Co-author: Ricole Tay
‘When food was one’s biggest comfort until it was not.’ Over the years, the rising diagnosis of eating disorders has been an area of concern. In this day and age, where individuals are exposed to multiple platforms such as reality tv shows and social media, there is an addition of factors that can affect one’s view of their body image. It is normal for humans to pay attention to their physical appearances and desire to look good. However, to what extent is it considered to be an unhealthy obsession level? When talking about eating disorders, it is common for one to picture an exceptionally thin individual. However, it may not necessarily be the case. In this article, we hope to shed light on atypical anorexia nervosa.
What is atypical anorexia nervosa
Atypical anorexia nervosa is classified under Other Specified Feeding and Eating Disorder (OSFED) in the Diagnostic and Statistical Manual of Mental Illness. Generally, eating disorders are more complex than they are presented. It is more than just an unhealthy relationship with food. Individuals with atypical anorexia nervosa tend to suffer a significant impact on their day-to-day life due to the biopsychosocial symptoms. Individuals with atypical anorexia nervosa may present biological symptoms that can induce medical complications such as:
Poor immune system
Significant weight loss yet being within normal weight limits
Gastrointestinal issues
Constipation
Loss of muscles and bones
Irregular menstrual cycle for women
Fatigue and low energy
Individuals with atypical anorexia nervosa also commonly experience psychological symptoms such as:
Intense fear of gaining weight
Excessive focus on body weight
Distorted perception of thinness
Low self-esteem
Only consuming food they think is lower in calories - which may not necessarily be true
Social symptoms that they may display include:
Refusal to eat socially
Withdrawn
Coming up with excuses to not eat
Preoccupied with counting calories, fats, carbohydrates and sugar content in food
Difference between atypical anorexia nervosa and anorexia nervosa
The symptoms and behaviours of individuals with anorexia nervosa and atypical anorexia nervosa are very similar. The distinct diagnostic difference is the Body Mass Index (BMI) criteria. Individuals with anorexia nervosa have abnormally low body weight. On the other hand, atypical anorexia nervosa individuals are not accompanied by extremely low body weight, and individuals can be of average or above-average weight. However, this does not discount the seriousness of the disorder.
Common behaviours displayed
Individuals with atypical anorexia nervosa tend to experience intrusive thoughts about food and body image that cause them to avoid eating or feel guilty for eating. Atypical anorexia nervosa affects one neurologically, where individuals unintentionally practise an abnormal reward system, potentially explaining why they find pleasure in starvation. Additionally, they have a distorted perception of an attractive body image, which results in their drive to relentless weight loss. Individuals may also find themselves in cycles of restrictive eating, binge eating, purging and laxative abuse. Individuals may, too, engage in excessive exercise.
In social settings, individuals with an eating disorder may eat only a small portion or not eat at all. They may face disruptions in their quality of life as the individuals are heavily distracted with their body image and ways to lose weight, such as constantly planning the next meal that they feel is less sinful. The social circle of those individuals may also be affected for various reasons.
Factors that potentially affect the onset of atypical anorexia nervosa
Biopsychosocial factors have a pathway of influence and effects in atypical anorexia nervosa.
Genetics. The biological standpoint of eating disorders has presented that genes contribute to the predisposition of acquiring the disorder. It has been noted that eating disorders often run in the family because of shared genetic factors.
Friends. Peers tend to mock each other, which can come across as fat-shaming. To one, this may just be a harmless comment, but it can be triggering to another, causing one to begin to be conscious of their body shape. Therefore, they may start to take action to lose weight in fear of getting humiliated again and, in turn, increase the risk of an eating disorder. Additionally, friends may be influenced to achieve a particular body shape. Suppose someone in the friend group has been overly conscious of their weight, food intake and body shape, chances are that the people around them would begin to critically evaluate themselves as well.
Family. The family, especially parents, are no doubt the children’s closest kin, one who they turn to for comfort and validation. However, this can have a reverse negative impact if parents are not aware of the weight of their comments and actions. For example, suppose parents have always been controlling about what their children eat, constantly preaching about the importance of an attractive body image, or are even body-conscious themselves; in that case, chances are that their children would grow up with the same insecurities.
The environment. Environment includes one’s passion and workplace. One’s passion, such as dance or sports, can ironically contribute to the onset of an eating disorder. More often than not, these activities require individuals to maintain a certain body weight and outlook. This results in a cautious approach toward food. Such a pressurising environment where individuals are constantly taking their weight and body measurements to ensure that they stay in shape can gradually result in an eating disorder. In some occupations, individuals require a desirable outlook. Being brainwashed to think that only a particular body image is deemed elegant and presentable can also increase the risk of an eating disorder.
Social media. The prevalent use of social media has made users more conscious of their appearance. The portrayal of celebrities and influencers has been unhealthy as the majority often fit into what society deems as beauty standards. Comments posted online have also been a source of validation for many. This makes individuals critically evaluate themselves and change how they look in order to fit into the beauty standards.
Personality traits. Traits such as perfectionism have been noted to elevate the risk of an eating disorder. These individuals can be obsessed with exercising, weight and body image to convey the ‘perfect’ idea to the world.
The dangers of atypical anorexia nervosa
Atypical anorexia nervosa drastically impacts one’s day-to-day life because of the intrusive thoughts one faces. They are often preoccupied with their body image and methods to lose and avoid gaining weight. Atypical anorexia nervosa also affects the body's ability to function normally. The lack of nutrient intake can amount to serious damage to the vital organs, resulting in life-threatening medical issues over time. If help is not sought, eating disorders could lead to fatal consequences. Additionally, eating disorders are comorbid with other mental disorders such as depression and body dysmorphic disorder.
Treatment
Family-based therapy. Eating disorders require assistance from one’s closest social circle. Individuals often spend the bulk of their time at home, where family members are present. It is crucial for family members to refrain from being sceptical and dismissive but instead be supportive. Therefore, including the whole family can help to establish the road to recovery and work towards normalising eating behaviours.
Cognitive behavioural therapy. CBT addresses and challenges faulty assumptions and distorted perceptions of a perfect body. CBT subsequently involves learning to better cope with irrational thoughts, thereby relieving the symptoms and gradually working towards becoming more productive in their lives.
Psychodynamic therapy. In psychodynamic therapy, unconscious processes driving one’s thoughts and behaviour are brought to awareness. Hence, allowing the therapist and client to work together to make sense of the behaviour and help the client make more conscious choices.
Summary
With the common misconception that eating disorder patients are abnormally skinny, despite experiencing symptoms of atypical anorexia nervosa, individuals who are of acceptable body weight or obese may believe that they are not sick enough to have an eating disorder. However, it is important to note that eating disorders are not limited to only a specific gender and body shape and that atypical anorexia nervosa is not any less severe as compared to other mental disorders. Getting diagnosed with an eating disorder is just the tip of the iceberg, and there can be many underlying factors that are critical to explore and understand further. Thus, as intimidating as it may be, it is vital to acknowledge that help is needed and that seeking professionals can help you understand your struggles and provide effective treatments.