Should amenorrhea be a diagnostic criterion for anorexia nervosa?

Abstract

Objective: 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. Method: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.Results: 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.Discussion: 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.

La amenorrea como criterio diagnóstico de la anorexia nerviosa

“…De acuerdo con lo observado en trabajos previos (Abbate-Daga et al, 2010;Abraham, Pettigrew, Boyd, Russell & Taylor, 2005;Attia & Roberto, 2009;Smith & Wolfe, 2008), en nuestro estudio apenas se observaron diferencias en las variables evaluadas entre las pacientes con AN y las que presentaban ANSA. Ambos grupos resultaban estadísticamente equiparables en cuanto a su edad, tal y como otros autores han observado (Roberto et al, 2008;Watson & Andersen, 2003), si bien otros estudios (Cachelin & Maher, 1998;DalleGrave et al, 2008) han advertido que sus muestras de mujeres con amenorrea eran más jóvenes en el momento de ser admitidas a tratamiento.…”

“…La posibilidad de eliminar este criterio en la futura quinta edición del mencionado manual (DSM-V) ha sido considerada por varios autores (Abbate-Daga et al, 2010;Attia & Roberto, 2009;Smith & Wolfe, 2008). Finalmente, la APA (2012) ha propuesto la eliminación de dicho criterio de cara a la publicación del futuro DSM-V, ya que no resulta útil para el diagnóstico de los hombres, de las mujeres premenárquicas y posmenopáusicas, ni de aquellas que reciben terapia de reemplazo hormonal (ej., anticonceptivos orales).…”

Role of Anxiety, Depression and Anger in Eating Disorders-Structural Model

“…Anorexia nervosa is characterized by an abnormally low body weight (at least 15% below what would be expected), a corresponding fear of weight gain, and an undue emphasis on weight and shape in self-evaluation [7]. Although amenorrhea (ie, loss of 3 consecutive menstrual cycles) is currently required for the diagnosis, the importance of this symptom is unclear, and as such, the eating disorders workgroup of the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Fifth Edition) has strongly considered removing it as a criterion for AN [8] Anorexia nervosa can be classified into 2 subtypes: the restricting subtype and the binge-eating/purging subtype. Patients with AN who rarely binge-eat or purge but maintain a fairly regular pattern of caloric restriction may be classified as having the restricting subtype, whereas those who regularly engage in binge eating and/or compensatory behavior to prevent weight gain will be diagnosed as having the bingeeating/purging subtype [7].…”

“…Overeating episodes often occur at social functions, where abundant food is readily available, the mood is relaxed or positive, and other people are also overeating, whereas binge episodes typically are secretive and occur in the context of negative mood and all-ornothing thinking. Primary care physicians may elect to screen for BED using the Eating Attitudes Test, the most widely used eating disorder screening tool [8][9][10]. Alternatively, the Eating Disorder Diagnostic Scale is a 22-item, self-report inventory created to diagnose AN, BN, and BED in accordance with DSM-IV criteria.…”

Food for Thought: Change in Ego-Dystonicity and Fear of Self in Bulimia Nervosa Over the Course of Inference Based Treatment

“…Participants included in the study were adults with a principal diagnosis of AN (AN-restrictive (r) or binge-purge subtype (bp)) or BN (BN-purging subtype (p) or non-purging subtype (np)) in accordance with criteria put forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) [1]. Amenorrhea was not a requirement for individuals diagnosed with AN, given recommendations that this criterion be removed from the core diagnostic features in DSM V [36]. All medications were stabilized 3 months prior to participation.…”