Anorexia nervosa through the looking glass of the draft ICD-11 diagnostic criteria: a disorder in transition

Micali, Nadia

doi:10.1007/s00787-015-0771-8

Cited by 9 publications

(12 citation statements)

References 19 publications

(21 reference statements)

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“…Important limitations to highlight, however, relate to attrition, which was relatively high at age 18, and was higher amongst girls who were assigned to symptomatic classes vs. those in the asymptomatic class at 14 years of age; low power to investigate boys, due to low endorsement of ED symptoms under study. This might be due to the questions included as indicators, maybe geared towards female-specific ED behaviours and cognitions[38,39]. Indicators used were based on questions derived from the Youth Risk Behavior Surveillance System questionnaire[22], therefore symptoms were self-reported and fewer behaviours consistent with anorexia nervosa were present in the questionnaire, therefore limiting our ability to investigate anorexia-type behaviours.…”

Section: Discussionmentioning

confidence: 99%

Eating disorder behaviours amongst adolescents: investigating classification, persistence and prospective associations with adverse outcomes using latent class models

Micali

Horton

Crosby

et al. 2016

Eur Child Adolesc Psychiatry

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Diagnostic criteria for eating disorders (ED) remain largely based on clinical presentations, but do not capture the full range of behaviours in the population. We aimed to derive an empirically based ED behaviour classification using behavioural and body mass index (BMI) indicators at three time-points in adolescence, and to validate classes investigating prospective associations with adverse outcomes. Adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC) provided data on ED at age 14 (n = 6615), 16 (n = 5888), and 18 years (n = 5100), and had weight and height measured. Psychological and behavioural outcomes were assessed at 15.5/16 and 17.5/18 years. We fit gender- and age-stratified latent class models, and employed logistic regression to investigate associations between classes and later outcomes. One asymptomatic and two symptomatic (largely representing higher and lower frequency ED behaviours) classes were observed at each time-point, although their relative prevalence varied by age and gender. The majority of girls in symptomatic classes remained symptomatic at subsequent assessments. Girls in symptomatic classes had higher odds of subsequent anxiety and depressive disorders, binge drinking, drug use, and deliberate self-harm. Data analyses were underpowered amongst boys. The presence of two symptomatic classes (characterised by different ED behaviour frequency) and their prospective association with adverse outcomes suggest a need to refine diagnostic thresholds based on empirical data. Despite some instability of classes, particularly in mid-adolescence, evidence that half of girls in symptomatic classes remained symptomatic suggests persistence of ED behaviours in adolescence, and highlights a need for early identification to reduce chronicity.

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Section: Discussionmentioning

confidence: 99%

Eating disorder behaviours amongst adolescents: investigating classification, persistence and prospective associations with adverse outcomes using latent class models

Micali

Horton

Crosby

et al. 2016

Eur Child Adolesc Psychiatry

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“…The use of the fifth BMI-centile as the weight cut-off had previously been deemed too strict in that it would prevent a larger group of patients from receiving the diagnosis of AN [5,6]. In addition, the DSM-IV weight cut-off ("body weight less than 85% of that expected") had been shown to correspond to absolute BMI-values that age dependently fall between the fifth and tenth BMI-centile [2], leading the investigators to favor the use of the tenth BMI-centile as the more inclusive weight cut-off.…”

Section: Introductionmentioning

confidence: 99%

Age dependency of body mass index distribution in childhood and adolescent inpatients with anorexia nervosa with a focus on DSM-5 and ICD-11 weight criteria and severity specifiers

Engelhardt

Föcker

Bühren

et al. 2020

Eur Child Adolesc Psychiatry

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Both DSM-5 and ICD-11 have provided weight cut-offs and severity specifiers for the diagnosis of anorexia nervosa (AN) in childhood, adolescence and adulthood. The aims of the current study focusing on inpatients aged < 19 years were to assess (1) the relationship between age and body mass index (BMI; kg/m2), BMI-centiles, BMI-standard deviation scores (BMI-SDS) and body height-SDS at referral, (2) the percentages of patients fulfilling the DSM-5 and ICD-11 weight criteria and severity categories for AN, and (3) the validity of the AN severity specifiers via analysis of both weight related data at discharge and inpatient treatment duration. The German Registry for Anorexia Nervosa encompassed complete data sets for 469 female patients (mean age = 15.2 years; range 8.9–18.9 years) with a diagnosis of AN (n = 404) or atypical AN (n = 65), who were ascertained at 16 German child and adolescent psychiatric hospitals. BMI at referral increased up to age 15 to subsequently plateau. Approximately one tenth of all patients with AN had a BMI above the fifth centile. The ICD-11 specifier based on a BMI-centile of 0.3 for childhood and adolescent AN entailed two equally sized groups of patients. Discharge data revealed limited validity of the specifiers. Height-SDS was not correlated with age thus stunting had no impact on our data. We corroborate the evidence to use the tenth instead of the fifth BMI-centile as the weight criterion in children and adolescents. Weight criteria should not entail major diagnostic shifts during the transition from adolescence to adulthood. The severity specifiers based on BMI or BMI-centiles do not seem to have substantial clinical validity.

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“…But it was not the only difficulty. Responses to the beta draft of ICD‐11, have included approval over what was seen as its de‐emphasis on unsupported presuppositions as to AN individuals' motivational states, described as “non‐empirically substantiated views” that “should not continue to shape our concept of this disorder” ( 14 :1151). If we continue to “infer intentions” from patients, “we need to have compiled the relevant evidence” (page 1151), these researchers conclude.…”

Section: Qualifications and Exclusionsmentioning

confidence: 99%

Capturing the anorexia nervosa phenotype: Conceptual and normative issues in ICD‐11

Radden

2021

Evaluation Clinical Practice

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Introduction ICD‐11's diagnostic definition possesses conceptual lacunae and normative implications calling for further attention. Method Assumptions underlying it and their ethical implications, are examined employing philosophical analysis; particularly, these are (1) changes to eliminate implications of voluntary agency to caloric restriction; (2) definitions of “dangerously low weight;” and (3) disorder boundaries as stated in qualifications and exclusions. Results (1) The extent to which AN behaviour can be acknowledged to be driven by forces out of, or limiting, voluntary control is unresolved; this is illustrated using the contested part played by excessive exercise, clarification of which requires understanding of AN motivation. (2) AN's uncertain aetiology leaves doubt over the sub‐threshold state. This affects not only when treatment is appropriate, but how definitions of morbidly low body weight are determined, putting individuals with prodromal symptoms at the social risks associated with “medicalizing“ normal variation. Concluded here is not that ICD‐11's conservative definition is mistaken but that since false positives are common, they must be factored into the complex cost‐risk assessments involved. (3) ICD‐11 efforts to minimize reliance on subjective motivation reveal limitations in exclusion criteria. Were AN motivation itself better understood, it would be possible to deal with non‐anorexic motivation by exclusion. But the history of “fat fears“ illustrates that uncertainty attaches to interpretations of AN motivation. Neither AN motivation nor cultural norms around other forms of self‐starvation admit of clear characterization, leaving an impasse. Discussion At least with present day medical and scientific knowledge, a complete characterization of the AN phenotype cannot be achieved without reference to psychological states of motivation. And more research, not only clinical, genetic and neurobiological but also conceptual and ethical, will be required to resolve the challenges presented by AN.

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Anorexia nervosa through the looking glass of the draft ICD-11 diagnostic criteria: a disorder in transition

Cited by 9 publications

References 19 publications

Eating disorder behaviours amongst adolescents: investigating classification, persistence and prospective associations with adverse outcomes using latent class models

Eating disorder behaviours amongst adolescents: investigating classification, persistence and prospective associations with adverse outcomes using latent class models

Age dependency of body mass index distribution in childhood and adolescent inpatients with anorexia nervosa with a focus on DSM-5 and ICD-11 weight criteria and severity specifiers

Capturing the anorexia nervosa phenotype: Conceptual and normative issues in ICD‐11

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