Bone density, body composition, and psychopathology of anorexia nervosa spectrum disorders in DSM‐IV DSM‐IV vs DSM‐5 DSM‐5

摘要

ABSTRACT Objective DSM5 revised the diagnostic criteria for anorexia nervosa (AN) by eliminating the amenorrhea requirement, liberalizing weight and psychological criteria, and adding the formal diagnosis of atypical AN for individuals with AN psychological symptoms without low weight. We sought to determine whether bone density (BMD) is impaired in women diagnosed with AN using the new, more liberal,DSM5 criteria.Method Crosssectional study of 168 women, 18 45y:( 1) AN byDSMIV ( DSMIV AN ) (n = 37), (2) AN byDSM5 but notDSMIV criteria (DSM5 AN ) (n = 33), (3) atypical AN (ATYPICAL AN ) (n = 77), (4) healthy comparison group (HC ) (n = 21). Measurements included dual energy Xray absorptiometry, Eating Disorder ExaminationQuestionnaire, Eating Disorder Inventory2, Hamilton Depression and Anxiety Rating Scales.Results BMDZ score 1.0 was present in 78% ofDSMIV , 82% ofDSM5 , and 69% of ATYPICAL. MeanZ scores were comparably low inDSMIV andDSM5 , intermediate in ATYPICAL, and highest in HC. Lack of prior low weight or amenorrhea was, but history of overweight/obesity was not, protective against bone loss. Mean lean mass and percent fat mass were significantly lower in all AN groups than HC.DSMIV, DSM5, and ATYPICAL had comparable psychopathology.Discussion Despite liberalizing diagnostic criteria, many women diagnosed with AN and atypical AN usingDSM5 criteria have low BMD. Presence or history of low weight and/or amenorrhea remain important indications for DXA. Loss of lean mass, in addition to fat mass, is present in all AN groups, and may contribute to low BMD. The deleterious effect of eating disorders on BMD extends beyond those with current low weight and amenorrhea. ?2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:343351)