EDITORIAL
Time to revisit the definition of atypical anorexia nervosa
Neville H. Golden MD,
B. Timothy Walsh MD,
Corresponding Author
Neville H. Golden MD
Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Stanford, California, USA
Correspondence
Neville H. Golden, The Marron and Mary Elizabeth Kendrick Professor of Pediatrics Emeritus, Stanford University School of Medicine, 750 Welch Road, Suite 210, Palo Alto, CA 94304, USA.
Email: [email protected]
Contribution: Conceptualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorB. Timothy Walsh MD
Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
Contribution: Conceptualization, Writing - review & editing
Search for more papers by this authorNeville H. Golden MD,
B. Timothy Walsh MD,
Corresponding Author
Neville H. Golden MD
Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Stanford, California, USA
Correspondence
Neville H. Golden, The Marron and Mary Elizabeth Kendrick Professor of Pediatrics Emeritus, Stanford University School of Medicine, 750 Welch Road, Suite 210, Palo Alto, CA 94304, USA.
Email: [email protected]
Contribution: Conceptualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorB. Timothy Walsh MD
Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
Contribution: Conceptualization, Writing - review & editing
Search for more papers by this authorAction Editor: Ruth Striegel Weissman
Abstract
In this special issue, international researchers investigate how atypical anorexia nervosa (atypical AN) differs from anorexia nervosa (AN) and other eating disorders with respect to demographics, psychological and physiological morbidity, as well as treatment course and outcome. Manuscripts in this special issue report that atypical AN is associated with substantial medical and psychological morbidity, and the majority of studies find few differences between atypical AN and AN. While much remains to be learned about the long-term course and treatment response of individuals with atypical AN to psychological and pharmacological interventions, the evidence supports conceptualization of atypical AN as part of a spectrum-based restrictive eating disorder. These findings together with the potentially stigmatizing use of the term “atypical” suggest it may be time to revise the existing definition of atypical AN.
REFERENCES
- American Psychiatric Association (Ed.). (2013). Diagnostic and statistical manual of mental disorders ( 5th ed.). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425596
10.1176/appi.books.9780890425596 Google Scholar
- Bicaker, E., Trolio, V., Miller, A. E., Zhu, L. Y., White, C., & Racine, S. E. (2024). Affective processes underlying restrictive eating in atypical anorexia nervosa: Comparisons to anorexia nervosa and bulimia nervosa using ecological momentary assessment. The International Journal of Eating Disorders, 57(4), 879–891. https://doi.org/10.1002/eat.24134
10.1002/eat.24134 Google Scholar
- Billman Miller, M. G., Gioia, A. N., Essayli, J. H., & Forrest, L. N. (2024). Few differences in psychiatric comorbidities and treatment response among people with anorexia nervosa and atypical anorexia nervosa. The International Journal of Eating Disorders, 57(4), 809–818. https://doi.org/10.1002/eat.24046
10.1002/eat.24046 Google Scholar
- Birgegård, A., Mantilla, E. F., Breithaupt, L. E., Borg, S., Sanzari, C. M., Padalecki, S., Hedlund, E., & Bulik, C. M. (2023). Proposal for increasing diagnostic clarity in research and clinical practice by renaming and reframing atypical anorexia nervosa as "restrictive eating disorder" (RED). Eating Behaviors, 50, 101750. https://doi.org/10.1016/j.eatbeh.2023.101750
- Davis, C., Lie, H. M. M. E., Vasanwala, R. F., Tan, J. S. K., Oh, J. Y., Rajasegaran, K., & Chew, C. S. E. (2024). Prevalence and risk factors associated with low bone mineral density in Asian adolescents with anorexia nervosa and atypical anorexia nervosa. The International Journal of Eating Disorders, 57(4), 819–826. https://doi.org/10.1002/eat.24076
10.1002/eat.24076 Google Scholar
- Fitterman-Harris, H. F., Han, Y., Osborn, K. D., Faulkner, L. M., Williams, B. M., Pennesi, J. L., & Levinson, C. A. (2024). Comparisons between atypical anorexia nervosa and anorexia nervosa: Psychological and comorbidity patterns. The International Journal of Eating Disorders, 57(4), 903–915. https://doi.org/10.1002/eat.24147
10.1002/eat.24147 Google Scholar
- Forney, K. J., Brown, T. A., Holland-Carter, L. A., Kennedy, G. A., & Keel, P. K. (2017). Defining "significant weight loss" in atypical anorexia nervosa. The International Journal of Eating Disorders, 50(8), 952–962. https://doi.org/10.1002/eat.22717
- Forney, K. J., Rezeppa, T. L., Hill, N. G., Bodell, L. P., & Brown, T. A. (2024). Examining the placement of atypical anorexia nervosa in the eating disorder diagnostic hierarchy relative to bulimia nervosa and binge-eating disorder. The International Journal of Eating Disorders, 57(4), 839–847. https://doi.org/10.1002/eat.24122
10.1002/eat.24122 Google Scholar
- Garber, A. K., Cheng, J., Accurso, E. C., Buckelew, S. M., Downey, A. E., Le Grange, D., Gorrell, S., Kapphahn, C. J., Kreiter, A., Moscicki, A. B., & Golden, N. H. (2024). Short-term outcomes of the study of refeeding to optimize inpatient gains for patients with atypical anorexia nervosa. The International Journal of Eating Disorders, 57(4), 859–868. https://doi.org/10.1002/eat.24115
10.1002/eat.24115 Google Scholar
- Gibson, D., Stein, A., Khatri, V., Wesselink, D., Sitko, S., & Mehler, P. S. (2024). Associations between low body weight, weight loss, and medical instability in adults with eating disorders. The International Journal of Eating Disorders, 57(4), 869–878. https://doi.org/10.1002/eat.24129
10.1002/eat.24129 Google Scholar
- Golden, N. H. (2023). Atypical anorexia nervosa is not atypical at all! Commentary on Walsh et al. The International Journal of Eating Disorders, 56(4), 826–827. https://doi.org/10.1002/eat.23871
- Golden, N. H., Kapphahn, C. J., Cheng, J., Kreiter, A., Downey, A. E., Accurso, E. C., Machen, V. I., Adams, S. H., Buckelew, S. M., Moscicki, A. B., Le Grange, D., & Garber, A. K. (2024). Course and outcome in individuals with atypical anorexia nervosa: Findings from the study of refeeding to optimize iNpatient gains (StRONG). The International Journal of Eating Disorders, 57(4), 799–808. https://doi.org/10.1002/eat.24029
10.1002/eat.24029 Google Scholar
- Hagan, K. E., Johnson, A., Venables, K., Mahara, A., the Spit for Science Working Group, & Haynos, A. F. (2024). Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students. The International Journal of Eating Disorders, 57(4), 924–936.
10.1002/eat.24152 Google Scholar
- Haines, M. S., Kimball, A., Dove, D., Chien, M., Strauch, J., Santoso, K., Meenaghan, E., Eddy, K. T., Fazeli, P. K., Misra, M., & Miller, K. K. (2024). Deficits in volumetric bone mineral density, bone microarchitecture, and estimated bone strength in women with atypical anorexia nervosa compared to healthy controls. The International Journal of Eating Disorders, 57(4), 785–798. https://doi.org/10.1002/eat.24014
10.1002/eat.24014 Google Scholar
- Hay, P. (2023). Disentangling eating disorder diagnostic schemes. Commentary on Walsh et al., "A systematic review comparing atypical anorexia nervosa and anorexia nervosa.". The International Journal of Eating Disorders, 56(4), 841–843. https://doi.org/10.1002/eat.23895
- Hebebrand, J., Seitz, J., Föcker, M., Preuss-van Viersen, H., Huss, M., Bühren, K., Dahmen, B., Becker, K., Weber, L., Correll, C. U., Jaite, C., Egberts, K., Romanos, M., Ehrlich, S., Seidel, M., Roessner, V., Fleischhaker, C., Möhler, E., Hahn, F., … Peters, T. (2024). Premorbid body weight predicts weight loss in both typical and atypical anorexia nervosa: Further support for a single underlying disorder. International Journal of Eating Disorders, 57(4), 967–982.
10.1002/eat.24189 Google Scholar
- Herb Neff, K. M., Buta, E., Fenn, L. M., Ramsey, C. N., Snow, J. L., Haskell, S. G., & Masheb, R. M. (2024). Distinguishing probable atypical anorexia nervosa from weight loss alone in a national sample of U.S. military veterans: Disentangling the roles of weight suppression and cognitive concerns. The International Journal of Eating Disorders, 57(4), 827–838. https://doi.org/10.1002/eat.24116
10.1002/eat.24116 Google Scholar
- Jablonski, M., Schebendach, J., Walsh, B. T., & Steinglass, J. E. (2024). Eating behavior in atypical anorexia nervosa. The International Journal of Eating Disorders, 57(4), 780–784. https://doi.org/10.1002/eat.23886
10.1002/eat.23886 Google Scholar
- Johnson-Munguia, S., Negi, S., Chen, Y., Thomeczek, M. L., & Forbush, K. T. (2024). Eating disorder psychopathology, psychiatric impairment, and symptom frequency of atypical anorexia nervosa versus anorexia nervosa: A systematic review and meta-analysis. The International Journal of Eating Disorders, 57(4), 761–779. https://doi.org/10.1002/eat.23989
10.1002/eat.23989 Google Scholar
- Keegan, E., & Wade, T. D. (2024). The role of readiness and confidence to change in the treatment of atypical anorexia nervosa and bulimia nervosa. The International Journal of Eating Disorders, 57(4), 1020–1025. https://doi.org/10.1002/eat.23918
10.1002/eat.23918 Google Scholar
- Kons, K., Essayli, J., & Shook, J. (2024). Comparing the knowledge, attitudes, and practices of pediatric and family medicine clinicians toward atypical anorexia nervosa versus anorexia nervosa. The International Journal of Eating Disorders, 57(4), 993–1001. https://doi.org/10.1002/eat.24095
10.1002/eat.24095 Google Scholar
- Lyall, A. E., Breithaupt, L., Ji, C., Haidar, A., Kotler, E., Becker, K. R., Plessow, F., Slattery, M., Thomas, J. J., Holsen, L. M., Misra, M., Eddy, K. T., & Lawson, E. A. (2024). Lower region-specific gray matter volume in females with atypical anorexia nervosa and anorexia nervosa. The International Journal of Eating Disorders, 57(4), 951–966. https://doi.org/10.1002/eat.24168
10.1002/eat.24168 Google Scholar
- Manwaring, J. L., Blalock, D. V., Duffy, A., Le Grange, D., Mehler, P. S., Riddle, M., & Rienecke, R. D. (2024). An examination of adults with atypical anorexia nervosa at admission to treatment at higher levels of care: An attempt to increase diagnostic clarity. The International Journal of Eating Disorders, 57(4), 848–858. https://doi.org/10.1002/eat.24124
10.1002/eat.24124 Google Scholar
- Matthews, A., Lin, J., Jhe, G., Peters, T., Sim, L., & Hebebrand, J. (2024). Differentiating anorexia nervosa and atypical anorexia nervosa with absolute weight cut-offs results in a skewed distribution for premorbid weight among youth. The International Journal of Eating Disorders, 57(4), 983–992.
10.1002/eat.24188 Google Scholar
- Meneguzzo, P., Antoniades, A., Garolla, A., Tozzi, F., & Todisco, P. (2024). Predictors of psychopathology response in atypical anorexia nervosa following inpatient treatment: A propensity score matching study of weight suppression and weight loss speed. The International Journal of Eating Disorders, 57(4), 1002–1007. https://doi.org/10.1002/eat.24135
10.1002/eat.24135 Google Scholar
- Nagata, J. M., Vargas, R., Sanders, A. E., Stuart, E., Downey, A. E., Chaphekar, A. V., Nguyen, A., Ganson, K. T., Buckelew, S. M., & Garber, A. K. (2024). Clinical characteristics of hospitalized male adolescents and young adults with atypical anorexia nervosa. The International Journal of Eating Disorders, 57(4), 1008–1019. https://doi.org/10.1002/eat.24132
10.1002/eat.24132 Google Scholar
- Phillipou, A., & Beilharz, F. (2019). Should we shed the weight criterion for anorexia nervosa? The Australian and New Zealand Journal of Psychiatry, 53(6), 501–502. https://doi.org/10.1177/0004867418814958
- Ralph, A. F., Brennan, L., Byrne, S., Caldwell, B., Farmer, J., Hart, L. M., Heruc, G. A., Maguire, S., Piya, M. K., Quin, J., Trobe, S. K., Wallis, A., Williams-Tchen, A. J., & Hay, P. (2022). Management of eating disorders for people with higher weight: Clinical practice guideline. Journal of Eating Disorders, 10(1), 121. https://doi.org/10.1186/s40337-022-00622-w
- Sandoval-Araujo, L. E., Cusack, C. E., Ralph-Nearman, C., Glatt, S., Han, Y., Bryan, J., Hooper, M. A., Karem, A., & Levinson, C. A. (2024). Differentiation between atypical anorexia nervosa and anorexia nervosa using machine learning. The International Journal of Eating Disorders, 57(4), 937–950.
10.1002/eat.24160 Google Scholar
- Silbiger, K. (2024). Mental health providers' perceptions of restrictive eating disorders: Relationship with client body weight. The International Journal of Eating Disorders, 57(4), 916–923. https://doi.org/10.1002/eat.24154
10.1002/eat.24154 Google Scholar
- Verma, S. (2024). A case for re-conceptualizing the ‘atypical’—A lived experience perspective. The International Journal of Eating Disorders, 57(4), 1026–1028. https://doi.org/10.1002/eat.24086
10.1002/eat.24086 Google Scholar
- Walsh, B. T., Hagan, K. E., & Lockwood, C. (2022). A systematic review comparing atypical anorexia nervosa and anorexia nervosa. The International Journal of Eating Disorders, 56(4), 798–820. https://doi.org/10.1002/eat.23856
Citing Literature
