A case for re‐conceptualizing the ‘atypical’—A lived experience perspective

“…anorexia is an illness that blurs culture and pathology, and modern medicine still does not understand it.” (Bryant, 2021, p. 866) Recent research paints a powerful picture on people with anorexia across the weight spectrum. Walsh et al.'s (2022) systematic review found that people with anorexia at ‘normal’ or higher weights (atypical anorexia) comparably experience poor mental health as people with anorexia at lower weights (anorexia nervosa) yet show higher overall levels of hallmark psychological eating disorder symptoms. Johnson-Munguia et al. (2023) extend this: people with higher-weight anorexia experience similar levels of depression, preoccupation with food, compensatory behaviors, and dietary restraint as lower-weight counterparts, yet are significantly more dissatisfied with their body, have greater concerns around their weight and shape, and show a stronger drive to be thin. Reading this is bittersweet for me; I feel excited by recent discourse that challenges current nosology yet a quiet sorrow for those who fly beneath the radar. I offer the following in light of my own lived experience. Some time ago now, I found myself hovering at the confusing cleft of ‘typical’ and ‘atypical’ anorexia. To a mind already sensitized to quantification and binaries, anorexia nervosa felt ‘pure’ and legitimized while atypical—alien, other (uncannily reflecting the diagnostic category it sits within). And our health systems convey this; the experiences of people with anorexia who are not ‘clinically’ underweight are often doubted, invalidated and nullified as they are ‘not sick enough’ (Barko & Moorman, 2023) when indeed, they are (Johnson-Munguia et al., 2023). This minimization and pathologization of people with higher weight anorexia can delay identification and treatment, trigger relapses and hinder people's recovery (Harrop et al., 2023) which is deeply concerning as while termed ‘atypical’, higher weight anorexia is as common if not more so than anorexia nervosa (Harrop et al., 2021). It seems this brute weight-centrism by which we currently conceptualize and refer to ‘anorexia’ reduces it wrongfully to its bare bones, inevitably medicalizing and colluding with the nature of the disease itself in that less is more. This is an odd and erroneous way to conceptualize an illness of the mind. We need and deserve better language. As a researcher and clinician early in her career, I am struck by the positivist pursuit of diagnostic ‘truths’ that permeates the field today. As the opening quote, anorexia is a blurring force that bewitches us. We must be careful of tunnel vision in our diagnostic efforts as eating disorders and recovery experiences are inherently dynamic, diverse and complex (Barko & Moorman, 2023; Burke et al., 2020). Dichotomizing anorexia presents yet another binary that people, particularly people of color, queer and gender non-confirming folk can fall on the wrong side of. We will do well by broadening and deepening our current conceptualization, treatment, and eating disorder prevention frameworks to humanize lived/living experience communities, not further medicalize, neglect, or erase them. Critical feminist writings on eating disorders help us here, reminding us to be self-reflexive and aware of complex power structures that implicate us all (LaMarre et al., 2022). Engage better with diverse lived/living experiences. This means: On finishing, I ponder the power and radicality of recovery. For me, this was a process of de-constructing and re-constructing. It would be wise of us to do the same as we move towards re-conceptualizing what it means to experience, recover from, prevent, and treat anorexia and eating disorders more broadly. I am grateful to be witnessing and being part of this dialogue, and I feel hopeful of change. Sumedha Verma: Conceptualization; visualization; writing – original draft; writing – review and editing. This piece was written on Wurundjeri country—I pay my respects to Elders past and present. Sovereignty was never ceded. I would like to acknowledge the following people at Eating Disorders Victoria and the InsideOut Institute for Eating Disorders who have supported me in my voice and growth: Breanna Guterres, Andrew Synnot, Morgan Sidari, Phillip Aouad, Lauren Bruce, Rachael Duck, Ruth Green, Belinda Caldwell and Sarah Maguire. I would lastly like to thank Didi for her unconditionality, encouragement, and existence. The author holds a postdoctoral position funded through a National Health and Medical Research Council Medical Research, Future Fund Million Minds Mission Grant (APP1178922). There are no conflicts of interest to declare. Views expressed are my own. This article has earned a Preregistered Research Designs badge for having a preregistered research design, available at https://osf.io/zecqr/.

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