When You Don't Look Sick: Atypical Anorexia Nervosa

You eat less than your body needs. You think about food all the time — planning meals, avoiding meals, regretting meals. You feel the grip of control, perfectionism, anxiety, and guilt after eating even a bite more than you “should.” And yet… you’re not “underweight.” Maybe your doctor hasn’t flagged it. Maybe loved ones haven’t noticed. Maybe they even praise your discipline.

So you wonder: Is it really that bad? The answer: Yes. And also — you don’t have to wait until it gets worse to get help.

Welcome to the often-misunderstood world of atypical anorexia nervosa.

A Misleading Name

The word “atypical” can be misleading. It sounds like a rare exception, a minor variation. But the truth is, atypical anorexia nervosa is far more common than many people realize — and just as serious as what we think of as “classic” anorexia.

Atypical anorexia falls under the umbrella of Other Specified Feeding or Eating Disorders (OSFED) in the DSM-5. The key difference? People with atypical anorexia meet all the criteria for anorexia nervosa — except they aren’t clinically underweight. In many cases, individuals may even be within what’s considered a “normal” or “above average” weight range.

But the psychological and physical risks? They’re the same. The malnutrition, the obsessive thinking, the internal distress — all still present. All still real. All still worthy of attention and care.

“But You Don’t Look Sick…”

One of the cruelest aspects of atypical anorexia is how easily it flies under the radar. Our culture is saturated with narrow images of what an eating disorder should look like — emaciated bodies, visible bones, dramatic weight loss. When someone doesn't fit that image, their struggle can be minimized, questioned, or outright ignored.

Clients often tell me things like:

• “People compliment me on my weight loss — they have no idea I’m barely eating.”

• “I feel like I’m not sick enough to deserve help.”

• “I’m terrified of gaining weight, but everyone keeps telling me I look ‘great.’”

This kind of invalidation can deepen shame and make reaching out even harder. You might even start gaslighting yourself: Am I making this up? Do I really need support?

Let me be clear: Disordered eating doesn’t need to look a certain way to be valid. You don’t need to earn your pain. And you absolutely deserve help — right now, as you are.

The Invisible Toll

Just because someone appears “fine” on the outside doesn’t mean their body and mind aren’t suffering. Atypical anorexia can cause serious medical complications — electrolyte imbalances, slowed heart rate, hair thinning, dizziness, hormonal disruptions, GI issues, and more — even at higher weights.

And the mental and emotional toll? Exhaustion. Constant rumination. Social withdrawal. Mood swings. Anxiety. Depression. The exhausting calculations: How many calories? How many steps? Did I earn that snack?

It can feel like your entire life is being slowly overtaken by numbers and rules — and the fear of breaking them.

What’s Underneath the Surface

Atypical anorexia, like other eating disorders, isn’t really about food. It’s about the deeper currents underneath:

• A need for control when life feels chaotic

• A way to numb difficult emotions or trauma

• A desire to feel “good enough” through discipline and perfection

• Fear of judgment or rejection

• Cultural and family messages about weight and worth

• The internalized belief: If I can just shrink myself, maybe I’ll finally feel safe.

Eating becomes a coping strategy — albeit one that slowly starts to consume the person using it.

Healing Without Waiting

Many people with atypical anorexia wait a long time to seek help — often until symptoms escalate. But healing doesn’t require hitting bottom. In fact, the earlier you reach out, the more space there is for curiosity, compassion, and choice in your recovery.

Therapy for atypical anorexia is about far more than changing eating habits. It’s about understanding the why behind those habits, meeting the wounded parts of you with kindness, and gradually building a relationship with food, your body, and your emotions that is less about fear and more about freedom.

What Therapy Might Look Like

In our work together, we might explore:

• What food means to you — emotionally, symbolically, and practically

• How restriction functions — what it protects you from, and what it costs

• The parts of you that strive for control or perfection — and what they’re really needing

• The voice of your inner critic — and how to gently challenge its grip

• Somatic awareness — noticing how emotions and memories live in the body

• Reclaiming joy, pleasure, and nourishment — not just through food, but in your whole life

There is no one-size-fits-all path through recovery. But there is a path. And you don’t have to walk it alone.

You Are Not a Puzzle That Needs Solving

Maybe you’re tired of fighting your own body. Maybe you’re scared to let go of the rules, because they’ve become your safety net. Or maybe you’re not sure what you feel — just that something’s off, and food has become both a focus and a fog.

Wherever you are in your journey, please know: You are not a problem to fix. You are a person to care for.

You deserve a life where meals are just meals — not moral tests or emotional minefields. A life where you can trust your body instead of punishing it. A life where you feel present, not preoccupied.

It’s possible. Truly. Even if your inner voice is whispering otherwise.

A Final Word

If you see yourself in this description — even a little bit — I want to gently encourage you to take the next step. Whether that’s reaching out to a therapist, talking to someone you trust, or simply acknowledging to yourself: Something’s not right, and I want support.

You don’t need to wait until your weight changes. You don’t need to prove your pain. You don’t need to shrink to be taken seriously.

You are already enough.

And you are not alone.

Interested in working together? I offer compassionate, personalized therapy for individuals navigating disordered eating — including atypical anorexia — using a blend of approaches that honor your body, your story, and your values. If you’re curious, I invite you to reach out. Healing starts with a conversation.