Jenni Schaefer, 42, was a young child when she began to struggle with negative body image.

"I actually think existence 4 years old and existence in dance course, and I distinctly retrieve comparing myself to the other little girls in the room and feeling bad about my body," Schaefer, now based in Austin, Texas, and author of the book "Almost Anorexic," told Healthline.

As Schaefer got older, she began to restrict the amount of food she ate.

By the time she started high school, she adult what'south now known every bit atypical anorexia.

At that signal in time, atypical anorexia wasn't an officially recognized eating disorder. But in 2013, the American Psychiatric Association added it to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The DSM-5 criteria for singular anorexia are similar to those for anorexia nervosa.

In both weather, people persistently restrict the calories they eat. They demonstrate an intense fear of gaining weight or a refusal to gain weight. They also experience distorted trunk image or put excessive stock in their torso shape or weight when evaluating their self-worth.

Only unlike people with anorexia nervosa, those with singular anorexia aren't underweight. Their body weight tends to fall within or to a higher place the so-called normal range.

Over time, people with singular anorexia tin get underweight and meet the criteria for anorexia nervosa.

But even if they don't, atypical anorexia tin can cause serious malnutrition and impairment to their wellness.

"These people can be very medically compromised and quite sick, even though they may be at a normal weight or fifty-fifty overweight," Dr. Ovidio Bermudez, chief clinical officer of the Eating Recovery Center in Denver, Colorado, told Healthline.

"This is not a bottom diagnosis [than anorexia nervosa]. This is just a dissimilar manifestation, all the same compromising health and putting people at medical risk, including risk of death," he continued.

From the exterior looking in, Schaefer "had it all together" in high school.

She was a directly-A student and graduated 2d in her class of 500. She sang in varsity bear witness choir. She was headed to college on a scholarship.

Only underneath it all, she struggled with "unrelenting painful" perfectionism.

When she couldn't run into the unrealistic standards she set for herself in other areas of her life, restricting food gave her a sense of relief.

"Restricting actually tended to numb me in a fashion," she said. "So, if I was feeling anxious, I could restrict food, and I actually felt better."

"Sometimes I would binge," she added. "And that felt better, too."

Seeking help without success

When Schaefer moved away from home to attend higher, her restrictive eating got worse.

She was nether a lot of stress. She no longer had the construction of daily meals with her family to assistance her meet her nutritional needs.

She lost a lot of weight very quickly, dropping below the normal range for her height, age, and sex activity. "At that point, I could have been diagnosed with anorexia nervosa," she said.

Schaefer'southward loftier schoolhouse friends voiced concerns virtually her weight loss, but her new friends at college complimented her advent.

"I was receiving compliments every solar day for having the mental affliction with the highest mortality rate of any other," she recalled.

When she told her medico that she'd lost weight and hadn't gotten her period for months, her doctor simply asked her if she ate.

"There's a big misconception out there that people with anorexia or singular anorexia do non eat," Schaefer said. "And that's only not the case."

"And so when she said, 'Do yous eat?' I said yeah,'" Schaefer continued. "And she said, 'Well, you're fine, you're stressed out, it'south a big campus.'"

It would take some other five years for Schaefer to seek assistance again.

Getting praise for weight loss

Schaefer's not the only person with atypical anorexia who's faced barriers to getting help from healthcare providers.

Earlier Joanna Nolen, 35, was a teenager, her pediatrician prescribed her diet pills. Past that indicate, he'd already been pushing her to lose weight for years, and at age eleven or 12, she now had a prescription to do only that.

When she hitting junior college, she began to restrict her nutrient intake and exercise more.

Fueled in part past the positive reinforcement she received, those efforts chop-chop escalated into atypical anorexia.

"I started to notice the weight coming off," Nolen said. "I started to get recognition for that. I started to get praise for what I was looking similar, and there was now a huge focus on, 'Well, she'southward got her life together,' and that was a positive matter."

"Watching the things that I ate turned into massive, obsessive calorie counting and calorie brake and obsession with practice," she said. "Then that progressed into abuse with laxatives and diuretics and forms of nutrition medications."

Nolen, based in Sacramento, California, lived similar that for more than than a decade. Many people lauded her weight loss during that time.

"I flew under the radar for a very long time," she recalled. "It was never a red flag to my family. Information technology was never a red flag to doctors."

"[They thought] that I was determined and motivated and dedicated and healthy," she added. "But they didn't know what was all going into that."

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Facing barriers to handling

According to Bermudez, these stories are far also common.

Early diagnosis can help people with singular anorexia and other eating disorders get the treatment they need to begin the recovery process.

Simply it many cases, it takes years for people with these conditions to get assistance.

As their condition continues untreated, they may fifty-fifty receive positive reinforcement for their restrictive eating or weight loss.

In a gild where dieting is widespread and thinness is valorized, people often fail to recognize eating matted behaviors as signs of illness.

For people with atypical anorexia, getting assist can mean trying to convince insurance companies you need handling, fifty-fifty if you're non underweight.

"We're still struggling with people who are losing weight, losing menses, becoming bradycardic [slow heart vanquish] and hypotensive [low claret pressure,] and they get a pat on the back and told, 'It'southward good that you lost some weight,'" Bermudez said.

"That's true in people who wait similar they're underweight and ofttimes traditionally malnourished in appearance," he connected. "So imagine what a barrier there is for people who are of relatively normal size."

Getting professional person support

Schaefer could no longer deny she had an eating disorder when, in her final yr of college, she began to purge.

"I mean, restricting nutrient is what nosotros're told to practice," she said. "We're told nosotros're supposed to lose weight, so those eating disorder behaviors often get missed considering we think we're simply doing what everybody'southward trying to practice."

"But I knew that trying to make yourself throw up was incorrect," she continued. "And that was non good and that was dangerous."

At first, she thought she could overcome the affliction on her own.

But eventually she realized she needed assist.

She called the National Eating Disorders Association's helpline. They put her in touch with Bermudez, or Dr. B every bit she affectionately calls him. With financial support from her parents, she enrolled in an outpatient treatment program.

For Nolen, the turning point came when she developed irritable bowel syndrome.

"I idea that it was due to the years of abuse with laxatives, and I was terrified that I had washed severe damage to my internal organs," she recalled.

She told her md virtually all of her efforts to lose weight and her persistent feelings of unhappiness.

He referred her to a cognitive therapist, who quickly connected her to an eating disorder specialist.

Considering she wasn't underweight, her insurance provider wouldn't cover an inpatient program.

So, she enrolled in an intensive outpatient plan at the Eating Recovery Center instead.

Jenni Schaefer

Recovery is possible

As office of their handling programs, Schaefer and Nolen attended regular support group meetings and met with dietitians and therapists who helped them on the road to recovery.

The recovery process wasn't piece of cake.

Simply with the assistance of eating disorder experts, they've developed the tools they demand to overcome singular anorexia.

For other people who are experiencing like challenges, they advise the most of import affair is to reach out for help — preferably to an eating disorder specialist.

"Y'all don't take to look a sure way," said Schaefer, now an administrator for NEDA. "You don't have to fit into this diagnostic criteria box, which in many ways is arbitrary. If your life is painful and you feel powerless because of food and body image and the calibration, get assist."

"Full recovery is possible," she added. "Don't stop. Y'all really can get better."