1.4. Body mass index at last menstrual period in anorexia nervosa

Abstract

INTRODUCTION In a previous study we reported on body weight and menstruation in the first 100 female patients on the database, assessed between 1960 and 1970 (Crisp & Stonehill, 1971). Patients with primary amenorrhea and onset of illness before 15 years of age were excluded (because of an inability to control for growth rate and matching of a control population). Difficulties in obtaining accurate/honest information about premorbid body weight andmenstruation were recognised and addressed. The comparison group comprised the general population, matched for age, sex and height. The proband group was premorbidly heavier than the general population (this finding required that the information be sought from sources other than the patient). Menstruation ceased at a mean of 52.1�6.2 kg and returned when this weight threshold was regained in treatment (53.3�6.2 kg). Thus, onset of amenorrhea in this anorectic population supervened at a level barely below mean matched population weight. At presentation in the clinic it was often put forward as the earliest feature of the disorder whereas, in reality, a mean of around 8 kg of body weight had already been lost in relation to major (often concealed) dietary calorie restriction. This early loss of menstruation, in people with anorexia nervosa, was attributed to the selective calorie starvation (predominantly carbohydrate during the 1960s (see this Issue, Paper 3) that characterises the condition. During the 1960s there was a major adolescent social rebellion, including a so-called sexual revolution that coincided with the introduction of the contraceptive pill and escalating availability of junk food, factors that probably contributed to the great increase in incidence and prevalence of bulimia nervosa around that time (Crisp, 1980). Concurrently it became evident clinically, in respect of anorexia nervosa, that onset of amenorrhea, though still associated with a wide range of body weights, was more often occurring at lower weights.