Atypical Anorexia Explained: Why Restriction Happens at Every Body Size

by Dr. Marianne Miller, LMFT, Offering Eating Disorder Therapy in San Diego, California, Texas, and Washington, D.C.

When many people think of anorexia, they imagine a body that is visibly small. This image comes from decades of media portrayals, outdated medical training, and diet culture messaging. But anorexia can exist in every body size. One diagnosis that reveals this truth is atypical anorexia.

What Is Atypical Anorexia and How Is It Diagnosed?

Atypical anorexia appears in the DSM-5 under OSFED (Other Specified Feeding or Eating Disorder). People with atypical anorexia meet all the diagnostic criteria for anorexia nervosa except for one: they are not medically underweight.

A person can severely restrict food, experience an intense fear of gaining weight, and develop significant physical and psychological effects while having a weight in the “normal” or “overweight” BMI range. The behaviors and risks remain the same as anorexia nervosa. The difference is body size.

Why the Term “Atypical” Creates Confusion and Stigma

The word “atypical” suggests something rare or unusual. Researchers have shown a different story. Studies show that at least 50% of people who meet the criteria for anorexia are not underweight (Sawyer et al., 2016). This means that people in mid-sized and fat bodies experience anorexia as often as those in smaller bodies.

The label reinforces stigma by implying that thinness is the standard presentation and everything else is an outlier. This bias can shape how providers, families, and individuals themselves view the seriousness of the illness.

How Common Is Atypical Anorexia? The Statistics You Need to Know

Recent research indicates that atypical anorexia is not rare. It likely represents a significant portion of all anorexia cases. Many people with this diagnosis never receive proper treatment because their bodies do not match the outdated stereotype of an eating disorder patient.

The Medical Risks of Atypical Anorexia at Any Weight

Restriction harms the body regardless of size. People with atypical anorexia can experience:

• Low heart rate (bradycardia)

• Electrolyte imbalances

• Hormonal disruptions

• Bone density loss

• Gastrointestinal issues

• Severe fatigue and weakness

These medical complications result from inadequate nutrition, not from weight alone. Larger-bodied people are just as vulnerable to these risks as smaller-bodied people.

How Weight Stigma Delays Eating Disorder Diagnosis

Weight stigma in healthcare leads to dangerous delays in diagnosis. Many providers praise weight loss without asking about eating patterns, mental health, or physical symptoms. Some encourage restrictive behaviors, believing they are “healthy” or “necessary.”

This response can reinforce the eating disorder and prevent people from recognizing they need help. For some, these harmful messages delay treatment for years.

Signs and Symptoms of Atypical Anorexia You Shouldn’t Ignore

Atypical anorexia can include:

• Skipping meals or fasting for long periods

• Avoiding entire food groups

• Counting calories or macros obsessively

• Eating only “safe” foods

• Exercising to compensate for eating

• Intense fear of weight gain

• Preoccupation with food and body image

If these patterns interfere with daily life, they deserve attention, regardless of body size.

Why Restriction Happens in Every Body Size

Restriction does not depend on weight. People in fat bodies may start restricting due to internalized weight stigma, medical advice to lose weight, or personal trauma. Over time, restriction can become a deeply ingrained coping mechanism that is hard to break.

Society often praises weight loss, which can make restrictive behaviors feel socially acceptable or even encouraged, despite the physical and emotional harm they cause.

The Overlap Between Atypical Anorexia and Neurodivergence

Neurodivergent individuals, including autistic and ADHD people, often experience unique challenges with eating. Sensory sensitivities can make certain textures, smells, or tastes intolerable. Executive functioning differences can make meal planning and preparation difficult. Rigid thinking patterns can reinforce food rules and routines.

When these experiences happen in fat bodies, providers often overlook them or attribute them to “bad habits” rather than recognizing an eating disorder.

Barriers to Treatment for People With Atypical Anorexia

People with atypical anorexia face multiple barriers to treatment:

• Lack of recognition from healthcare providers

• Social reinforcement for weight loss

• Financial and geographic limits on eating disorder care

• Internalized beliefs about not being “sick enough”

These barriers can keep people stuck in harmful patterns for years.

Steps Toward Recovery From Atypical Anorexia

Recovery begins with acknowledging the eating disorder and recognizing its seriousness. Steps may include:

• Restoring adequate and consistent nourishment

• Challenging restrictive food rules

• Addressing body image concerns

• Working through trauma and anxiety

• Navigating sensory needs and executive functioning challenges

• Building support systems that are weight-inclusive and affirming

How to Find Weight-Inclusive Eating Disorder Treatment

Seek providers who use a weight-inclusive, neurodivergent-affirming, and trauma-informed approach. This type of care recognizes that healing requires safety, validation, and respect for individual needs.

Why You Don’t Need to Be Underweight to Deserve Care

Your worth does not depend on the number on the scale. If you are restricting food, struggling with fear of eating, or living in constant body distress, you deserve care now. You do not have to lose more weight or wait until someone else believes you are “sick enough.”

Work With Dr. Marianne

I provide eating disorder therapy in California, Texas, and Washington, D.C. I specialize in atypical anorexia, ARFID, binge eating disorder, and eating struggles connected to neurodivergence and trauma. My work is weight-inclusive, neurodivergent-affirming, and trauma-informed.

You can take the first step toward recovery today. Learn more and reach out here: https://www.drmariannemiller.com