Anorexia nervosa is an eating disorder and mental health condition which manifests as the sufferer trying to keep their weight as low as possible. The name was first coined in 1874 by a physician called William Gull, but the condition is believed to be much older.
The diagnosis of atypical anorexia is much newer and was introduced into the DSM-5 in 2013. It recognises that body weight has been given too much focus when making a diagnosis of anorexia and that anorexia nervosa symptoms can be frequently observed in people with higher body weights.
The difference between anorexia and atypical anorexia
The most significant difference between anorexia and its atypical form is the weight of the patient. The diagnosis of atypical anorexia came into being as the clinical understanding of anorexia started to evolve.
Anorexia is usually thought of as being associated with significant weight loss on the part of the sufferer and being significantly underweight. Many people believe that it is the low body weight that causes many of the health problems related to anorexia – and indeed, anorexia is a very dangerous condition, with the highest mortality rate of all psychiatric conditions. However, many of the life-threatening complications of anorexia are not related to body weight at all, but to self-starvation.
Unexplained or severe weight loss is still taken into account when making a diagnosis of anorexia – but atypical anorexia recognises the fact that body weight should not be a definitive criterion for making a diagnosis.
What makes anorexia so dangerous?
Self-starvation has many serious and detrimental effects on physical health, and these can happen no matter the weight of the patient. Symptoms of atypical anorexia and typical anorexia include the following:
- Heart problems, such as arrhythmias, chest pain, cardiomyopathy and heart attacks
- Electrolyte deficiencies
- Low blood glucose, blood pressure and blood cell count
- Chronic fatigue
- Diabetes
- Organ damage
- Cirrhosis
- Degenerative joint disease
People with anorexia, whether it’s typical or atypical, can experience severe malnutrition from restricting their food intake, and this is a major factor in many of anorexia’s most life-threatening complications. Electrolytes, for instance, are not stored in the body – you get them from food. Electrolytes are present in body fluids and tissues and are depleted quickly if you don’t eat. Severe electrolyte balances are life-threatening – electrolytes are crucial for controlling muscle contractions, and a deficiency can lead to heart failure.
Challenges of atypical anorexia diagnosis
Anorexia nervosa symptoms include the following:
- Restricting food intake – skipping meals, discomfort eating around others, and drinking excessive water or other low-calorie beverages
- Gastrointestinal issues
- A fear of gaining weight
- Distorted self-image
- Being hyper-critical of their body shape or size
- Being in denial about how serious their condition is.
These criteria can be fulfilled regardless of the weight of the patient – which is why body weight mustn’t be a definitive criterion for making a diagnosis of anorexia. Body weight can be taken into account, but it does not need to be significantly low for these behaviours to be present and a diagnosis of anorexia to be given.
Focusing on the weight of the patient runs the risk of missing a diagnosis in someone who does not present as a typical sufferer of anorexia – and this delays treatment and ultimately puts their life at risk. A person with atypical anorexia is more likely to present with significant weight loss, but over a longer period. They’re also likely to suffer from a different type of self-stigma than a typical anorexia patient, and their condition may not be taken as seriously, both by clinicians and by people in their lives, because they don’t fit the regular profile of someone with anorexia. Because anorexia is a psychologically and physically dangerous condition regardless of body weight, atypical anorexia patients must be taken seriously and properly diagnosed and treated.
The psychological impact of anorexia
A person with anorexia may go to great lengths to hide their body due to the shame they feel about it or to keep their weight loss secret from others out of fear that others will intervene and try to get them to help. Their relationship with food and exercise will become obsessive and can manifest as calorie counting, hyper-focusing on low-calorie food and drinks, and a rigid, excessive exercise routine.
Anorexia is physically dangerous, but the psychological impact is also very serious. People with eating disorders are at an elevated risk of suicide, and suicide is the second most common cause of death in people with anorexia.
Do typical and atypical anorexia require different eating disorder treatments?
While there are some small differences in the approach taken to treat atypical anorexia compared to typical anorexia, the core treatments used are the same.
One core component of typical anorexia treatment is supervised weight gain, which is required to counteract the cognitive impairment and severe deficiency in calories seen in typical anorexia.This focus will not be quite the same for people with atypical anorexia, as they won’t be underweight. The focus will instead be on stabilisation, so they are not aggressively losing weight and getting them into consistent eating patterns.This can be psychologically challenging for a person with atypical anorexia, as they often will need to gain some weight to become stable.
Other than focusing on stabilisation, the treatment for eating disorders used for both conditions is typically very similar.
Nutritional rehabilitation
After a comprehensive assessment of the patient’s health, including medical complications and deficiencies, a nutritional rehabilitation plan is made to restore the patient to health. This starts with an appropriate calorie goal that supports gradual health improvement without risking refeeding syndrome – this is a dangerous shift in electrolytes that can occur when someone has been malnourished for a long time.
The nutritional rehabilitation plan has several goals.
- Balancing the diet by ensuring the patient has all the micro and macro nutrients they need to be healthy. This can include supplementation for deficiencies.
- Structured meal planning that focuses on normalising eating and reducing food anxiety.
- Nutritional education that keeps the patient informed on healthy choices.
Psychotherapy
As well as trying to counteract food anxiety through normalising better eating patterns, patients will undergo psychotherapeutic treatments to help them deal with and overcome their condition.
- Cognitive Behavioural Therapy
CBT is a behaviour-focused approach that aims to challenge faulty and distorted beliefs about eating.
- Acceptance and Commitment Therapy
ACT is a form of CBT that focuses on helping individuals accept their thoughts and feelings instead of fighting them.
- Dialectical Behaviour Therapy
DBT focuses on mindfulness, distress tolerance and emotional regulation. It aims to reduce the frequency of harmful behaviours, like eating restrictions, to deal with painful emotions.
Ongoing monitoring
The patient will be monitored on an ongoing basis – both to ensure they’re healthy and that their nutritional needs are being met, and to prevent relapse.
Medication hasn’t been shown to be effective for treating anorexia itself. However, it may be offered as part of recovery to treat co-occurring mental health conditions like anxiety and depression.
Getting help
If you’re struggling with disordered eating, we can support you through your journey to recovery. With the right treatment and support, a happier, healthier future is possible. Reach out to Banbury Lodge today to find out more.