Symposium 132 - Exploring 'Atypical': Understanding the Role of Othering in the Diagnosis of Atypical Anorexia Nervosa

Chair(s)

• LD

  Lauren Davis, B.A. (she/her/hers)

  Graduate Student
  Rutgers University
  Highland Park, New Jersey
• VW

  Valerie Wong, B.S. (she/her/hers)

  Graduate Student
  Rutgers, The State University of New Jersey
  Philadelphia, Pennsylvania

Discussant(s)

• RP

  Rebecka Peebles, M.D. (she/her/hers)

  Associate Professor
  Perelman School of Medicine at the University of Pennsylvania
  Philadelphia, Pennsylvania

Presenter(s)

• GH

  Grace Haase, B.A. (she/her/hers)

  Research Coordinator
  Children's Hospital of Philadelphia
  PHILADELPHIA, Pennsylvania
• LD

  Lauren Davis, B.A. (she/her/hers)

  Graduate Student
  Rutgers University
  Highland Park, New Jersey
• VW

  Valerie Wong, B.S. (she/her/hers)

  Graduate Student
  Rutgers, The State University of New Jersey
  Philadelphia, Pennsylvania
• EH

  Erin Harrop, Ph.D., LICSW (they/them/theirs)

  Assistant Professor
  University of Denver
  Aurora, Colorado

Atypical anorexia nervosa describes individuals who meet all of the psychological and behavioral criteria for anorexia nervosa (AN) but who, despite significant weight loss, weigh within or above the ‘normal’ range. The number of individuals with atypical AN is growing (Agostino et al., 2021; Harrop et al., 2021; Masheb et al., 2021), underscoring the need to look beyond low weight to capture the diversity of patients with restrictive eating disorders in research and clinical practice. This symposium will highlight new developments in research on this under-recognized diagnosis, and critically evaluate the role of weight stigma in the marginalization of individuals with atypical AN.

Aside from the absence of low weight, atypical AN is not ‘atypical’ at all, with studies suggesting that atypical AN is two to three times more common than AN (Harrop et al., 2021). Despite experiencing the same or higher level of medical and psychological comorbidity as individuals with full-threshold AN (Walsh et al., 2022), fewer individuals with atypical AN are identified and referred for care, representing a significant disparity in access to treatment. When individuals do gain access to treatment, they may be further minimized and stigmatized by healthcare professionals (Eiring et al., 2021; Harrop, 2022), highlighting the importance of understanding current limitations in treatment for atypical AN.

In addition to gaps in treatment, atypical AN is an overlooked concern in the scientific literature. There is much debate surrounding the diagnostic relationship between atypical AN and AN, and whether there should be a distinction based on weight. Little is known about the development of atypical AN and its behavioral and psychological characteristics, both in terms of how it compares to AN as well as its unique features as a diagnostic entity (Walsh et al., 2022). Atypical AN symptoms may not only develop and be just as severe as those of AN despite their higher weight, but may be exacerbated by weight stigma and invalidation around eating disorder struggles because of their higher weight. 

This symposium will review the development, clinical presentation, and treatment of atypical AN, and introduce important considerations surrounding restrictive eating disorders among higher weight individuals who have been systematically excluded from research and treatment. Of note, individuals with atypical AN are more likely than those with AN to have other marginalized identities (i.e., racial, gender; Mitchison et al., 2020). It is imperative for the field to increase the recognition and understanding of atypical AN in the research literature, and to consider how psychological science can increase access to and quality of treatment for these individuals.