The Truth About Atypical Anorexia

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It’s time we talk about “Atypical Anorexia.” Here’s a hint: it’s not so atypical, after all. If you're a longtime reader, you may know that I’ve mentioned the term here and there, so I figured it was about time we dedicated a post to the subject because atypical anorexia deserves complete validation.

What is atypical anorexia?

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), atypical anorexia is placed in the Other Specified Feeding or Eating Disorders (OSFED) category and is defined as matching all of the criteria for Anorexia Nervosa with the exception of an extremely low bodyweight. In a previous post on the Difference Between Anorexia and ARFID, I unpack the DSM-5’s definition of “Typical” Anorexia, so if you aren’t yet familiar with the criteria and want the lowdown, be sure to give that a read!

Anywho, persons dealing with atypical anorexia nervosa will exhibit the same behaviors as an individual with Anorexia Nervosa, including the fear of weight gain and in many cases, distorted body image, but here’s the catch: to be diagnosed with “atypical” anorexia, the individual must be within or above the "normal" weight range according to BMI. So basically, the presence of anorexic symptoms without an underweight BMI makes the presentation “atypical.”

Where do we even start with this? BMI is complete BS. I did an entire post on the history of BMI and how it came to be, but basically, BMI (Body Mass Index) was created over 200 years ago by – get this – a mathematician! So no, not even a medical doctor created this “health” system.

The problem with BMI

This mathematician, Lambert Adolphe Jacques Quetelet, was a Belgian man with a passion for probability calculus of which he applied to study human physical characteristics. Quetelet is best known for his sociological work aimed at identifying the characteristics of l’homme moyen, meaning "the average man" in French. This "average man" was Quetelet’s representation of a social ideal, an ideal that he believed was the mathematical average of a population.

Based on his measurements of White Western European men (so yes, BMI was created to exclude women, members of the LGBTQIA+ community, people of color, immigrants, and well, anyone else who wasn’t a white European man), Quetelet concluded that “other than the spurts of growth after birth and during puberty, the weight increases as the square of the height.”

Long story short, BMI would better be called Bullshit Measurement Index. The human body is so beyond complex that there is no way for a simple math formula to decide whether or not you are healthy! I mean, just think about it: if you are constantly obsessing over food and exercise and are just plain miserable because you’re being consumed by an eating disorder, well isn’t that reason enough for your weight to be arbitrary?

Is someone with atypical anorexia "sick enough"?

Aside from the BMI factor, another problem with the "atypical" terminology around anorexia is that it's invalidating. An eating disorder isn’t about weight or size or shape; it’s about a way of thinking; it’s about your mindset around food and exercise. Labeling someone who’s struggling as “atypical” causes them to feel like they’re not "sick enough” and like they don’t deserve help. The hefty focus on weight in all kinds of eating disorders further promotes the stigma and stereotype that an eating disorder is only for thin white cis teenage girls. But if you’re reading this, I don’t have to tell you that stereotype couldn’t be further from the truth.

In fact, Atypical Anorexia is not atypical at all. To understand this, let’s have a look at the dictionary definition of the word atypical.

According to Merriam Webster Dictionary, “atypical” is defined as not representative of an age, group, or class. In other words, “atypical” means out of the ordinary.

In a sentence: a dog with three legs is quite an atypical occurrence.

Atypical anorexia is NOT atypical!

If atypical anorexia really was "atypical," it would mean that more people with anorexia would be severely underweight than “overweight” or "normal" weight. However, this is not the case. According to an Australian study in the Journal Of Eating Disorders, Atypical Anorexia is five times more likely than "stereotypical" anorexia...and I’m willing to bet that this figure is truly much higher, for how do we even account for all the people who don't seek or receive an eating disorder diagnosis due to shame and weight stigma?

Because of the restrictive behaviors an individual with atypical anorexia exhibits, they will experience the same consequences of anyone engaging in disordered eating: hair loss, fatigue, organ damage, heart failure, dizziness, not to mention the mental hell of preoccupation with food and exercise. You can be starving at any weight, size, or shape as eating disorders do not discriminate. So it’s about time society stopped discriminating and labeling people with silly eating disorder labels like atypical anorexia.

The eating disorder spectrum

In fact, I believe it would be much more productive to completely eliminate the word “disorder.” Altered ways of eating are merely adaptations to perceived danger. Just like autism is not a “disorder” and is rather a spectrum with different behaviors that are all adaptations to feel safe, I propose we start seeing eating disorders as a spectrum of adaptive eating behaviors. Not only would this view eliminate the questioning and doubt about whether or not your eating disorder is “valid” or if you are “sick enough” to receive help, but it opens the door to conversations about what’s at the root of the eating problems. It allows people to address what’s underneath: why don’t they feel safe? What don’t they trust? Only when we are asking the questions that actually matter, can we start living our answers in a way that aligns with healthy values.

If you’re finding yourself caught between these often arbitrary or mislabeled definitions and are in need of additional support with navigating your way out and toward those aforementioned healthy values, don’t hesitate to book a consultation call for 1-1 coaching with me here! Everyone is deserving of assistance, my friend.