. In recovery, food can become a source of pleasure, culture, celebration, and connection once again.
At the same time, eating disorders exist within a broader social context, and that reality cannot be ignored. Internalized weight stigma, diet culture, and other oppressive systems deeply influence how individuals relate to themselves and their bodies. Effective and compassionate treatment addresses these wounds directly, naming and validating the harm caused by these forces, and helping clients dismantle internalized shame. Treatment can also provide practical skills to support clients in advocating for change and seeking inclusive, empowering communities throughout the recovery process. As awareness grows, and the cultural roots of eating disorders become clearer, clients may begin to cultivate self-compassion and develop a deeper desire for systemic change.
Conclusion
Restrictive eating disorders are frequently overlooked, minimized, and even misdiagnosed among people who are not “underweight.” Much of this stems from deeply ingrained weight stigma, both in society and within healthcare systems. Healthcare providers who are unaware of their own biases can easily damage the trust patients have in these systems, exacerbate restrictions, and deepen shame. Body size cannot measure psychological pain, reflect symptom severity, or reveal medical risk, and it certainly cannot determine whether someone deserves help. Restrictive eating disorders do not discriminate by weight, shape, race, or gender, and the dangers of restriction are real, serious, and often overlooked.
Healing begins when we reject weight-based assumptions, recognize the impact of weight stigma, and focus on the underlying emotional and cultural forces that fuel eating disorder symptoms. Compassionate, evidence-based care prioritizes restoring safety and trust in the body, addressing the emotional roots of restriction, and finding food freedom beyond the lies of diet culture and societal ideals. Awareness is the first step toward change: by challenging stereotypes and advocating for equitable treatment, we can ensure that every person struggling with the symptoms of anorexia, regardless of their body size, receives the care, validation, and support they deserve.
If you or a loved one is struggling, The Renfrew Center is here to help. With the right support, healing and progress are possible – every step forward is meaningful, and hope is always within reach.
The Renfrew Center provides compassionate care for all bodies.
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Resources:
Brady, S., Siegel, G., Albers, R. W., & Price, D. L. (Eds.). (2011). Basic neurochemistry: Principles of molecular, cellular, and medical neurobiology (8th ed.). Academic Press.
Harrop EN, Mensinger JL, Moore M, Lindhorst T. (2021). Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. The International Journal of Eating Disorders, 54, pp. 1328–1357.
Jablonski, M., Schebendach, J., Walsh, B. T., & Steinglass, J. E. (2024). Eating behavior in atypical anorexia nervosa. The International Journal of Eating Disorders, 57(4), pp. 780–784.
Johnson-Munguia, S., Negi, S., Chen, Y., Thomeczek, M. L., & Forbush, K. T. (2024). Eating disorder psychopathology, psychiatric impairment, and symptom frequency of atypical anorexia nervosa versus anorexia nervosa: A systematic review and meta-analysis. The International Journal of Eating Disorders, 57(4), pp. 761–779.
Kons, K., Essayli, J., & Shook, J. (2024). Comparing the knowledge, attitudes, and practices of pediatric and family medicine clinicians toward atypical anorexia nervosa versus anorexia nervosa. The International Journal of Eating Disorders, 57(4), pp. 993–100.
Lyall, A. E., Breithaupt, L., Ji, C., Haidar, A., Kotler, E., Becker, K. R., Plessow, F., Slattery, M., Thomas, J. J., Holsen, L. M., Misra, M., Eddy, K. T., & Lawson, E. A. (2024). Lower region-specific gray matter volume in females with atypical anorexia nervosa and anorexia nervosa. The International Journal of Eating Disorders, 57(4), pp. 951–96.
Silbiger, K. (2024). Mental health providers’ perceptions of restrictive eating disorders: Relationship with client body weight. The International Journal of Eating Disorders, 57(4), pp. 916–923.
