Trigger warning: This article discusses atypical anorexia, including restrictive eating, weight concerns, and the emotional impact of the condition. Please read with care and seek support if you need it.
You can also explore our wider Understanding Eating Disorders hub for more information about related conditions.
What Is Atypical Anorexia?
Atypical anorexia falls within the category of Other Specified Feeding or Eating Disorders (OSFED) in the DSM-5, the manual used by clinicians to classify mental health conditions. To meet the criteria, an individual must show the key features of anorexia nervosa, such as restrictive eating, intense fear of weight gain, and a preoccupation with food, exercise, and body image. The difference is that their weight does not fall below the threshold typically associated with anorexia nervosa.
In other words, someone may lose a significant amount of weight through restriction but still remain at a weight that appears “healthy” to others. Alternatively, they may begin at a higher weight and lose a large proportion of their body mass without falling into the underweight category. The diagnosis does not minimise the seriousness of the condition. The health consequences can be severe, and the psychological distress just as intense as with anorexia nervosa.
Why the diagnosis is misunderstood
The word “atypical” can itself be misleading. It suggests something rare or less serious, when in fact atypical anorexia is relatively common and poses the same risks as anorexia nervosa. The misunderstanding is fueled by social stereotypes that associate eating disorders only with very thin individuals.
As a result, people with atypical anorexia may be praised for their weight loss, reinforcing harmful behaviours rather than prompting concern. Health professionals may fail to diagnose the condition because the patient does not appear underweight. Family members may overlook serious signs, assuming their loved one “looks fine”. These barriers delay treatment and allow the disorder to deepen.
Recognising the signs of Atypical Anorexia
Atypical anorexia can be harder to recognise than other eating disorders because weight alone does not reveal the problem. Instead, it is important to look at behaviours, thoughts, and emotions.
A person with atypical anorexia may restrict food intake to an unhealthy degree, skip meals, or avoid entire food groups. They may exercise excessively to control their weight, or show deep anxiety about eating in public. Food becomes a source of constant preoccupation, and body image concerns dominate daily life.
The physical consequences can also be significant. Individuals may experience dizziness, fatigue, digestive issues, disrupted menstrual cycles, or a weakened immune system. These symptoms arise from the body’s lack of adequate fuel, regardless of the person’s weight.
How Atypical Anorexia affects emotional wellbeing
Living with atypical anorexia often brings deep distress. The secrecy and rigid control around food can cause isolation. Many feel ashamed, confused, or fearful of being judged. Because they do not fit the stereotype of anorexia, they may question whether they “deserve” help, or worry they will not be taken seriously if they seek support.
This internal conflict compounds the problem. The person may continue harmful behaviours while believing they are not “ill enough” to justify concern. For young people, this can interfere with school, friendships, and family relationships. For adults, it can affect work, social life, and overall quality of life.
The role of weight bias
A major challenge in atypical anorexia is the role of weight bias in society. Thinness is often equated with health and self-control, while higher weight is stigmatised. When someone at a higher weight restricts food and loses weight, they may receive praise rather than alarm. Comments such as “you look great” or “you must be so disciplined” can reinforce dangerous behaviours.
This bias exists not only in social circles but sometimes within healthcare itself. Professionals may overlook symptoms if a patient’s weight is not below a certain threshold. This can delay intervention and worsen outcomes. Recognising that eating disorders are about behaviours and psychological distress, not simply weight, is essential.
The physical risks
Atypical anorexia carries the same physical risks as anorexia nervosa. Malnutrition can affect every system in the body. The heart is placed under strain, bones may weaken due to low calcium, and electrolyte imbalances can become life-threatening. Hormonal changes can disrupt growth, puberty, or fertility.
These risks occur regardless of body weight. A person at a higher weight who loses a large amount rapidly is still at significant medical risk. Parents and carers should not be reassured by the idea that “healthy weight” means a healthy body. The internal damage caused by restriction is often invisible.
How families experience Atypical Anorexia
For families, atypical anorexia can be confusing and frightening. Parents may notice their child eating less, avoiding meals, or exercising excessively, but hesitate to act because the child does not appear underweight. Friends and relatives may dismiss concerns, reinforcing the sense that something is being exaggerated.
Over time, family life can become dominated by food and mealtimes. Parents may spend hours negotiating with their child to eat, while siblings feel the strain of conflict at the table. Emotional energy is consumed by worry, frustration, and guilt. Recognising atypical anorexia as a legitimate diagnosis can provide families with the validation they need to seek help.
Diagnosis and Assessment
Diagnosis begins with a GP or referral to an eating disorder service. Clinicians assess behaviours, psychological symptoms, and physical health. Weight is part of the assessment but not the defining factor. Parents play a crucial role by describing patterns they have observed over time, since restrictive behaviours may not be obvious during a short consultation.
Because atypical anorexia is often misunderstood, persistence is sometimes required to ensure concerns are taken seriously. Keeping a record of eating behaviours, physical symptoms, and emotional distress can support the case for referral.
Treatment and Support
The principles of treatment for atypical anorexia are similar to those for anorexia nervosa. The focus is on restoring adequate nutrition, addressing psychological distress, and supporting healthier attitudes towards food and body image.
Therapies may include Cognitive Behavioural Therapy (CBT) or family-based interventions, where parents are actively involved in supporting recovery. Medical monitoring is often essential to track the impact of restriction on physical health. Support groups and peer services can also provide valuable encouragement, helping individuals feel less alone in their experience.
At First Steps ED, we understand the importance of treating each person as an individual. Our One-to-One Support and Parent and Carer Support services are designed to provide tailored guidance, recognising the unique challenges of atypical anorexia.
Schools and Professional Settings
Schools are often the first places where atypical anorexia becomes visible. Teachers may notice a student avoiding lunch, appearing fatigued, or showing obsessive interest in exercise or weight. Raising awareness in schools is important, as early recognition can prompt families to seek help.
Workplaces can also play a role. For adults, the pressure to maintain performance while secretly managing an eating disorder can be overwhelming. Colleagues and managers who understand that eating disorders are not confined to a particular look are better placed to provide support.
Why Early Intervention Matters
As with all eating disorders, early intervention greatly improves the chances of recovery. The longer atypical anorexia continues, the more entrenched the behaviours become, and the greater the physical and psychological damage. Acting early reduces risks and allows individuals to rebuild a healthier relationship with food before long-term complications develop.
Families should never wait for a child to become visibly underweight before seeking help. Behaviours and distress are valid reasons to act, regardless of the number on the scale.
Living with Atypical Anorexia
Recovery from atypical anorexia is possible, though it can be a long and non-linear journey. Progress may involve small steps, such as eating previously avoided foods, reducing compulsive exercise, or learning to challenge negative thoughts. Families may need to adjust expectations and celebrate incremental gains.
With the right support, individuals can move towards a life where food is no longer a source of fear and control. Recovery does not necessarily mean the absence of all difficulties but does mean improved health, reduced distress, and greater freedom in daily life.