You don’t have to look very thin to have an eating disorder. People with atypical anorexia nervosa often don’t think they’re “sick enough” for eating disorder treatment. But if you have atypical anorexia, you’re at risk for serious health complications. Learn more about the symptoms, risks and treatment for atypical anorexia nervosa.

What Are the Symptoms of Atypical Anorexia?

Atypical anorexia is sometimes called the invisible eating disorder. Most people picture a very thin person when they think of anorexia. People with atypical anorexia usually are a normal weight. Sometimes they’re considered overweight. Many times the condition flies under the radar. Those closest to them and even healthcare providers may not recognize the condition.

If you’re struggling with atypical anorexia, you may feel you have a serious problem with food and weight. You may also feel invalidated because you don’t fit the mold of someone with an eating disorder. Others don’t see your suffering so you may question your own concerns.

Atypical anorexia is as serious as other eating disorders. Symptoms of atypical anorexia are the same as anorexia nervosa. The only difference is that the diagnosis doesn’t include a low body weight. Atypical anorexia is classified with other atypical eating disorders. They fall under the DSM 5 category: OSFED. This stands for other specified feeding or eating disorder.

Signs and symptoms of atypical anorexia nervosa include:

  • Intense fear of weight gain
  • Continuing to fear gaining weight even after losing weight
  • Distorted body image
  • Using extreme measures for weight loss such as fasting or excessive exercise
  • Disordered eating and weight-control measures interfere with everyday functioning
  • Unrealistic idea of weight
  • Preoccupation with food, weight loss, exercise and dieting
  • Calorie counting
  • Cutting out entire food groups
  • Ritualistic eating behaviors like only eating certain food groups or food colors
  • Spitting out food instead of swallowing it
  • Preoccupation with food sources or cleanliness
  • Skipping meals
  • Avoiding social situations with food
  • Labeling some foods as “bad” and others as “safe”
  • Isolation and social withdrawal
  • Avoiding eating in public
  • Wearing baggy clothing

Why Atypical Anorexia Is Dangerous

Atypical anorexia has serious physical and mental health risks. A 2016 study by The University of Melbourne compared atypical anorexics to anorexics. They found atypical anorexics:

  • Have more severe disordered eating symptoms
  • Lose more weight over a longer period of time
  • Experience lower self-esteem
  • Have greater distress over body image and food

The study didn’t find major differences between atypical anorexics and anorexics in:

  • Low body temperature
  • Binge and purging episodes
  • Low heart rate
  • Co-occurring mental illnesses
  • Suicidality or self-harm
  • Resting pulse rate
  • Low blood pressure
  • Hospital admissions

Another study found 31% of atypical anorexics have the same complications as anorexia. These include both physical and mental issues. The researchers urged medical professionals to always ask questions about weight loss. Too often weight loss seems like a positive thing. In reality, it could be an indicator that the person needs help.

Like anorexics, atypical anorexics might also experience:

  • Sleep problems
  • Fainting spells
  • Dehydration and electrolyte imbalances
  • Malnutrition: affecting hair, nails, teeth, skin and other physical appearances
  • Abnormal blood counts
  • Sensitivity to cold temperatures
  • Thinning hair
  • Fatigue
  • Menstrual cycle stopping
  • Constipation and other gastrointestinal issues

How Do You Treat Atypical Anorexia?

There aren’t universal clinical guidelines for treating atypical eating disorders. Clinicians treat OSFEDs like their most similar eating disorder. Eating disorders are complex. Long-term residential care in a treatment center may be necessary.

Treatment for atypical anorexia nervosa may include:

Family Therapy

Strained relationships often go hand-in-hand with anorexia. Research shows the importance of family therapy in treatment of anorexia. In a 2017 study, patients had fewer mental health symptoms with family-based treatment.


Intensive therapy with counselors trained in eating disorders is important. Anorexics have distorted thinking and ingrained views about themselves and their world. Therapists often need to use a variety of approaches. It can be difficult to open the lines of communication. It’s hard to change inaccurate beliefs and views. Psychotherapy can help anorexics understand what’s behind their fear of weight gain.

Dual Diagnosis Treatment

Co-occurring disorders like mental illness are common in people with eating disorders. One study followed women in residential treatment for eating disorders. Researchers found 97% also struggled with mental illness. It’s imperative that eating disorder treatment include mental health treatment. Untreated issues like depression, anxiety and personality disorders can make eating disorders worse.

Group Therapy

Relationship issues and isolation affect people with eating disorders. Group therapy can help by giving people insights into themselves and how others see them. Hearing from others with eating disorders helps them feel less alone. Group therapy is a safe place to practice relationship skills. This helps improve relationships outside of treatment.

Nutrition Counseling

Treatment for atypical anorexia should include work with a nutritionist or dietician. People with eating disorders need to change their relationship with food. A nutritionist can help them maintain a healthy body weight.


Co-occurring mental health issues are common in people with anorexia. Clinicians may prescribe medications to treat both anorexia and co-occurring disorders. Preliminary research shows some medications may help. They can reduce depression and eating disorder symptoms in atypical anorexics. These medications are fluoxetine or venlafaxine. They’re most effective in combination with cognitive behavioral therapy (CBT).

Krisi Herron

Medically Reviewed by

Krisi Herron, LCDC

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