Exploring the Experiences of Individuals Labeled “Not Sick Enough”

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Contributor: Staff at Timberline Knolls Residential Treatment Center

When thinking of anorexia nervosa, most people picture someone who is underweight. However, placing too much emphasis on someone’s thinness can contribute to the dangerous misconception that a person has to be underweight to have an eating disorder. People who struggle with atypical anorexia may not always appear sick, but their symptoms are as valid as those of individuals who have anorexia.

What Is Atypical Anorexia?

Atypical anorexia is listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as an other specified feeding or eating disorder. A person who has atypical anorexia may struggle with the same symptoms as someone who has anorexia nervosa, including dramatic weight loss. However, someone who has atypical anorexia may stay within a normal weight range despite their weight loss. This can cause them to appear “healthy” while suffering from the disorder.

The Danger of Focusing on Physical Appearance 

Only considering someone’s weight and body measurements when determining if they have an eating disorder can be dangerous. By focusing on a person’s physical appearance, their friends, family, and doctors may unintentionally ignore any mental health concerns.

Instead of looking at a person’s thinness, they should consider the psychological symptoms of anorexia, including:

  • Anxious thoughts about food and eating
  • Preoccupation with weight and appearance
  • Body image concerns
  • Skipping meals or hiding food
  • Isolation from others
  • Fear of weight gain
  • Counting calories

Even if they have these symptoms, an individual who has atypical anorexia may struggle to reach out for help out of fear that they won’t be taken seriously.

Feeling the Need to Prove an Eating Disorder

For many people who have an eating disorder, their symptoms aren’t just about food and eating. Many individuals who struggle with an eating disorder use food to gain a sense of control in their life. They may even develop perfectionism about their eating habits, and having others view them as “not sick enough” may harmfully motivate them to prove themselves.

One study on women who have atypical anorexia interviewed participants about the importance of feeling “successful” at an eating disorder. Many participants described anorexia as an “area of expertise” and something they wanted to be “the best” at [1].

The potentially competitive nature of eating disorders can cause worsened symptoms and increased weight loss for individuals who are viewed as “not sick enough.” Some treatment centers even require patients to be a certain weight and have certain body measurements to begin treatment. This can result in people who are suffering from atypical anorexia actually needing to become sicker before they can receive the help they need.

Problems with Receiving Treatment 

When compared with patients who have anorexia nervosa, those who have atypical anorexia often suffer from the illness for longer and are less likely to receive treatment [2]. This is likely due to medical professionals and loved ones dismissing their symptoms because of their normal weight.

Despite not being underweight, studies show that individuals who have atypical anorexia are still at risk for many of the same complications connected with anorexia nervosa. Even if someone is still at what is considered a normal weight, restrictive eating and rapid weight loss can lead to heart problems and loss of bone density [2].

Instead of considering a person’s current weight, it’s important to look at how much weight they have lost in a certain amount of time. Rapid weight loss should be taken just as seriously in those who are at a normal weight as it is in those who are underweight, allowing more patients who have atypical anorexia to be seen.

Every participant of the study on women who have atypical anorexia and anorexia described situations where they felt misunderstood, and many reported that this made them feel discouraged about their recovery process [1].

If we take all types of anorexia seriously, regardless of a person’s weight, the misconceptions about physical appearance and eating disorders may start to decrease.

References 

[1] Eiring, K., Wiig Hage, T., & Reas, D.L. (2021). Exploring the experience of being viewed as “not sick enough”: a qualitative study of women recovered from anorexia nervosa or atypical anorexia nervosa. Journal of Eating Disorders, 9(142). https://doi.org/10.1186/s40337-021-00495-5

[2] Golden, N.H. & Mehler, P.S. (2020). Atypical anorexia nervosa can be just as bad. Cleveland Clinic Journal of Medicine, 87(3), 172-174. https://doi.org/10.3949/ccjm.87a.19146

About Timberline Knolls

Timberline Knolls is a residential treatment center located on 43 beautiful acres just outside Chicago.

The opinions and views of our guest contributors are shared to provide a broad perspective of 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 on February 10th, 2022. Published on EatingDisorderHope.com
Reviewed & Approved on March 12, 2024 by Jacquelyn Ekern, MS, LPC