Article

Should Amenorrhea Be a Diagnostic Criterion for Anorexia Nervosa?

Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, USA.
International Journal of Eating Disorders (Impact Factor: 3.13). 11/2009; 42(7):581-9. DOI: 10.1002/eat.20720
Source: PubMed

ABSTRACT

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.

    • "Amenorrhea was not required for AN participants (Attia and Roberto, 2009), but the participant's weight needed to be below the 85th percentile according to the medium frame weight for height and sex on the 1959 Metropolitan Life Insurance Tables. Items of the Eating Disorder Examination (EDE) (see measures) were used to determine diagnostic criteria in AN (item " maintain low weight, " 1; items " fear of weight gain, " ≥4; and " importance of weight or shape " or " feeling fat, " ≥4, all for the past 3 months) (Fairburn et al., 2008). "

    No preview · Article · Jun 2015 · Journal of Nervous & Mental Disease
    • "Regarding BDD, we included only BDD participants with a score on the Yale-Brown Obsessive Compulsive Scale adapted for BDD (Phillips et al., 1997) of ≥20, as a previous study has derived this cut-off as an indicator of significant body image concerns (Deckersbach, Wilhelm, Otto, Savage, & Buhlmann, 1998). With regard to AN, we did not require amenorrhea as an inclusion criterion, as individuals with or without amenorrhea do not differ psychologically (Attia & Roberto, 2009). Underweight was defined as being below the 85th percentile according to the medium frame weight for height and gender on the 1959 Metropolitan Life Insurance Tables. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although body image is central to the etiological models of anorexia nervosa and body dysmorphic disorder, studies comparing body image and beliefs about attractiveness between the disorders are rare. Sixty-nine individuals (anorexia nervosa: n=24, body dysmorphic disorder: n=23, healthy controls: n=22) completed self-report measures (body image and general psychopathology), diagnostic interviews, and Go/No-Go Association tasks measuring implicit associations. Compared to controls, both clinical groups exhibited greater negative body image, a more negative attitude toward their physical selves, and more dysfunctional coping strategies (ps<.001). Also, both clinical groups shared greater explicit beliefs about the importance of attractiveness (ps<.001). In addition to supporting previous research with regard to comparable body image disturbance, this study also showed that beliefs regarding the importance of appearance (e.g., "one must be attractive to be successful") might be a fruitful target for therapy across both disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Apr 2015 · Body image
    • "Only BDD participants with a score on the Yale-Brown Obsessive Compulsive Scale adapted for BDD (Phillips et al., 1997) of Z20 were included in the study, as a previous study has derived this cut-off as an indicator of significant body image concerns (Deckersbach et al., 1998). Amenorrhea was not required for AN participants in order to make the sample more comparable to studies using current DSM-5 criteria and as it has been shown that individuals with AN with or without amenorrhea do not differ much psychologically (Attia and Roberto, 2009). The participant's weight needed to be below the 85th percentile according to the medium frame weight for height and gender on the 1959 Metropolitan Life Insurance Tables. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Negative body image is the hallmark of anorexia nervosa (AN) and body dysmorphic disorder (BDD). One aspect of body image, appearance-related thoughts, have shown to be a major contributor to relapse, thus further investigation of successful treatment strategies targeting these maladaptive thoughts are warranted. The present study tested an acceptance/mindfulness (AC), a cognitive restructuring (CR), and a distraction strategy with regard to their short-term effectiveness of reducing the frequency of thought occurrence and associated outcomes in participants with AN (n=20), BDD (n=21), and healthy controls (HC; n=22). Although all strategies led to a significant reduction of thought frequency, there was no group×strategy interaction effect in their reduction. Positive affect increased in the BDD group through the AC strategy, but decreased in healthy controls. Acceptance of the thought increased in the CR strategy in AN, whereas that strategy seemed to work least for BDD. Healthy controls showed most acceptance when using distraction. Taken together, the study suggests that all strategies might have their benefits and that it might be worthwhile further investigating differential indication of the strategies with regard to diagnosis and individual factors. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Dec 2014 · Psychiatry Research
Show more