Atypical Anorexia in Teens

Women struggling with eating disorder

Adolescence is a dangerous time for potential disordered eating behaviors. While a startling number of pre-teens and teens meet the criteria for an eating disorder, it is important to also consider those that engage in harmful and dangerous behaviors such as atypical anorexia that do not.

For example, with anorexia nervosa, an individual typically needs to weigh below 85% of their ideal body weight for diagnosis [1]. However, there is a large population of individuals that experience the same symptoms of anorexia, such as “restrictive eating, over-exercising, distorted body image, and an intense fear of weight gain,” but have a normal body weight [1].

In 2013, the DSM-5 (Diagnostic and Statistical Manual of Mental Illness, 5th Edition) officially put a name to these symptoms, calling it Atypical Anorexia Nervosa. This diagnosis falls under the DSM-5 category of Other Specified Feeding and Eating Disorders (OSFED), which are the most prevalent among any eating disorder diagnosis.

According to Neville Golden, MD, who is the professor of pediatrics at Stanford School of Medicine, individuals struggling with atypical anorexia “can be just as sick medically and psychologically as anorexia nervosa patients who are underweight” but that they are “underrecognized and undertreated [1].”

Golden recently contributed to “the largest, most comprehensive assessment to date of normal-weight adolescents with atypical anorexia nervosa” and learned groundbreaking information about this disorder and the dangers it poses for teens [1].

The study determined that it is not weight, specifically, but rapid weight loss that is “the best predictor of medical and psychological problems in patients with atypical anorexia [1].”

Issues common in anorexia nervosa, such as “dangerously low heart-rate and blood pressure, as well as serious electrolyte imbalances and psychological problems” are common for those with atypical anorexia as well [1].

Study authors hypothesize that the prevalence of atypical anorexia diagnoses results from the recent trend of adolescent obesity, which has quadrupled over the past 30 years [1].

Adolescent Girl struggling with atypical anorexiaAdolescents labeled as “obese” are being stigmatized and pressured to lose weight without being taught functional, sustainable, and healthy ways of doing so. As such, they engage in dangerous and restrictive behaviors to avoid further condemnation and ridicule from classmates and medical professionals alike.

These individuals had higher weight-to-height ratios, to begin with. Therefore, in restricting, their body weight may be medically termed as “normal,” however, the drastic loss over a short period of time has severe consequences on their physical health that are being ignored.

The study mentioned above solidified this in their findings, noting that it is the amount, speed, and duration of weight loss that mark the severity of a disorder, not the amount the individual weighs at diagnosis.

These results “challenge(s) reliance on current weight to assess illness severity [2].” Essentially, the study is reminding us of the supremely important message that weight cannot be a determining factor in someone’s health.

There is a larger picture that must be considered for every individual in determining whether or not their behaviors are detrimental.

This information needs to be considered by anyone that interacts with adolescents moving forward since early intervention of atypical anorexia nervosa increases the likelihood of recovery and reduces the chances of the illness becoming more severe in its presentation.


[1] Digitale, E. (2019). Normal body weight can hide eating disorders in teens, study finds. Retrieved from–study-find.html.

[2] Garber, A. K. (2019). Weight loss and illness severity in adolescents with atypical anorexia nervosa. Official Journal of the American Academy of Pediatrics.

About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published March 19, 2020, on
Reviewed & Approved on March 19, 2020, by Jacquelyn Ekern MS, LPC

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