Exploring the experience of being viewed as “not sick enough”: a qualitative study of women recovered from anorexia nervosa or atypical anorexia nervosa

A persistent myth is that restrictive eating disorders are outwardly recognizable due to severely low body weight or emaciation. Atypical anorexia nervosa (AAN) and anorexia nervosa (AN) are both characterized by restrictive eating behavior. Individuals with AAN do not have current low body weight, although some research suggests they have higher levels of impairment and eating disorder pathology than their peers with AN, and their physical health may be equally compromised. Despite this, individuals with AAN are more likely to have a longer duration of illness and less likely to receive inpatient care, suggesting their illness is not always recognized by others. Additionally, thinness is highly valued in today’s society and restrictive eating behavior or “dieting” is commonplace, which may promote trivialization, or even reinforcement, of initial weight loss by friends or family. With this in mind, our study aimed to explore the experiences of seven recovered individuals recovered from AN or AAN who were directly or indirectly told by peers, families, or healthcare professionals that they were “not sick enough” at some point during their course of illness. We explored the perceived effects on symptoms, motivation for treatment, mental health and well-being. Participants reported their symptoms were occasionally trivialized or dismissed, leading to shame, confusion, and self-doubt regarding the seriousness of their symptoms. For some, a deterioration in eating disorder symptoms ensued that led to additional weight loss, sometimes in a competitive or perfectionist pursuit to “succeed” at eating restrictively. Findings demonstrated the value of being seen and understood, as well as the potential damage of being considered as “not sick enough” by others when battling a restrictive eating disorder.