Should amenorrhea be a diagnostic criterion for anorexia nervosa?


  • Evelyn Attia MD,

    Corresponding author
    1. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York
    • Columbia Center for Eating Disorders, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, New York, 10032
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  • Christina A. Roberto MS

    1. Department of Psychology, Yale University, New Haven, Connecticut
    2. Department of Epidemiology and Public Health, Yale University, New Haven, Connecticut
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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. © 2009 American Psychiatric Association. Int J Eat Disord 2009