Content warning: eating disorder thoughts and behaviors
Most of us have an image of anorexia: the famine-thin teenager with the protruding bones who exercises too much and thinks an apple will make her fat. The Mayo Clinic says anorexia includes an “abnormally” low body weight, an overpowering terror of gaining weight, and a distorted body image. People with anorexia usually restrict the amount they eat severely, and may “binge and purge,” or consume a lot of food and get rid of the calories by using laxatives or throwing it up. Their physical symptoms, such as an intolerance to cold, are similar to starvation; they often lie about how much they’ve eaten or skip meals entirely. They may develop rituals around food. Most of us know the signs and symptoms. But there is such a thing as atypical anorexia.
What we don’t know: you don’t have to be stick-thin to have anorexia.
The eating disorder world is itself fat-phobic.
According to Molly Gwen, who was considered “morbidly obese” when she was diagnosed as having anorexia, “the eating disorder treatment and recovery field exists in a world riddled with weight discrimination.” What we call “atypical anorexia,” or anorexia without being extremely underweight, is simply … anorexia.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) classifies it under “Other Specified Feeding and Eating Disorder (OSFED)” according to Eating Disorder Hope, because, as they say, “Though often associated with extreme weight loss, individuals with anorexia nervosa are not always underweight.” Got it? Like Gwen, I was technically obese when I developed anorexia. I wore a size 18. When I started losing weight, people congratulated me.
Atypical anorexia, Gwen also points out, also doesn’t mean you haven’t lost enough to have “real” anorexia yet. Restricting calories, not eating for days, skipping meals, lying about your food intake, and suffering the physical effects of starvation means you have anorexia, whether you weight ninety pounds or a hundred and ninety. I probably weighed 150 pounds when my hair started thinning due to anorexia.
But it takes us far longer to notice that people with atypical anorexia have atypical anorexia. I had to scream at my husband that I have an eating disorder, and I still don’t think he really believes me (despite my going from a size 1X to an XS, a size 18 to barely a size 2, and fretting that I needed to lose more). People still congratulate me for losing weight; my mother, who has seen me at least once a week through all this, has no idea. They tell me I look good. When Gwen landed in the hospital with complications from anorexia, a friend thought she was there for a gastric bypass surgery.
Atypical anorexia has the same physical consequences.
We know people with anorexia suffer complications. Your body consumes its own tissue to survive; as National Eating Disorders Assocation says, the most important muscle in your body — some of the first tissue the body goes after for nutrients — is the heart. Eating disorders raise your risk of heart failure; your heart rate and blood pressure sink lower. My recent physical included the lowest blood pressure I’ve ever had.
Atypical anorexics can also suffer from the same slowed digestion, which can cause constipation, nausea and vomiting, and blood sugar fluctuations. The constipation can come simply because there aren’t enough nutrients for the intestines to bother trying to empty, says the National Eating Disorders Association.
You can have trouble falling asleep or staying asleep (I’m writing this at two in the morning), and trouble concentrating. You may have fainting spells or dizziness; it can mess with your menstrual cycle. Your hair can fall out. You can be cold all the time (I’m writing this under a robe and a blanket and a warm puppy). Your kidneys can fail; you can develop anemia. In all, you have a 5.2% “crude mortality rate” according to the National Eating Disorders Assocation.
Atypical anorexia requires intervention.
If this hasn’t convinced you yet, atypical anorexia isn’t just losing a few pounds. It’s a serious eating disorder with serious consequences. Just because a person doesn’t look like a stereotypical person with anorexia doesn’t mean they aren’t suffering from severe physical and psychological consequences.
They need help.
I had to tell my psychiatrist what was going on. We are both working hard on my recovery. At the time of this writing, I’ve stopped actively losing weight. It’s an uphill, constant, all-consuming battle.
As Eating Disorder Hope says in an explanation of atypical anorexia, it’s important to remember: weight is not the criteria on which we need to judge whether or not someone needs help. We need to look at their behavior and think about whether or not it will cause physical consequences. Skipping meals or inducing starvation will cause you to suffer consequences and requires medical intervention, no matter what your weight, and no matter if you’re losing — Gwen didn’t even lose weight. In fact, she gained it instead. That didn’t make her any less sick as her body hoarded what little she gave it.
Treatment may include the same things that are used to treat typically presenting anorexia: things like psychotherapy for the eating disorder itself, “dual-diagnosis therapy” to treat other mental health issues, group therapy, nutrition counseling, and medication, according to The Ranch Treatment Centers. And because of the new DSM-V criteria, your insurance is more likely to cover it, says Eating Disorder Hope.
I began dealing with atypical anorexia in October of 2019. I weighed over 200 pounds. A year and several months later, I bought a size 0 pants — size 0, do I not exist? I’m proud to say part of me recognized that was not something to celebrate — and through the constant care of a psychiatrist, I have stopped losing weight. The physical effects of anorexia have scared me into the occasional sundae, though I still struggle hard with normal eating patterns. My hair is growing back from the buzz cut I gave myself (because I was losing clumps of hair) into more of a Cersei Lannister cut, though I still wear wigs. I am still cold all the time. I get winded easily. My blood sugar clearly fluctuates, and my blood pressure is the lowest its ever been. I’m sometimes frightened I’ve done permanent damage to my body.
So I’m working very, very hard to eat. It’s a struggle. It’s hard to let go of the voice in your head that says you’re fat, food is bad, keep trying to lose weight. But I try to surround myself with people who are fervently body positive. I clapback at the comments about how good I look. And I try hard, for my kids, to let this go. Medication and therapy have helped. But you need the will to get better.
I think I’m there.
If you believe you may be suffering from an eating disorder and need help, contact the National Eating Disorders Helpline.