Comparisons between atypical anorexia nervosa and anorexia nervosa: Psychological and comorbidity patterns

Abstract

ObjectiveLiterature comparing “atypical” anorexia nervosa (atypical AN) and anorexia nervosa (AN) suggests these diagnoses share significant similarities in eating disorder (ED) pathology and psychiatric comorbidities. This study evaluated potential differences in ED pathology, psychiatric comorbidity, associated mechanisms (i.e., ED fears and perfectionism), and demographic factors (i.e., ethnicity and age) between individuals with atypical AN and AN.MethodData from seven protocols were combined for a total 464 individuals diagnosed with atypical AN (n = 215) or AN (n = 249). Between‐group differences in ED severity and behaviors, psychiatric comorbidities, ED fears, perfectionism, and demographic factors were assessed using t‐tests, Wilcoxon rank‐sum tests, and Fisher's exact test.ResultsParticipants with atypical AN reported higher levels of overvaluation of weight and shape than those with AN. Participants with AN scored higher on food‐related fears (anxiety about eating, food avoidance behaviors, and feared concerns) and fears of social eating, as well as obsessive‐compulsive symptoms. Participants with AN were more likely to identify as Asian or Pacific Islander. No other statistically significant differences were found between groups for overall ED severity, ED behaviors, psychiatric comorbidities, general ED fears, perfectionism, or demographic factors.DiscussionOverall, results support previous literature indicating limited differences between individuals with atypical AN and AN, though individuals with atypical AN reported more overvaluation of weight and shape and those with AN reported higher food and social eating fears and obsessive‐compulsive symptoms. Relatively few overall differences between atypical AN and AN highlight the importance of exploring dimensional conceptualizations of AN as an alternative to the current categorical conceptualization.Public SignificanceThis study assessed differences among individuals with atypical anorexia nervosa and anorexia nervosa in eating disorder severity and behaviors, comorbid psychiatric diagnoses, associated mechanisms, and demographic factors. Few differences emerged, though participants with atypical anorexia nervosa reported more overvaluation of weight and shape, while those with anorexia nervosa reported more food and social eating fears and higher obsessive‐compulsive symptoms. Results support exploration of these diagnoses as a spectrum disorder.

‘Beyond the Scale’: A Qualitative Exploration of the Impact of Weight Stigma Experienced by Patients With Obesity in General Practice

“…In particular, the biased assumption that disordered eating, specifically restrictive eating and binge‐purge eating behaviours are represented by ‘thinness’ and not higher weight [ 19 ]. These false attributions not only reflect the lack of understanding of the spectrum of eating disorders in general practice settings [ 47 ] but reinforce the presence of biased assumptions of the controllability of obesity and eating behaviours [ 46 , 48 ].…”

“…Recent research has highlighted the significant symptomatology overlap of all eating disorders regardless of whether restrictive in nature [ 48 ]. It is also estimated that up to 50% of bariatric treatment seeking populations may have binge eating disorder, compared with 1%–2% in nonsurgical populations [ 49 ].…”