Should non‐fat‐phobic anorexia nervosa be included in DSM‐V?

Abstract

Objective: Cross-cultural data suggest that rationales for food refusal vary in anorexia nervosa (AN), and a variant, termed non-fat-phobic AN (NFP-AN), has been described. This review evaluates whether data support modification of the requirement for intense fear of weight gain to meet AN criterion B in DSM-V.Method: We performed a systematic search of the Medline and PsychInfo literature and evaluated the relevant publications by Robins and Guze's (Am J Psychiatry 126, [983][984][985][986][987] 1970) criteria as a standard for diagnostic validity. We also performed a meta-analysis comparing the severity of eating pathology in AN to (a) NFP-AN and (b) AN with low drive for thinness (low-DT-AN).Results: A modest literature indicates that NFP-AN has wide geographic distribution and occurs in both Western and non-Western populations alongside cases of typical AN. Aggregating across eligible studies, patients with NFP-AN or low-DT-AN score at least 2/3 of a standard deviation lower on measures of eating pathology than patients with conventional AN. Transcultural comparison of drive for thinness suggests significantly lower norms in non-Western cultures.Discussion: NFP-AN occurs with wide distribution. Further research is necessary on the course and outcomes of NFP-AN to characterize its congruence with, or distinction from, conventional AN. We discuss several options for including a description of NFP-AN in DSM-V. V

Clarifying criteria for cognitive signs and symptoms for eating disorders in DSM‐V

“…30 Whereas these cultural differences may attenuate risk for an eating disorder, 29,30 they may also introduce alternative social pressures that motivate behavioral symptoms with distinctive rationales. [31][32][33][34] In addition, idioms of distress vary substantially across cultural contexts and frequently reflect the legitimacy or desirability of direct expression of distress or complaint. 35 Social convention, stigmatization of mental distress, or constraints in health care resources may encourage somatic rather than psychological elaboration of symptoms.…”

“…37 Notably, there is a substantial literature that addresses a phenomenologic variant of AN in which criterion B (''Intense fear of gaining weight or becoming fat, even though underweight'' 12 ) is absent. 34,73 Whether individuals who otherwise appear to meet criteria for AN but who lack endorsement of fat phobia because of an alternate rationale for food refusal differ from those who lack insight or deliberately conceal weight concerns is unclear and requires further research. In other words, patients who do not endorse AN criterion B may comprise a heterogeneous group with a distinctive clinical course.…”

Making eating disorders classification work in ICD‐11

“…This increases the risk that different clinicians and researchers use the categories to mean different things. For example, the presentation that has been described as non-fat phobic ED in adults (Becker, Thomas, & Pike, 2009) or as food avoidance emotional disorder when seen in children is classified by some clinicians under 'Atypical anorexia nervosa', by others as 'Eating Disorder -Other' and by some as not an ED at all. There is poor inter-rater reliability over atypical ED presentations (Nicholls, Chater, & Lask, 2000).…”

Pathological fear of weight gain is a necessary criterion of anorexia nervosa

“…критерий, касающийся искажения образа своего тела у таких больных [1]. При этом некоторые авто-ры [4,5] опираются в своих выводах в основном на ряд исследований, проведенных в Юго-Восточной Азии или западных странах на отдельных этнических популяциях [6]. По этим данным значительное количество пациенток отрицают наличие страха ожирения или прибавки массы тела.…”