What Is Atypical Anorexia Nervosa?


Can someone who is overweight have anorexia? It may seem counterintuitive, but some larger people, as well as some individuals who appear to have a healthy body weight, have a type of this eating disorder called atypical anorexia nervosa. Atypical anorexia nervosa (AAN) is a condition that involves the same unhealthy eating patterns seen in anorexia nervosa but does not include being underweight. It can easily be overlooked as people with atypical anorexia might appear overweight or “healthy” in their body weight and body mass index (BMI). Some who have lost significant amounts of weight may even be complimented on their body shape, which can perpetuate the disorder.

Surprisingly, the lesser-known atypical anorexia is 3 to 4 times more common than anorexia, according to research in the Journal of Abnormal Psychology. However, because these individuals are not noticeably underweight, the condition often remains overlooked or undiagnosed. And this can have dangerous ramifications.

According to 2017 research published in Current Problems in Pediatric and Adolescent Health Care, anorexia nervosa is the leading cause of death among all psychiatric disorders. Clearly, there is an urgency to receive treatment and healing from this illness and atypical anorexia nervosa, which has similar symptoms and consequences.

People with atypical anorexia nervosa have an extreme fear of gaining weight but might not be considered underweight—in fact, they might appear overweight or “healthy” in their body weight. Click To Tweet


Some people who are diagnosed with AAN are not considered underweight but have an extreme fear of gaining weight and have a severely warped view of their body shape and size. This can cause malnourishment, dehydration, and a host of other physical ailments, some of which can be fatal. Someone who was previously considered medically overweight can fit in this category if they have lost significant weight but feel they still need to lose more, even if they are no longer considered overweight.

Sadly, the mortality rate for people who have had inpatient treatment for anorexia nervosa is five times higher than those without anorexia. A 2020 editorial published in the Cleveland Clinic Journal of Medicine suggested that AAN can be just as destructive as anorexia nervosa, as people are less likely to receive medical care or inpatient treatment for their illness.

The presence of anxiety, depression, and suicidality is common in people with atypical anorexia. It is unclear which condition causes the other disorders, but a 2022 study suggests that people with AAN are more likely to suffer from anxiety and depression. Research published in the journal Clinical Psychology Review shows that suicidal ideation and attempts are higher in people with anorexia and atypical anorexia, and suicide is one of the three main causes of death.


Emotional and behavioral symptoms of atypical anorexia nervosa include:

  • Intense fear of and preoccupation with weight gain
  • Body dysmorphia, or a feeling of body shape/weight as repulsive
  • Terror of regaining weight after weight loss, even if at a healthy current weight and BMI
  • Avoiding food in social settings, and general social isolation
  • Engaging in extreme exercise routines without allowing time for recovery
  • Preoccupation with food intake, fasting, and exercising that interferes with daily life
  • Malnourishment to decrease weight such as skipping meals and only eating certain types of food
  • Wearing loose-fitting clothing to hide body shape
  • Chewing but not swallowing food and spitting out food
  • Defining foods as “good” and “bad” (or “healthy/clean” versus “unhealthy/junk food”)


The emotional impact of AAN is difficult enough to navigate; the physical repercussions make this disorder even more of a struggle. Some of the physical manifestations of atypical anorexia include:

  • Hypotension, or low blood pressure, can lead to nausea, dizziness, blurred vision, low energy, and fainting
  • Low heart rate
  • Sleep interruption or insomnia
  • Chronic dehydration and depleted electrolytes
  • Erratic or absence of menstrual cycle in women (amenorrhea)
  • Constipation and other gastrointestinal issues
  • Low body temperature/sensitivity to cold


The impact that atypical anorexia has is extensive and frightening. Getting proper treatment is imperative as it is deeply challenging to change course and overcome this condition without support. Gaining insight and knowledge about the causes of eating disorders is imperative, and it starts in the brain. Brain SPECT imaging shows that people who suffer from all eating disorders—atypical anorexia included—have abnormalities such as:

  • Overactivity in the basal ganglia, where anxiety originates
  • Overactivity in the anterior cingulate gyrus, which regulates rumination
  • Parietal lobe issues, which involve a sense of direction and sensory processing (a facet of body dysmorphia)

Support for AAN is multidimensional and brain scans can be beneficial in getting to the origin of the eating disorder as well as co-occurring issues such as anxiety and depression. Dispelling shame at an individual and societal level is crucial when it comes to all types of eating disorders. Silence, secrecy, and shame can have fatal consequences. While a solution to atypical anorexia might not be straightforward given the complicated array of issues associated with this disorder, help, and recovery are possible.

To heal from atypical anorexia, nutritional counseling should be combined with treatment for any underlying brain health or mental health issues. Addressing any environmental factors, such as chronic stress, troubled relationships, or negative thinking patterns, is another key element of the healing process. Following this type of comprehensive treatment plan can help put people with this condition on the road to regaining control of their eating, emotional well-being, and physical health.

Eating disorders, anxiety, depression, and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.

1 Comment »

  1. I am having a hard time understanding the root cause of anorexia. Is there a biological base of brain malfunction? What is it that triggers this disease that has the same common characteristics of those who suffer from it?

    Comment by Lori Taylor — March 13, 2023 @ 6:13 AM

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