Criteria For Anorexia Nervosa Research Articles

Afrontamiento en hombres operados de cáncer de laringe.

This study looks at the main coping strategies used by a sample of men who had undergone operations for larynx cancer, assessing possible differences with a sample of healthy men. We also try to gauge what the partners of these men think about this subject. We use the “Ways of Coping Scale” of Lazarus & Folkman (WCS) adapted to Spanish by Sanchez-Canovas (1991). The coping strategies used most by the larynx cancer patients are “Distancing” and “Positive Re-assessment”. Unlike the larynx operated patients, the healthy males used to a lesser extent “Acceptance of Responsibility” and “Planning”. Finally, there are no significant differences between the perceptions of the larynx-operated patients and their partners, as is the case with the healthy males and their partners. (� il0� N-GB;mso-fareast-language:AR-SA;mso-bidi-language:AR-SA'> Of the women with EDs, 17 had purgative bulimia nervosa (BN), 17 had non-purgative BN, 42 fulfilled the majority of DSM-IV-TR criteria for BN and 22 fulfilled the majority of criteria for anorexia nervosa (AN). The Positive and Negative Emotional Experience Frequency Scale was designed ad hoc for the study. The results revealed that women who experienced positive emotions less frequently and negative emotions more frequently were those who fulfilled the majority of criteria for AN. Also, the clearest emotional differences were observed between those who fulfilled the majority of criteria for AN and those who fulfilled the majority of criteria for BN. In addition to having important clinical implications, these results also suggest the need to continue studying this question in order to confirm whether (as the results suggest) it is necessary to review the DSM-IV-TR non-specific disorder category.

Épidémiologie de l’anorexie mentale : revue de la littérature

A critical review of the literature was conducted to provide answers to three questions: firstly, are we facing a national and/or international epidemic of anorexia nervosa (AN) as claimed in the media by certain professionals? Secondly, is AN simply an ordinary crisis of adolescence? Thirdly, is it a pathology that solely affects the higher socio-professional categories?A Medline search was conducted and backed up by a manual search to find all the studies or literature reviews published on prevalence, incidence rates, outcomes, morbidity and mortality in AN and its links with social class, covering the period 2000-2011.The differing methodologies of the studies on these themes have a considerable impact on the interpretation of results. For each indicator retained, the results observed in the different studies are detailed and commented in the light of these differences. The prevalence of AN in women aged 11 to 65 in non-clinical population ranges from 0 to 2.2 %. It varies in particular with the age of the studied subjects, the measurements used, and the definition criteria for AN. Among men, the lifetime prevalence is around 0.3%. The marked disparities in incidence rates observed are related to the nature of the samples considered: subjects consulting in hospital, whether in a specialised department or in any department, those consulting general practitioners (GPs), or subjects from general population samples recruited in different surveys (girls in schools for example). The incidence of female cases is low in general medicine or specialised consultation in town (whatever the speciality): from 4.2 and 8.3/100,000 individuals per year. It is much higher in the general population, ranging from 109 to 270/100,000 individuals per year. In fact, the studies reporting variations in the incidence of AN were conducted on samples from clinical populations in certain countries (United States and United Kingdom). They are probably more a reflection of variations in detection rates and use of healthcare, than of variations in the incidence in the general population. The mean duration of AN appears shorter in the general population than in clinical populations. On average, 47% of the individuals treated for AN recovered, 34% improved, 21% had a chronic eating disorder, and 5% died. The outcome is better for subjects treated during adolescence. Mortality is frequently expressed in crude mortality rate (CMR), which is not very informative on account of the heterogeneous natures of the cohorts followed; only the studies reporting standardised mortality rate (SMR) are informative. AN appears as having one of the highest mortality rates among psychiatric pathologies. Mortality varies according to the population considered. Rates observed are 6.2 to 10.6 times greater than that observed in the general population for a follow-up duration ranging respectively from 13 to 10 years. It is lower for longer follow-up periods, only 3.7 times more frequent than in the general population for follow-up periods of 20 to 40 years. It appears lower for subjects treated before the age of 20. The main causes of death are eating disorder complications, suicide and cancer. One review of the literature concluded in the absence of any significant link between this pathology and social class.There is nothing in the incidence and prevalence data to back up the notion of a recent "epidemic" of AN. AN is not simply a crisis of adolescence: morbidity and mortality are considerable in this pathology. The relationship between AN and social class is not established.

Anorexia nervosa in a Thai adolescent

In Thailand, anorexia nervosa (AN) has rarely been reported. We report a 13- year-old female adolescent with AN restrictive type, the first from Thailand to meet all Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition - Text Revision (DSM IVTR) criteria for AN. The emergence of a patient with AN in Khon Kaen, a province from the region with the lowest gross domestic product, accentuates the existence of eating disorders in adolescents beyond Thailand capital. Future studies considering sociocultural issues on normal eating attitudes, eating behaviors and body image in Thailand should be conducted.

Self-reported history of anorexia nervosa and current quality of life: findings from a community-based study

To evaluate the impact of a lifetime history of anorexia nervosa (AN) on current quality of life (QoL) and eating disorder (ED) symptomatology. 3,034 participants from a randomly selected sample of households in the Australian population were interviewed for current ED symptoms and QoL (SF-36). 89 participants (2.9 %) reported a history of AN, 73 of whom were female. These participants scored lower on six of the eight subscales on the SF-36, including all of the mental health subscales, and were more likely to report binge eating and extreme weight or shape concerns than participants who did not report a history of AN. On the other hand, participants who reported a history of AN were less likely to be overweight. None of the participants who reported a history of AN met current criteria for AN; however, one met criteria for bulimia nervosa non-purging subtype and four met criteria for binge eating disorder. The endorsement of current ED symptoms was found to moderate the impact of a history of AN on scores of the social functioning and role limitations due to emotional health SF-36 subscales, such that participants who reported a history of AN scored lower on these subscales if they also reported current ED symptoms. A history of AN has a deleterious impact on current QoL, despite remittance from the disorder. This may be explained in part by the presence of certain ED symptoms, including objective binge eating and the persistence of extreme weight and shape concerns.

Family‐based Early Intervention for Anorexia Nervosa

This study explores whether potential risk factors for anorexia nervosa (AN) can be modified by a family-based Internet-facilitated intervention and examines the feasibility, acceptability, and short-term efficacy of the Parents Act Now programme in the USA and Germany. Forty-six girls aged 11-17 were studied during a 12-month period and evaluated at screening, baseline, and post-intervention. Parents participated in the six-week intervention. Twenty-four per cent of girls (n = 791) screened met the risk criteria for AN. Parents accessed the majority of the online sessions and rated the programme favourably. At post-assessment, 16 of 19 participants evidenced reduced risk status. Participants remained stable or increased in ideal body weight and reported decreased eating disorder attitudes and behaviours. Results suggest that an easily disseminated, brief, online programme with minimal therapist support is feasible, accepted favourably by parents, and may be beneficial for prevention of exacerbation of AN pathology.

Alliance-focused therapy for anorexia nervosa: Integrative relational and behavioral change treatments in a single-case experimental design.

Evidence supporting outpatient treatments for anorexia nervosa (AN) is severely lacking, due to low retention and poor outcome. One explanation for drop-out is weak treatment alliances. A single-case experimental analysis accompanied by in-depth qualitative description is presented for Ms. O, who received a novel treatment for AN called Alliance Focused Treatment (AFT) that attends to ruptures in the alliance, interpersonal difficulties and emotional avoidance. At intake Ms. O met diagnostic criteria for AN, Major Depressive Disorder, and Social Phobia. She was characterized as having symptoms of Obsessive Compulsive, Avoidant, and Depressive personality disorders. Treatment began with a Baseline followed by the experimental (AFT) and comparison treatments (Behavioral Change Treatment [BCT]) using a replicated experimental single-case phase change design. Graphs of slopes of kilocalorie and alliance change facilitated observation of treatment effects. Ms. O participated in 16 sessions of AFT and 8 sessions of BCT with specific benefits. Ratings of the treatment alliance were consistently high and she evidenced significant changes in weight, quality of life, and personality pathology. Associations between rupture/repair episodes and kilocalorie increases were observed. The utility of the treatment relationship in facilitating emotional expression was evident. At posttreatment, Ms. O endorsed cognitive AN symptoms, although these were not explicitly treated. This study provides preliminary support for the feasibility and effect of AFT and BCT, and highlights the importance of the alliance in treating adults with AN. Further research on emotion regulation in AN and its effect on the treatment relationship are needed.

Early Onset Eating Disorders in Male Adolescents: A Series of 10 Inpatients

This case series aims to describe the demographic and clinical features of male inpatients with early onset eating disorders. Retrospective review was made of medical files of male patients treated for eating disorders at two children's hospitals over a 2 year period, with an onset of eating disorder before age 14 years, presenting for index admission. Demographic characteristics, DSM-IV diagnosis, clinical characteristics and treatment received were reviewed. Ten male patients with a median age of 12.8 years (range 10.2 to 13.5) were identified; three met the full criteria for anorexia nervosa (AN) and four met all except the weight criterion. There was high psychiatric comorbidity: four with a major depressive episode, seven an anxiety disorder, three with obsessive-compulsive disorder (OCD) symptoms. Seven engaged in over-exercise. Seven were treated with an antidepressant, and five with an atypical antipsychotic; six required nasogastric tube (NGT) feeding. A minority of patients met full diagnostic criteria for AN, with many not meeting weight criteria despite medical instability. The main clinical features were food restriction, over-exercise and psychiatric comorbidity. Treatment with antidepressants, antipsychotics and NGT feeding was frequent. Future prospective studies could help identify gender-specific features as well as benefits and potential side effects of pharmacotherapy in this age group.

Depressive dimensions and item response analysis of the Hamilton Depression Rating Scale–17 in eating disorders

BackgroundMost patients having eating disorders (EDs) experience depressive symptoms. To date, there have been few reports about the different depressive dimensions in EDs. ObjectiveThe aim of this study was to investigate the dimensions of depressive symptoms and highlight the distribution of the symptoms. The psychometric properties of these measures were tested using item response theory methods. MethodsA total of 103 consecutively admitted inpatients and outpatients who met the Diagnostic and Statistical Manual of Mental Disorders, Revised Fourth Edition, criteria for anorexia nervosa, bulimia nervosa, and EDs not otherwise specified were rated with the Hamilton Depression Rating Scale (HDRS-17). A factor analysis of the HDRS-17 was carried out with the Cf-varimax rotation. ResultsFactor analysis showed 2 independent and clinically interpretable factors corresponding to “anxious depression” and “somatic complaints” that constituted the core of depression. For the HDRS-17, item response theory analyses revealed that most of the items were maximally related to the core concept of depression and provided a good functioning. The 17 items were distributed in almost the same way as in the factor analyses found by other authors with different clinical groups. We conclude therefore that for the sample of EDs, 2 factors constitute the core symptoms of depression and most of the items provided a good functioning.

Increased resting energy expenditure by fat-free mass in children and teenagers with constitutional leanness

To compare the resting energy expenditure (REE) and the REE/Fat-free-mass (FFM) quotient in children with constitutional leanness (CL) and children with normal body weight, and to describe the within-family clustering of CL. We have studied 18 children and teenagers with CL, 10 girls and 8 boys, and 18 gender and age matched normal controls, with the same pubertal stage. All were recruited from the outpatient pediatric clinic nutrition unit. None of the children with CL showed symptoms of chronic illness, they had normal laboratory results, they had a normal caloric food intake, and they did not agree with the DSM-IV-TR criteria for anorexia nervosa. We describe the body mass index (BMI) of children and their parents. The children were classified according to Cole's recently published BMI cut-offs for thinness: under 18.5 points in CL group, stable at least in the last year, and between 18.5 and 25 cutt-offs in the control group. The body composition was calculated by anthropometric methods (skinfold thickness measurements). In addition REE was measured using fasting indirect calorimetry. The CL group had a higher mean percentage of FFM, and a mean FM significantly less, relative to controls (p < 0.001). The average absolute REE was significantly lower in the CL group (1,106.55 ± 240.72 kcal) than the control group (1,353.33 ± 270.01 kcal/dia) (p < 0.01). However, the REE adjusted for FFM showed a mean significantly greater in the CL group (41.39 ± 2.26 kcal/kg FFM) (Mean confidence interval (CI) 95 %: 40.33-42.45) than the controls (37.37 ± 3.06 kcal/kg FFM) (Mean CI 95 %: 35.93-38.81) (p < 0.001). Finally, in the family study, the mean BMI of fathers of CL group was significantly lower (p < 0.01), but there were not any differences in the mean BMI of mothers. Among parents with BMI known, 8 of 35 parents of CL group had an BMI lower 18.5, and only 2 of 36 parents in the control group (p < 0.05). This increased energy expenditure-to-FFM ratio differentiates between CL and controls. These metabolic differences are probably genetically determined.

« Maraudeur, étranger, malhabile et malade… » À propos de…« L’invisibilité sociale » de Guillaume Le Blanc

Nous avons réalisé une revue critique de la littérature afin de répondre à trois questions : (1) Faisons-nous face à une « épidémie » nationale et/ou internationale d’anorexie mentale (AM) comme le clament certains professionnels via les médias ? (2) L’AM n’est-elle qu’une banale crise d’adolescence ? (3) Est-ce une pathologie affectant exclusivement les catégories socioprofessionnelles élevées ?Nous avons réalisé une recherche par Medline complétée par une recherche manuelle pour retrouver toutes les études ou revues de la littérature publiées sur la prévalence, le taux d’incidence, le devenir, la morbidité et la mortalité de l’AM durant la période 2000–2011.Les différences de méthodologie des études menées sur ces thèmes ont des conséquences importantes sur l’interprétation des résultats. Pour chaque indicateur retenu, nous détaillons les résultats observés dans les différentes études et commentons à la lumière des différences méthodologiques.Rien n’appuie l’idée d’une épidémie récente d’AM. L’AM n’est pas une simple crise d’adolescence compte tenu de la morbidité et de la mortalité qui sont considérables. La relation entre l’AM et la classe socio-économique n’est pas prouvée.A critical review of the literature was conducted to provide answers to three questions: firstly, are we facing a national and/or international epidemic of anorexia nervosa (AN) as claimed in the media by certain professionals? Secondly, is AN simply an ordinary crisis of adolescence? Thirdly, is it a pathology that solely affects the higher socio-professional categories?A Medline search was conducted and backed up by a manual search to find all the studies or literature reviews published on prevalence, incidence rates, outcomes, morbidity and mortality in AN and its links with social class, covering the period 2000–2011.The differing methodologies of the studies on these themes have a considerable impact on the interpretation of results. For each indicator retained, the results observed in the different studies are detailed and commented in the light of these differences. The prevalence of AN in women aged 11 to 65 in non-clinical population ranges from 0 to 2.2 %. It varies in particular with the age of the studied subjects, the measurements used, and the definition criteria for AN. Among men, the lifetime prevalence is around 0.3%. The marked disparities in incidence rates observed are related to the nature of the samples considered: subjects consulting in hospital, whether in a specialised department or in any department, those consulting general practitioners (GPs), or subjects from general population samples recruited in different surveys (girls in schools for example). The incidence of female cases is low in general medicine or specialised consultation in town (whatever the speciality): from 4.2 and 8.3/100,000 individuals per year. It is much higher in the general population, ranging from 109 to 270/100,000 individuals per year. In fact, the studies reporting variations in the incidence of AN were conducted on samples from clinical populations in certain countries (United States and United Kingdom). They are probably more a reflection of variations in detection rates and use of healthcare, than of variations in the incidence in the general population. The mean duration of AN appears shorter in the general population than in clinical populations. On average, 47% of the individuals treated for AN recovered, 34% improved, 21% had a chronic eating disorder, and 5% died. The outcome is better for subjects treated during adolescence. Mortality is frequently expressed in crude mortality rate (CMR), which is not very informative on account of the heterogeneous natures of the cohorts followed; only the studies reporting standardised mortality rate (SMR) are informative. AN appears as having one of the highest mortality rates among psychiatric pathologies. Mortality varies according to the population considered. Rates observed are 6.2 to 10.6 times greater than that observed in the general population for a follow-up duration ranging respectively from 13 to 10 years. It is lower for longer follow-up periods, only 3.7 times more frequent than in the general population for follow-up periods of 20 to 40 years. It appears lower for subjects treated before the age of 20. The main causes of death are eating disorder complications, suicide and cancer. One review of the literature concluded in the absence of any significant link between this pathology and social class.There is nothing in the incidence and prevalence data to back up the notion of a recent “epidemic” of AN. AN is not simply a crisis of adolescence: morbidity and mortality are considerable in this pathology. The relationship between AN and social class is not established.

Do the currently proposed DSM-5 criteria for anorexia nervosa adequately consider developmental aspects in children and adolescents?

The purpose of this article is to discuss the proposed criteria of the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for anorexia nervosa (AN) and to compare these with an alternative proposal which is based on a broader conception of the AN phenotype (Hebebrand and Bulik, in press). The proposed DSM-5 criteria seem to only insufficiently resolve the problems inherent to the current classification of AN because (1) the A criterion does not include a reference to allow the clinician to decide if the (young) patient meets the weight criterion, (2) the AN patient first must have evolved the cognitive capacity for complex abstract reasoning in order to fulfill the criteria B and C (Bravender et al. in Eur Eat Disord Rev 18:79-89, 2010), (3) physical symptoms of starvation including the neuroendocrine dysfunction characteristic of AN are not a diagnostic requirement, and (4) the subtypes are not helpful for classification of younger patients who almost all have the restricting type. On these grounds the proposed DSM-5 criteria will perpetuate the diagnostic tradition of a high percentage of patients who are subsumed under the diagnosis of eating disorders not otherwise specified (EDNOS), thus hampering both clinical practice and research. The use of our recently proposed alternative criteria for AN would result in most children and adolescents with an AN-like phenotype receiving a diagnosis of AN. Accordingly, our proposed criteria would be readily applicable to children, adolescents and adults.

Impact of broadening definitions of anorexia nervosa on sample characteristics

Practical limitations and sample size considerations often lead to broadening of diagnostic criteria for anorexia nervosa (AN) in research. The current study sought to elucidate the effects of this practice on resultant sample characteristics in terms of eating disorder behaviors, psychiatric comorbidities, temperament and personality characteristics, and heritability point estimates. Three definitions of AN were created: meeting all Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for AN (AN-DSM-IV), meeting all DSM-IV criteria except criterion D, amenorrhea, (AN-noD), and broadening DSM-IV AN criteria by allowing a higher body mass index value, eliminating criterion D, and allowing less stringent body weight concerns (AN-Broad). Using data from the Swedish Twin Registry, 473 women fit one of the three definitions of AN. Women with AN-DSM-IV reported significantly more eating disorder behaviors than women with AN-Broad. Women with AN-noD reported more comorbid psychiatric disorders than women with AN-DSM-IV and AN-Broad. Temperament and personality characteristics did not differ across the three groups. Heritability point estimates decreased as AN definition broadened. Broadening the diagnostic criteria for AN results in an increased number of individuals available for participation in research studies. However, broader criteria for AN yield a more heterogeneous sample with regard to eating disorder symptoms and psychiatric comorbidity than a sample defined by narrower criteria.

Evidence of complex involvement of serotonergic genes with restrictive and binge purge subtypes of anorexia nervosa

Objectives. There is mixed evidence of association of serotoninergic genes with anorexia nervosa (AN), but substantial evidence for the involvement of serotonergic mechanisms in appetite control. This study was designed to investigate possible associations between the two subtypes of AN (Restricting-RAN, and Binge-purging–BPAN) and polymorphisms within five genes encoding for proteins involved in the serotoninergic system. Methods. In order to carry out this investigation we have conducted a case–control association study on 226 females meeting the criteria for AN, and 678 matched healthy females. Results. Our data show a significant association between polymorphisms with the gene encoding HTR2A with both AN subtypes, an association between polymorphisms within the genes encoding HTR1D and HTR1B with RAN, and an association between polymorphisms within the gene encoding HTR2C with BPAN. No associations were found for any polymorphisms of the serotonin transporter gene. This outcome indicates a substantial and complex inter-relationship between serotoninergic genes and AN. Conclusions. Given these data we hypothesis that the expression or control of expression of several genes of the serotoninergic system, and interactions between these genes, could exert considerable influence over the specific symptomatology of the subtypes of AN.

Prefrontal brain metabolites in short-term weight-recovered adolescent anorexia nervosa patients

Various neuroimaging techniques have revealed morphological and functional alterations in anorexia nervosa (AN), although few spectroscopic magnetic resonance studies have examined short-term weight-recovered AN patients. Subjects were 32 female adolescent patients (between 13 and 18 years old) seen consecutively in our department and who met DSM-IV diagnostic criteria for AN. All of them had received a minimum of six months of treatment and were short-term weight-recovered (for one to three months) with a body mass index ranging from 18 to 23. A group of 20 healthy female volunteer controls of similar age were also included. All subjects were assessed with psychopathological scales and magnetic resonance spectroscopy. Total choline (Cho) ( p = 0.007) and creatine (Cr) ( p = 0.008) levels were significantly higher in AN patients than in controls. AN patients receiving psychopharmacological treatment with SSRIs ( N = 9) had metabolite levels similar to control subjects, but patients without this treatment did not. The present study shows abnormalities in brain neurometabolites related to Cho compounds and Cr in the prefrontal cortex in short-term weight-recovered adolescent AN patients, principally in patients not undergoing psychopharmacological treatment. More studies with larger samples are necessary to test the generalizability of the present results.

Should amenorrhea be a diagnostic criterion for anorexia nervosa?

The removal of the amenorrhea criterion for anorexia nervosa (AN) is being considered for the fifth edition of The Diagnostic and Statistical Manual (DSM-V). This article presents and discusses the arguments for maintaining as well as those for removing the criterion. The psychological and biological literatures on the utility of amenorrhea as a distinguishing diagnostic criterion for AN and as an indicator of illness severity are reviewed. The findings suggest that the majority of differences among patients with AN who do and do not meet the amenorrhea criterion appear largely to reflect nutritional status. Overall, the two groups have few psychological differences. There are mixed findings regarding biological differences between those with AN who do and do not menstruate and the relationship between amenorrhea and bone health among patients with AN. Based on these findings, one option is to describe amenorrhea in DSM-V as a frequent occurrence among individuals with AN that may provide important information about clinical severity, but should not be maintained as a core diagnostic feature. The possibilities of retaining the criterion or eliminating it altogether are discussed.

A 4‐year prospective study of eating disorder NOS compared with full eating disorder syndromes

To examine the course of Eating Disorder NOS (EDNOS) compared with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Prospective study of 385 participants meeting DSM-IV criteria for AN, BN, BED, and EDNOS at three sites. Recruitment was from the community and specialty clinics. Participants were followed at 6-month intervals during a 4-year period using the Eating Disorder Examination as the primary assessment. EDNOS remitted significantly more quickly that AN or BN but not BED. There were no differences between EDNOS and full ED syndromes, or the subtypes of EDNOS, in time to relapse following first remission. Only 18% of the EDNOS group had never had or did not develop another ED diagnosis during the study; however, this group did not differ from the remaining EDNOS group. EDNOS appears to be a way station between full ED syndromes and recovery, and to a lesser extent from recovery or EDNOS status to a full ED. Implications for DSM-V are examined.

Typical and atypical restrictive anorexia nervosa: Weight history, body image, psychiatric symptoms, and response to outpatient treatment

Few studies have examined the characteristics of atypical restrictive anorexia nervosa (AN) with a well-powered design. The study aims to explore this issue, with particular attention paid to psychopathology and response to outpatient treatment. The sample consists of 365 participants with restrictive AN and 204 with atypical AN. Three types of atypical AN were included: subthreshold (all the criteria except weight); partial (AN without amenorrhea); and participants with AN without fear of gaining weight. Participants with AN without fear of weight gain reported the lowest lifetime BMI and subthreshold AN the highest. Participant with partial AN reported the highest levels of psychiatric symptoms and novelty seeking. All types of atypical AN showed high rates of dropout, whereas participants with subthreshold AN showed the highest level of full remission after treatment. Before considering a revision of the diagnostic criteria of AN, further studies on adequately large samples are needed.

The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: Meta-analysis and implications for DSM.

Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder (ED) diagnosis. In this meta-analysis, the authors aimed to inform Diagnostic and Statistical Manual of Mental Disorders revisions by comparing the psychopathology of EDNOS with that of the officially recognized EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). A comprehensive literature search identified 125 eligible studies (published and unpublished) appearing in the literature from 1987 to 2007. Random effects analyses indicated that whereas EDNOS did not differ significantly from AN and BED on eating pathology or general psychopathology, BN exhibited greater eating and general psychopathology than EDNOS. Moderator analyses indicated that EDNOS groups who met all diagnostic criteria for AN except for amenorrhea did not differ significantly from full syndrome cases. Similarly, EDNOS groups who met all criteria for BN or BED except for binge frequency did not differ significantly from full syndrome cases. Results suggest that EDNOS represents a set of disorders associated with substantial psychological and physiological morbidity. Although certain EDNOS subtypes could be incorporated into existing Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) categories, others-such as purging disorder and non-fat-phobic AN-may be best conceptualized as distinct syndromes. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Amenorrhea as a Diagnostic Criterion for Anorexia Nervosa: A Review of the Evidence and Implications for Practice

Amenorrhea is currently a criterion in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text rev. [DSM-IV-TR]) for the diagnosis of anorexia nervosa (AN). Recently, there has been increased interest in examining the utility of this criterion. This article reviews the historical rationale for inclusion of amenorrhea in the DSM criteria for AN, clinical evidence evaluating amenorrhea as a diagnostic criterion for AN, and the nursing practice implications of amenorrhea as a diagnostic criterion for AN. Data suggest there is limited support for amenorrhea as a diagnostic criterion for AN. J Am Psychiatr Nurses Assoc, 2008; 14(3), 209-215. DOI: 10.1177/1078390308320288.

The clinical significance of amenorrhea as a diagnostic criterion for anorexia nervosa

Amenorrhea is a DSM-IV criterion for the diagnosis of anorexia nervosa (AN). Several studies have reported few differences between patients who meet the full DSM-IV criteria for AN and those who meet all but the amenorrhea criterion. Although this suggests that the absence of menses does not provide critical diagnostic information, many of these studies are limited by small sample sizes. This study aims to examine the clinical utility of amenorrhea as a criterion for the diagnosis of AN. A chart review was conducted of 240 consecutive patients admitted for inpatient treatment at the NY State Psychiatric Institute from 1993 to 2006. Menstrual data were collected from the Eating Disorder Examination conducted upon admission. Independent samples t-tests were performed to evaluate differences in clinical variables, including age, lifetime lowest body mass index (BMI), admission and discharge BMI, previous number of hospitalizations, duration of illness, Beck Depression Inventory total score, Beck Anxiety Inventory total score, and Eating Disorder Examination subscale scores. The amenorrheic and menstruating groups differed significantly only on lowest lifetime BMI and admission BMI, with individuals with amenorrhea having lower BMIs on both measures. These results indicate that amenorrhea does not distinguish between groups on a number of important measures of clinical severity. It may be that amenorrhea reflects weight and nutritional status, rather than providing useful diagnostic information. Future studies are needed to examine the potential prognostic value of menstrual status.