*Trigger warning: anorexia and eating disorders*
Invisible or atypical anorexia is a condition in which someone has all of the symptoms of anorexia that a doctor would look for to make a diagnosis, but whose weight is in the ‘normal’ range. As such, getting treatment – or taken seriously – can be difficult, as well as profoundly isolating.
Here, Carrie Arnold, a 40-year-old journalist and author, fromVirginia, US shares her story of living with the issue.
I made the doctor’s appointment simply to convince everyone that I was fine. For the first half of 2012, my mum had been on my case about my decreasing weight and bizarre eating habits.
She even uttered the words no one else dared: anorexia relapse. I laughed in her face. How could that be, when my weight was completely normal? I’d struggled with an eating disorder in my late teens and twenties, but my weight had crept up over the years and, for the most part, my unhealthy behaviours had subsided. It meant that when I started restricting food and over-exercising again, the weight loss wasn’t obvious.
If you’re worried about your own or someone else’s relationship with food, contact Beat, the UK’s eating disorder charity, on 0808 801 0677 or go to beateatingdisorders.org.uk
I told myself that this wasn’t anorexia, and I scheduled a check-up to prove it.
‘Anorexia, hm?’ the doctor murmured, as I sat in my paper gown while she reviewed my health history, which included being hospitalised for an eating disorder several years earlier. Glancing up from the stack of papers, she looked me up and down. ‘Clearly, that’s not still a problem.’ My cheeks flushed with embarrassment, but I still felt a twinge of satisfaction at hearing an expert confirm that my mum was wrong.
Except, of course, I did still have a problem. My hair was thin and I felt weak and light-headed when I stood up– residual effects, I told myself, of my history. But, rather than ask if I was presenting any disordered eating behaviours, the doctor simply glanced at my outward appearance and thought: ‘Case closed.’ If I wasn’t underweight, I was fine, right?
The next few years of micromanaging calories and fretting overweight gain told a very different story. It was only after a second relapse in 2018, when doctors told me I was on the brink of heart and kidney failure, that I checked myself into a hospital that specialised in treating eating disorders.
There, I learned I was one among millions of people who fall into a diagnostic subcategory called atypical anorexia. Because we look bigger – we might even qualify as overweight on a medical chart – we’re often diagnosed later, because doctors don’t take us seriously. And despite being heavier, the problems we develop from anorexia – low heart rate and low blood pressure, brittle bones, cardiac and kidney problems, even risk of early death – are just as severe.
Historically, to be diagnosed with anorexia, you had to display harmful eating habits and also be clinically underweight. As a society, we’re conditioned to view anorexia as a weight-loss issue – not the life-threatening mental illness it is. If you don’t fit the stereotype? You can forget about a diagnosis. Yet according to an Australian study in the Journal Of Eating Disorders, while 0.5% of the population suffer with ‘stereotypical’ anorexia, 2.5%f all into the atypical anorexia category – that’s five times as many.
Of course, this doesn’t include the large number of people who don’t seek medical attention for fear of facing weight bias– which is part of what kept me away from the doctor after that awful appointment in 2012.
From experience, I know how it can fill you with shame – even terror – to reveal a mental disorder like this to a medical professional when you don’t think you look ill enough. Not only did I personally feel I’d failed to lose enough weight to have a ‘real’ diagnosis, medical doctors didn’t believe I had an issue, either.
In the past, one therapist tried to convince me I had a binge-eating disorder becauseI was overweight. Back in my twenties, when I first got treatment and was hesitant about putting on weight, more than one provider assured me they wouldn’t ‘let me’ get fat – as if fat was something to fear. Over and over, professionals reinforced stereotypes about eating disorders when they should have been challenging them.These old myths about anorexia drowned out the few genuinely helpful voices.
I still consider myself one of the lucky ones, though. When I checked into hospital two years ago, at 37, my husband and family rallied around me with unconditional support. I found a treatment centre with staff who understood me and I spent five months there nourishing my body and learning new coping mechanisms – like the ‘health at every size’ philosophy: a set of body-acceptance principles that taught me how to look after my wellbeing without pursuing weight loss.
But it also helped to learn that there are others like me; that I’m not the only one struggling with anorexia who doesn’t look the part.
I weigh more today than ever before. But I’m coming to terms with the fact that my size is only a tiny part of who I am. Just as health can exist at every size, so, too, can this deadly mental illness. Silence breeds shame, so I’m raising my hand to tell my story in the hope that this pain – experienced by millions, in secret – won’t remain invisible forever.
The facts about anorexia and mental health
Dr Bryony Bamford is clinical director and a consultant clinical psychologist at The London Centre for Eating Disorders and Body Image, and has specialised in the treatment of eating disorders for nearly 20 years
How common is atypical anorexia?
In the UK, atypical anorexia is categorised under the umbrella of ‘other specified feeding and eating disorders’ (OSFED). It’s likely that this is an extremely common form of eating disorder – many of our clients will meet its criteria. However, the majority of sufferers either find it difficult to access support, or don’t attempt to do so for fear of being seen as ‘not ill enough’.
It can be difficult to access targeted support within the NHS, but you can find it through specialist eating disorder charities or private clinics. It’s important to do so, as symptoms rarely resolve by themselves.
Besides weight loss, what are the signs that you – or someone you love – might be struggling?
Symptoms include extreme attempts to reduce or control food intake, an intense dislike of your body weight and shape, fear of weight gain and preoccupation with food, eating and weight. Extreme food restriction is still physically damaging to the body, even when not paired with low weight. Generally, people who are eating restrictively won’t be giving their bodies sufficient calories nor the nutrition needed to maintain good health. There are many physical and psychological consequences of food restriction even at healthy or higher weights, such as chronic constipation, anxiety and feelings of isolation.
Why is it important that people see anorexia as a mental health issue?
All eating disorders have underlying psychological causes, they’re not just a diet taken to the extreme – and they are never just about weight. In fact, the psychological and social effects of eating disorders can be as detrimental as the physical ones. Even when weight is restored, sufferers will need specialist help to overcome the lingering psychological and emotional symptoms of an eating disorder.
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