Eating disorders are a dangerous and deadly mental illness that affect 28.8 million people in the U.S. population, and 9 percent of people worldwide. There are multiple disorders with multiple criteria made to help diagnose and treat people with eating disorders. Although these criteria are used to be helpful, they can be harmful in some circumstances. 

Anorexia Nervosa, commonly known as Anorexia, is described by the Cleveland Clinic as an eating disorder where people who have a distorted self-image of themselves participate in limiting their calories and the type of food that they eat. This is known as the restricting subtype. There is also a purging subtype in which people with this disorder will exercise intensively, force themselves to vomit or misuse laxatives in order to get rid of any unwanted calories. This can cause weight loss that can potentially lead to malnutrition, health issues and even death in some cases. According to the National Library of Medicine, these are the criteria’s set to be diagnosed with Anorexia Nervosa:

• Restriction of energy intake relative to requirements, leading to a significant low body weight in the context of the age, sex, developmental trajectory and physical health (less than minimally normal/expected).
• Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain.
• Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape or persistent lack of recognition of seriousness of low bodyweight.
• In relation to the restricting subtype: In the past three months has not regularly engaged in binge-eating or purging.
• In relation to the binge/purging subtype: In the past three months has regularly engaged in binge-eating or purging.

It’s important to note that the body mass index, more commonly known as BMI, of a person describes how severe a person’s anorexia is. A BMI greater or equal to 17 is considered as mild, moderate is anywhere from a BMI of 16-16.99, severe is classified as 15-15.99, and extreme is any BMI lower than 15.

To understand why some of these classifications can be harmful, it’s important to also know what atypical Anorexia Nervosa is. Atypical Anorexia is an eating disorder categorized under Eating Disorders Not Otherwise Specified (EDNOS) that meets all of the requirements of Anorexia Nervosa besides being underweight. Acute defines the signs and symptoms of atypical anorexia:

• Current BMi, percent IBW normal or above normal
• Recent rapid, massive weight loss
  • Too fast: <3-6 months for duration of weight 
  • Too much: losing >25 percent of premorbid weight 
• Drive for thinness, body image distortions 

This small difference in the two criteria might not seem dangerous, but it can be very harmful to a person who suffers from an eating disorder. People who are at a “normal weight” or above can already feel extremely invalid in their disorders because of how the media portrays eating disorders. If someone pictures a person with anorexia, they’ll most likely think of someone who is severely underweight. This can be blamed on a lot of media playing into the idea that all people with anorexia are skinny, which isn’t true. According to ANAD, less than six percent of people with eating disorders are medically diagnosed at underweight.  Playing into this stereotype is harmful when there are so many people who suffer from anorexia who aren’t at an underweight BMI. It’s erasing a whole category of people and putting them in a category that is honestly looked at as less severe by many people.

Making a whole new category for anorexics who are at a “normal” or above normal weight can have dangerous effects. Anorexia is a mental illness, and people with anorexia want to feel validated with this illness. Calling their disorders atypical, a word meaning unusual or irregular, can make them feel like they aren’t sick or struggling enough. This can lead to them going to drastic measures to get to an underweight BMI and make themselves feel valid. It sets a goal for them by stating that a BMI lower than 17 is the usual requirement to be diagnosed with Anorexia Nervosa. 

Another reason that the distinction between these two diagnoses is  flawed is because of the inaccuracy of the BMI scale. Lambert Adolphe Jacques Quetelet was a mathematician who created the BMI scale in the 1800s. According to the CDC, the BMI does not account for excess fat, muscle, bone mass or the distribution of fat in a person. This is extremely flawed as all body types are different genetically and carry weight differently. A person with more muscle on their bodies could be classified as ‘overweight’ when in reality, they are healthy. The CDC also states that the same BMI is used for both men and women of every age. Men and women are built differently, and women often carry more fat especially around the stomach region to protect their reproductive organs. It’s inaccurate to base both females and males on the same system when there are genetic differences that affect the way their bodies are built. Additionally, basing all adults on the same system is harmful as well. Older adults usually carry more fat on their bodies once they age. It’s a natural occurrence that happens with age. BMI can be used to identify potential issues related to weight, but they should not be a tool used to diagnose how severe a person’s eating disorder is when the system is extremely flawed. 

Of course, the main reasoning for having two separate diagnoses for Anorexia is the fact that those with atypical diagnosis may not be as severe because of their weight or being less consistent with their behaviors. It is understandable to a certain degree because people underweight do have more of a risk of their bodies giving out and dying, so they need different treatment plans. But atypical anorexia is still anorexia. It’s an extremely dangerous illness and can lead to death. One case may be more at risk, but that doesn’t mean the two cases aren’t suffering from the same cause. 

Although it’s unlikely to see a change in diagnosis for now, it’s important to remember that both Anorexia Nervosa and Atypical Anorexia Nervosa are valid eating disorders that both deserve recognition and care from medical professionals, families and friends. Anyone suffering from any eating disorder deserves to have a support system and feel validated in their struggles. 

The different criteria for Anorexia Nervosa and Atypical Anorexia Nervosa can be harmful to those who have an eating disorder. It can cause a deep feeling of invalidation and make a person want to reach an underweight BMI in order to feel seen with their struggles. A disorder strived by weight should not be divided into different diagnoses, especially into ones that aren’t taken as seriously, that are based solely on weight.