Anorexia nervosa is a serious and potentially life-threatening eating disorder that primarily affects women, although men can also suffer from it. Characterized by intense fear of gaining weight and a distorted body image, anorexia often leads to severe dietary restriction, excessive exercise, and dangerous weight loss. However, anorexia does not manifest in a single, uniform way. There are several types and subtypes of anorexia, and understanding these distinctions is crucial for effective diagnosis, treatment, and recovery.
1. Restricting Type Anorexia Nervosa
The Restricting Type is one of the two main subtypes of anorexia nervosa as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is characterized by:
- Severe limitation of calorie intake
- Avoidance of food, sometimes entire food groups (e.g., fats or carbs)
- No regular bingeing or purging behavior
- Extreme control over eating habits
- Often accompanied by obsessive behaviors, such as counting calories, measuring food portions, or rigid meal planning
Psychological Profile
Women with this subtype often exhibit:
- Perfectionism
- Obsessive-compulsive tendencies
- A need for control in multiple areas of life
- Social withdrawal
- Intense fear of gaining weight even when severely underweight
This type may be less visibly dramatic than other subtypes (such as those involving purging), but it is no less dangerous. Malnutrition, organ damage, and psychological consequences can all result from prolonged restriction.
2. Binge-Eating/Purging Type Anorexia Nervosa
In contrast to the Restricting Type, the Binge-Eating/Purging Type of anorexia includes episodes of:
- Binge eating (consuming unusually large amounts of food in a short time)
- Purging behaviors, such as vomiting, misuse of laxatives, diuretics, or enemas
- Severe restriction between episodes of bingeing
This subtype shares features with bulimia nervosa, but differs in that the individual maintains an extremely low body weight, which is a key diagnostic criterion for anorexia nervosa.
Psychological Profile
Women with this subtype may:
- Experience shame and guilt following binge episodes
- Engage in secretive eating and purging
- Have co-occurring mood disorders, such as depression or anxiety
- Demonstrate impulsivity and emotional dysregulation
The cycle of bingeing and purging takes a significant toll on the body, increasing the risk of electrolyte imbalances, heart complications, gastrointestinal damage, and tooth erosion.
3. Atypical Anorexia Nervosa
Atypical Anorexia Nervosa (AAN) is a form of disordered eating where individuals meet all the criteria for anorexia nervosa except being underweight. These individuals may still have:
- Extreme food restriction
- Intense fear of gaining weight
- Distorted body image
- Significant weight loss, though not falling below the medically defined underweight threshold
Why It’s Overlooked
Atypical anorexia is often overlooked in clinical settings because of persistent stereotypes about eating disorders only affecting underweight individuals. However, the psychological and physical consequences of AAN can be just as severe as those of traditional anorexia.
Women with this form may have:
- Normal or above-average body weight
- Internalized fatphobia
- Greater stigma in seeking treatment due to not fitting the “anorexic look”
Because these women may not appear visibly ill, they often struggle to receive appropriate support or are misdiagnosed.
4. Orthorexia Nervosa (Not Officially Recognized in DSM-5)
While not officially classified in the DSM-5, orthorexia is increasingly recognized as a subtype or related disorder of anorexia, particularly among women.
Key Features:
- An obsessive focus on “clean,” “pure,” or “healthy” eating
- Avoidance of foods perceived as “impure” (e.g., processed, sugary, or animal-based)
- Extreme anxiety around food quality rather than quantity
- Moral judgment attached to food choices
Risks
Although orthorexia often begins with an interest in nutrition, it can spiral into:
- Malnutrition
- Social isolation
- Anxiety and guilt over eating “wrong” foods
- Physical consequences similar to traditional anorexia
Women are particularly vulnerable due to societal pressures around health, beauty, and wellness. The “clean eating” culture on social media can exacerbate these behaviors.
5. Anorexia Athletica (Exercise-Driven Anorexia)
Anorexia Athletica, also known as hypergymnasia or exercise anorexia, is characterized by:
- Compulsive, excessive exercise
- Restrictive eating habits to maintain or lower body weight
- Self-worth heavily tied to athletic performance or body image
It is common among women who are athletes, dancers, or involved in fitness professions. Unlike general anorexia, the driving factor is often performance-based rather than appearance-based.
Warning Signs
- Working out even when injured or ill
- Panic or distress at missing workouts
- Exercise used as punishment for eating
- Denial of fatigue or physical discomfort
This form can be especially insidious because society often praises discipline and fitness, masking the underlying disorder.
6. Pregorexia (Anorexia During Pregnancy)
Pregorexia refers to the manifestation of anorexic behaviors during pregnancy. Though not an official diagnosis, it’s a serious condition where a woman:
- Restricts food intake while pregnant
- Over-exercises to avoid weight gain
- Obsessively monitors calorie intake and body changes
Risks
- Preterm birth
- Low birth weight
- Miscarriage
- Nutrient deficiencies
- Postpartum depression
The societal pressure on women to maintain a certain appearance during and after pregnancy contributes to the development of pregorexia. It requires specialized care to protect both mother and baby.
7. Anorexia Nervosa in Midlife
Though often associated with adolescents and young adults, anorexia can and does occur in midlife women (40s, 50s, and beyond). This form may be a continuation of a lifelong eating disorder or may develop anew in response to:
- Menopause
- Divorce or relationship changes
- Career stress
- Identity transitions
Unique Challenges
- Physical health complications from long-term malnutrition
- Bone density loss and cardiovascular issues
- Resistance to treatment due to shame or stigma
- Lack of age-specific treatment programs
Eating disorders in older women are significantly under-researched, yet no less deserving of attention and care.
8. Comorbid Anorexia and Other Mental Disorders
Anorexia often co-occurs with other psychological disorders, leading to complex and mixed presentations.
Examples:
- Anorexia with Obsessive-Compulsive Disorder (OCD): Rituals around food, rigid routines, intrusive thoughts
- Anorexia with Depression: Loss of appetite, withdrawal, low self-esteem
- Anorexia with Anxiety Disorders: Social anxiety, generalized anxiety disorder, panic attacks
- Anorexia with Borderline Personality Disorder (BPD): Impulsive eating behaviors, emotional instability
These combinations affect how the anorexia presents, how it is treated, and the prognosis.
9. Cultural and Ethnic Variations in Anorexia Types
Cultural background influences how anorexia manifests in women. In some non-Western cultures:
- The drive for thinness may be less emphasized, but behaviors like food restriction or control may still exist
- Anorexia may be expressed through somatic symptoms (e.g., stomach pain) rather than body image concerns
- Cultural expectations around beauty, modesty, or family roles shape the disorder differently
Understanding these nuances is critical for culturally sensitive treatment and support.
10. Masked or Hidden Anorexia
Some women may hide their anorexia extremely well, especially if they function highly in their careers, families, or social lives. This is sometimes called “functional anorexia.”
Signs include:
- Preoccupation with food despite appearing socially “normal”
- Secretive eating or avoidance of meals with others
- Use of loose clothing to conceal weight loss
- Rationalizing disordered behaviors as part of a “healthy lifestyle”
These cases can go unnoticed for years, making intervention more difficult.
Conclusion
Anorexia nervosa is not a one-size-fits-all condition. Women experience anorexia in various ways, influenced by personality, environment, culture, age, and coexisting mental health conditions. Recognizing the different types of anorexia in women—from the DSM-5 subtypes to atypical, orthorexic, or age-specific forms—is essential for early identification and effective intervention.
Importantly, no form of anorexia is less serious than another. Regardless of weight, appearance, or eating pattern, each variation can have life-altering consequences. Treatment must be individualized, holistic, and grounded in compassion and understanding.
Raising awareness about the diversity within anorexia can help break harmful stereotypes, reduce stigma, and encourage more women to seek the help they deserve.