Special Section Review Article/Eating Disorders in DSM-V: Review of Existing Literature (Part 1)
Should non-fat-phobic anorexia nervosa be included in DSM-V?
Article first published online: 4 AUG 2009
Copyright © 2009 American Psychiatric Association. This Article is being co-published by the International Journal of Eating Disorders and the American Psychiatric Association
International Journal of Eating Disorders
Volume 42, Issue 7, pages 620–635, November 2009
How to Cite
Becker, A. E., Thomas, J. J., Pike, K. M. (2009), Should non-fat-phobic anorexia nervosa be included in DSM-V?. Int. J. Eat. Disord., 42: 620–635. doi: 10.1002/eat.20727
- Issue published online: 16 OCT 2009
- Article first published online: 4 AUG 2009
- Manuscript Accepted: 9 JUN 2009
- anorexia nervosa;
- fat phobia;
- non-fat-phobic AN;
- low drive for thinness AN
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.
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, 983–987, 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).
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.
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. © 2009 American Psychiatric Association. Int J Eat Disord 2009