A critical examination of the amenorrhea and weight criteria for diagnosing anorexia nervosa

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Abstract
Background: Amenorrhea and weight loss to below 15% of ‘healthy’ weight are current diagnostic criteria for anorexia nervosa (AN). This study compares females who meet current International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD‐10) and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV) criteria for AN with females who meet the essential psychopathology and significant self‐starvation, but lack either amenorrhea or weight loss below 85%. Method: This study retrospectively examined the medical charts of 588 consecutive admissions to an in‐patient treatment program. All diagnoses conformed to ICD‐10 and DSM‐IV. Results: Of 588 admissions, 297 females had some form of AN with 77.4% (230 of 297) meeting current criteria, while 22.6% (67 of 297) with core psychopathology and self‐starvation were classified as eating disorders not otherwise specified or ‘atypical’ because of some menstrual function or final weight above 85%. The groups showed few statistically significant differences on demographics, illness history, and treatment response, psychopathology, or bone density. Conclusion: Amenorrhea may not be a useful diagnostic criterion. Also, requiring below 85% of healthy weight may need generalization.

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