The problem with Atypical Anorexia Nervosa

Atypical Anorexia Nervosa (AAN) is a diagnosis of a restrictive eating disorder, where despite significant weight loss, the person’s weight remains within a ‘normal BMI’ range or ‘overweight BMI’ range, while they experience the same (or often worse) physical and psychological effects of Anorexia Nervosa.  AAN is therefore, by its very nature, a fat-phobic diagnosis as it defines the two diagnoses by BMI alone.  ‘if only you were thinner then you would have the real Anorexia’. The diagnosis can be a very invalidating one for your loved one, as it doesn’t acknowledge the profound physical and psychological impacts of a restrictive eating disorder.  It can make your loved one feel unworthy of help; in some cases, it may be difficult to access help. Despite losing a substantial amount of weight, losing her period and developing osteopenia (bone thinning), my daughter was told by the GP ‘Oh well, at least you’re still a normal weight’. This had the effect of delaying diagnosis and treatment and sadly is a common theme for many families.

Studies show that delays in diagnosis based on this problematic reliance on BMI can lead to people with AAN being much more unwell by the time they are finally able to access treatment, with people experiencing higher levels of distress related to eating and body image and lower self-esteem. Given the extreme challenge of recovering from a restrictive eating disorder at any body size, this is hugely concerning. My hope in future is that the two diagnoses are rolled into one and there is no delineation made between Anorexia Nervosa and Atypical Anorexia Nervosa.

© Carer Peerspective, 2024

Wong, Valerie Z and Michael R Lowe, ‘Is There a Basis for a Weight Cut-off Point? A Large-Scale Investigation of Atypical Anorexia and Anorexia Nervosa Subtypes among Patients at a Residential Treatment Centre’ [2024] European eating disorders review