Amenorrhea and Weight Criteria for AN Are Questioned

Currently, the diagnostic criteria for anorexia nervosa (AN) include amenorrhea and weight loss to below “healthy weight.” Results of a recent study at the University of Iowa have challenged the usefulness and validity of these criteria (Acta Psychiatr Scand 2003;108:175).

Drs. T. L. Watson and Arnold E. Andersen compared the records of two groups of women. The first met current International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) and DSM-IV criteria for AN. The second group met the essential psychopathological criteria for AN and used significant self-starvation, but did not have either amenorrhea or weight loss below 85% of healthy weight. The researchers used retrospective examination of the medical charts of 588 patients consecutively admitted to an inpatient treatment program. All the diagnoses conformed to ICD-10 and DSM-IV criteria.

Few differences noted

Of the 588 admissions, 297 females had some form of AN: 77.4% (230 of 297) met the current criteria, while 22.6% (67 of 297) with core psychopathology and self-starvation were classified as having eating disorders not otherwise specified, or were put into an “atypical” category because of some menstrual function or being above 85% of healthy weight. There were few significant differences in demographics, history of illness, treatment response, psychopathology, or bone density.

The authors concluded that amenorrhea may not be a useful diagnostic criterion for AN. Also, using a criterion of a weight below 85% of healthy weight needs to be better defined.