Atypical Anorexia: Not All Anorexia Nervosa Patients Are Underweight

Eating disorders are health conditions that affect your relationship with food. One of the most common eating disorders is called anorexia nervosa (AN). Anorexia causes a distorted body image and changes in your eating habits. 

There’s a stereotype that all people with anorexia look thin and emaciated. But the truth is people with anorexia come in all shapes and sizes. When someone with anorexia is not underweight, it’s called atypical anorexia (AAN).  

Read on to learn more about “typical” anorexia nervosa and atypical anorexia nervosa. We’ll also talk about how AAN is diagnosed and treated, and how to take the next steps in getting help. 

What are anorexia nervosa and atypical anorexia nervosa?

Anorexia nervosa and atypical anorexia nervosa are common eating disorders that affect your weight and body image. 

AN and AAN are exactly the same except for one difference:

• People with AN have a significantly low body weight.

• People with AAN are not underweight and can even have overweight or obesity.

People with AN and AAN avoid or restrict food in order to change their body weight. Some people also exercise obsessively, binge eat, or purge using vomiting or laxatives.

What are the symptoms of atypical anorexia?

People with AAN have the same symptoms as people with “typical” anorexia. 

People with atypical anorexia:  

• Avoid or restrict food

• Have a strong fear of gaining weight 

• Have a negative or distorted view of their body weight, shape, or appearance

• May binge, purge, or exercise excessively

Over time, people with AAN can also develop physical signs and symptoms. These include: 

• Missing periods (amenorrhea)

• Brittle hair and nails

• Fragile bones

• Fine hair growing all over the body (lanugo)

• Muscle weakness

• Severe constipation

• Fatigue

• Organ problems  

What is ARFID, and how is it different from anorexia?

Avoidant restrictive food disorder (ARFID) is another type of eating disorder. This eating disorder causes people to limit certain types of food or amounts of foods.

ARFID is different from anorexia because most people with ARFID do not have fears about weight or body shape. 

Do people with atypical anorexia have “real” anorexia?

Yes. AAN is a real type of anorexia. 

It can cause serious health problems just like “typical” AN, including hospitalization and death. 

How often is anorexia fatal?

Anorexia has the second-highest death rate of all mental health conditions, after substance use disorders. About 10% of people with anorexia will die from the condition, often from medical complications or suicide. 

How is atypical anorexia diagnosed?

The first step in getting a diagnosis is to talk to a healthcare provider. When you meet with a provider, they will want to hear more about your:

• Eating patterns

• Attitude about exercise, eating, and body image

• Family history of eating disorders

• Family history of mental illness

• Ability to function at work, school, and/or home

Your provider will also measure your weight, height, and blood pressure and do a physical exam. They may suggest additional tests, like a blood or urine sample. 

All of this information — the interview, the exam, and tests — can help your provider determine whether you have atypical anorexia. 

Atypical anorexia can be hard to recognize

People with AAN are not underweight, despite the stereotype that all people with eating disorders are thin and emaciated. 

This stereotype can make it harder for healthcare providers, friends, and family to recognize that you have an eating disorder. You might even have a hard time recognizing AAN yourself, or may even think, “I’m not thin enough to have an eating disorder.” 

How is atypical anorexia treated?

Atypical anorexia is treated with a combination of:

• Talk therapy

• Nutrition education

• General medical care

• Medications

Most people with eating disorders can be treated as an outpatient. This means you live at home and visit your provider’s office as needed. In some cases, you may need to stay in a treatment center or hospital. 

You can read more about therapy, medications, and care levels in our GoodRx guide to eating disorder treatments. 

What can I do to decrease the chance of relapse after recovery?

A relapse is when some (or all) of your eating disorder symptoms return after recovery. Relapses are a normal and expected part of recovery, especially in the first year after treatment.

As part of your eating disorder treatment, you will learn how to prevent and manage relapses. This could include understanding your triggers or having an action plan for getting through the relapse.  

Where can I go to get help with AAN?

Talking to your healthcare provider is a great place to start. If you need help finding a provider, the National Eating Disorders Association (NEDA) has a free online search tool. 

You can also text or call the NEDA Helpline at 1-800-931-2237. Helpline volunteers are available to assist you in finding treatment and to offer resources and support.   

Why trust our experts?

Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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