Atypical Anorexia Nervosa: What it is and how we can help
A patient walks into the nutrition office feeling frustrated that her calorie restriction and countless hours of exercise have not been successful in sustained weight loss. She reports feeling fatigued, irritable, and is having difficulty sleeping. When asked about appetite, the patient says that she can “go all day without eating” and feels that food has become more of a worry than a joy. She’s removed many foods from her daily intake, and she fears that reintroducing these foods will increase her discomfort with her body. She feels stuck.
The dietitian gathers a medical history, diet recall, and history around eating patterns. Then, she provides an eating disorder questionnaire. To the patient’s surprise, the questionnaire signaled that the disordered eating patterns had crossed into a clinical threshold. In fact, this patient met the criteria for atypical anorexia nervosa (AAN).
AAN is anorexia nervosa in which not all traditional criteria for this classification have been met; it is an Other Specified Feeding or Eating Disorder.1 Criteria include restricting food intake as well as a preoccupation with weight, food, and body. Unlike typical anorexia nervosa, however, in AAN the body weight itself does not have to be considered “low” to meet the criteria. This may be why AAN often goes unnoticed and untreated even though up to 5% of women may develop AAN over the course of their lifetime.2 Complications are often the same and can be just as severe as in typical anorexia: low heart rate, low blood pressure, loss of bone density, hormonal injuries, fatigue, and gastrointestinal symptoms such as constipation and bloating.
So what can we do to help? We can more commonly screen for eating disorder symptomatology irrespective of body size. We can refer to a multidisciplinary treatment team including nutritional care with a dietitian, psychological care with a mental health provider, and medical monitoring. We can help people with AAN make peace with food and their bodies again.
- Harrop, E.N., Mensinger, J.L., Moore, M. & Lindhorst, T. (2021). Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. International Journal of Eating Disorders: 54(8); 1328-1357.