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

Authors

  • Anne E. Becker MD, PhD, ScM,

    Corresponding author
    1. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
    2. Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
    • Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston, Massachusetts 02115
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  • Jennifer J. Thomas PhD,

    1. Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
    2. Klarman Eating Disorders Center, McLean Hospital, Belmont, Massachusetts
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  • Kathleen M. Pike PhD

    1. College of Liberal Arts, Temple University in Japan, Tokyo, Japan
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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, 983–987, 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. © 2009 American Psychiatric Association. Int J Eat Disord 2009

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