Abstract
Clinical and biological aspects of restrictive anorexia nervosa (R-AN) are well documented. More than 10,000 articles since 1911 and more than 600 in 2013 have addressed R-AN psychiatric, somatic, and biological aspects. Genetic background, ineffectiveness of appetite regulating hormones on refeeding process, bone loss, and place of amenorrhea in the definition are widely discussed and reviewed. Oppositely, constitutional thinness (CT) is an almost unknown entity. Only 32 articles have been published on this topic since 1953. Similar symptoms associating low body mass index, low fat, and bone mass are reported in both CT and R-AN subjects. Conversely, menses are preserved in CT women and almost the entire hormonal profile is normal, except for leptin and PYY. The aim of the present review is to alert the clinician on the confusing clinical presentation of these two situations, a potential source of misdiagnosis, especially since R-AN definition has changed in DSM5.
Highlights
In a young population of women, between 15 and 30 years old, a low body mass index (BMI) associated with apparent healthy state suggests that the diagnosis of anorexia nervosa (AN)
Previous DSM IV definition [2] included some psychological elements in the diagnosis such as “refusal to maintain a normal BMI for their age and height, weight loss leading to maintenance of body weight
This review summarizes the main features opposing restrictive anorexia nervosa (R-AN) and constitutional thinness (CT) including nutritional markers, bone loss physiology, appetite regulating hormones, and how the DSM5 definition can lead to misdiagnoses between those two etiologies of thinness
Summary
In a young population of women, between 15 and 30 years old, a low body mass index (BMI) associated with apparent healthy state suggests that the diagnosis of anorexia nervosa (AN). DIFFERENCES BETWEEN ANOREXIA NERVOSA AND CONSTITUTIONAL THINNESS In a similar population of women, a low BMI associated with apparent healthy state could suggests that the diagnosis of a not yet well-known entity called constitutional thinness (CT). This natural and physiological low BMI (
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