Atypical Anorexia: The Dangers of Weight Loss Stigmas
Author’s Note: This article discusses my personal experience with an eating disorder. Each and every experience is different. Even with the same diagnosis, no two cases are ever the same.
This article is written with an outlook on eating disorders from a recovery standpoint rather than a perspective from the active moments of the disorder and does not discuss numbers, weight, or abnormal eating habits to avoid the possibility of comparison by readers.
I find it remarkable that after a year and a half of struggling with food issues I never let myself acknowledge my experience as an eating disorder until I stumbled upon the term “Atypical Anorexia” while I was casually flipping through the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) one day. (Don’t ask me why I was spending a Thursday afternoon skimming a textbook that was more than half the length of a bible. I really don’t know the answer, but I’m glad I did).
According to this book that I had just picked up, Atypical Anorexia was listed as one of many “Other Specified Feeding or Eating Disorders” where “all of the criteria for Anorexia Nervosa are met, except that despite [any possible] significant weight loss, the individual’s weight is within or above normal range” (American Psychiatric Association, 2013).
As I sat feeling the smooth paper against my fingertips and the book’s cover digging into my lap, I let that last sentence resonate. After about a minute and a half, I let out a long sigh before closing the book and walking myself to a mirror and asking myself “Ok, now can you admit that you have a problem?”
After realizing that such a condition existed everything I had been experiencing suddenly began to make sense. I had essentially experienced what almost every person with a restrictive type of eating disorder experiences — the emotional roller coaster, self-esteem wreck, and energy drainage — except I had always remained at normal body weight (given my age, height, and biological sex).
Like most, I had fallen victim to the false notion that all eating disorders are and must be characterized by significant weight loss. This misconception is easily consumed by the public for a variety of reasons. For one, a majority of the stories offering insight into life with an eating disorder that circulate in the media belong almost exclusively to those with severe cases of Anorexia Nervosa — a restrictive disorder where patients do tend to experience significant downward fluctuations in body weight. Consequently, Anorexia Nervosa has become misguidedly viewed as the distinguishing image for eating disorders as a general concept. Additionally, these same stories have the tendency to concentrate solely on the individual’s physical appearance portraying their dramatic weight loss and weight restoration.
While bodyweight is currently one of the factors most heavily relied on for making a diagnosis, formal or informal, it is and will always remain one of the most flawed.
According to the diagnostic criteria for Anorexia Nervosa from the DSM-5, “individuals struggling with this disorder will restrict their energy intake relative to their caloric requirement, which leads to significantly low body weight in the context of several factors, including biological sex, physical health, age, developmental trajectory, and more. Other criterion includes an intense fear of gaining weight as well as a severe disturbance in body perception” (American Psychiatric Association, 2013).
A person dealing with Atypical Anorexia oftentimes exhibits these same criteria without weight loss making the presentation of this disorder “atypical.”
In other words, a person struggling with Atypical Anorexia may exhibit the same extreme fear of weight changes and engage in the same abnormal and dangerous eating and feeding behaviors as people with Anorexia Nervosa.
Because of its “lack of weight loss” factor, many individuals who have Atypical Anorexia may not even realize that they are struggling with a severe and deadly disorder simply due to the weight stigma that surrounds eating disorders. As a result, those with this illness oftentimes falsely view themselves as failed Anorexia Nervosa patients and push themselves to adhere to their restrictive habits more strongly, which can cause further internal bodily damage and increases their chance of unexpected death. They often tell themselves that they are not sick enough to have an eating disorder leading them to become the primary obstacle preventing them from seeking out help needed for recovery.
This sinister occurrence trapped me in a never-ending argument with myself where my eating disorder logic denied the existence of any disorder. I constantly told myself that, although I engaged in restrictive behaviors, my lack of weight loss automatically disqualified me from considering myself as one afflicted with an eating disorder. And worse, I did not consider myself to be a person who deserved any sort of help.
When I finally realized that there was a term to describe every emotion that I felt as I fought this losing battle against myself — the dissatisfaction, frustration, and self resentment for “failing at having an eating disorder” — an immense burden was lifted off of me. For the first time, I felt as though I could sit in the present moment, which allowed me to shift my focus off of trying to lose weight (weight that I then understood I would never be able to drop) and towards recovery. In a way, though my eating disorder logic was disappointed that, for whatever physiological reason, my body wasn’t able to lose weight no matter how hard I tried, this informal diagnosis gave me permission to acknowledge that I did indeed have an eating disorder. I was then, and only then, finally, able to set that lost cause aside and make the decision that recovery was something I truly wanted.
Recovery became even slower and more difficult when I realized that, given my circumstance, I wasn’t going to be following a “traditional recovery path” which, in most cases of Anorexia Nervosa, includes healthy and needed weight restoration. Every step I took towards recovering my eating disorder logic attempted to turn me around by invalidating my experience saying that mine wasn’t legitimate because “without weight restoration, what exactly was I recovering from?”
Every meal became a battle, an argument with my eating disorder logic:
You don’t really need that. You could easily just —
“Bitch shut the fuck up. You know this lasagna is good”
A battle where I won with every forkful. And there is no sweeter taste than the taste of victory.
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For those of you finding yourself in a similar situation regarding your relationship with food:
Because our culture is changing ever so slowly, I can only hope that the weight loss and “you don’t look sick” stigmas surrounding eating disorders of every kind will, too, slowly begin to fade so that those finding themselves in a similar situation do not have to struggle with the internalized debate that their experiences are not valid.
Since this change is slow and requires an unlearning and reteaching of deep-rooted cultural norms I, unfortunately, can only offer words to anyone struggling within the scope of these stigmas:
- Even if you are considered to be “normal weight” or “overweight”
- Even if you think that you are “too big” to have an eating disorder
- Even if you “still eat meals”
- Even if you have never had medical complications from your eating disorder
- Even if you have been told or feel like you don’t “look like you have an eating disorder”
- Even if you think that others “have it worse than you”
- Even if family and friends do not seem concerned about you
- Even if you feel like people won’t believe you if you tell them
If you are struggling with a preoccupation with food and weight, you are “sick enough” and you deserve to seek help and treatment.
As much as it pains me to have to say these things within the confines of weight stigmas and appearance, these were words that I know I needed to hear when I took my first steps towards receiving help.
I am also embedding the link to a book that was crucial in jumpstarting my recovery: Life Without Ed. Written by someone who has fought with an eating disorder first hand, it is a book that I continue to revisit to this day. Recovery is a process, be gentle with yourself.
