Anorexia Nervosa: The Diagnosis

OBJECTIVE: Our study aimed to review the outcome measures/assessment instruments used and to assess their heterogeneity/homogeneity in eating disorders (EDs) randomised controlled trials. METHODS: APA PsycInfo, PubMed, and Embase were searched in December 2022 to identify studies published between and inclusive of January 2012 and December 2022. Inclusion/exclusion criteria were: (1) complete articles published in peer-reviewed scientific journals, which were: (2) randomised trials, (3) in a clinical setting (4) with human subjects, (5) with an ICD or DSM diagnosis of Anorexia Nervosa, Binge Eating Disorder, or Bulimia Nervosa...

Anorexia nervosa (AN) belongs to the spectrum of food disorders and affects approximately 2.9 million people worldwide. It is responsible for numerous and serious medical complications. Osteoporosis is a common complication, and the decrease in bone mineral density (BMD) is one of the few potentially irreversible consequences of AN. When associated with AN, it can manifest at a very young age, possibly leading to irreparable damage. We describe the case of a 30-year-old woman with a one-year evolution diagnosis of AN, complaining of back pain...

PURPOSE: The differential diagnosis of lipodystrophy involves other disorders characterized by severe fat loss and may be sometimes challenging. Owing to the rarity of lipodystrophy, it is relevant to search for tools and assays that differentiate it from other diseases that may mimic it. We conducted a study on leptin and high molecular weight (HMW) adiponectin serum concentrations in a series of patients diagnosed with lipodystrophy and compared them with those found in anorexia nervosa, one of the illnesses that may be cause of a missed diagnosis of lipodystrophy...

OBJECTIVE: Body mass index (BMI) is the primary criterion differentiating anorexia nervosa (AN) and atypical anorexia nervosa despite prior literature indicating few differences between disorders. Machine learning (ML) classification provides us an efficient means of accurately distinguishing between two meaningful classes given any number of features. The aim of the present study was to determine if ML algorithms can accurately distinguish AN and atypical AN given an ensemble of features excluding BMI, and if not, if the inclusion of BMI enables ML to accurately classify between the two...

BACKGROUND: Although several types of risk factors for anorexia nervosa (AN) have been identified, including birth-related factors, somatic, and psychosocial risk factors, their interplay with genetic susceptibility remains unclear. Genetic and epidemiological interplay in AN risk were examined using data from Danish nationwide registers. AN polygenic risk score (PRS) and risk factor associations, confounding from AN PRS and/or parental psychiatric history on the association between the risk factors and AN risk, and interactions between AN PRS and each level of target risk factor on AN risk were estimated...

A middle-aged female patient with schizophrenia and osteoporosis presented to the emergency department with complaints of sore throat, neck pain, and dysphagia, which was identified as spontaneous pneumomediastinum (SPM) on chest CT. SPM has been reported in anorexia nervosa, but this is the first report of SPM in schizophrenia. In anorexia nervosa, an increase in intrathoracic pressure because of vomiting can cause positive pressure SPM, but this patient was considered to have negative pressure SPM because of decreased mediastinal pressure...

In anorexia nervosa (AN), measurable biological parameters can inform the process of treating patients. Such biomarkers include established laboratory parameters as well as a range of potential future biomarkers, including genetic, metabolomic, microbiomic, endocrine, immunological, hematological, electrophysiological, and neuroimaging parameters. In this opinion article we discuss how these biomarkers can support diagnosic and therapeutic processes at specific steps during the AN treatment cycle, that is, the diagnosis, diagnostic specification, risk management, choice of therapy, therapy monitoring, and treatment review...

Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the social network and the gut microbiota in pathogenesis has been added. Exogenous shocks such as the COVID19 pandemic have had a negative impact on patients with AN. The potential medical and nutritional impact of malnutrition and/or compensatory behaviors gives rise to a complex disease with a wide range of severity, the management of which requires a multidisciplinary team with a high level of subject matter expertise. Coordination between levels of care is necessary as well as understanding how to transition the patient from pediatric to adult care is essential...

PURPOSE: The present study describes the occurrence of eating disorder (ED)-related medical diagnoses in a publicly insured sample of youth with EDs. The study also compares ED medical diagnoses with other psychiatric disorders and identifies high-risk demographic groups. Improved screening practices are needed in public mental health systems where treatment is critical for youth with EDs. METHODS: Medicaid claims data were obtained from the state of California, including beneficiaries ages 7-18 who had at least one service episode between January 1, 2014, and December 31, 2016...

BACKGROUND: Eating disorders have become increasingly prevalent over the years; the age at which they appear has decreased, and they can lead to serious illness or death. Therefore, the number of studies on the matter has increased. Eating disorders like anorexia nervosa (AN) and bulimia nervosa (BN) are affected by many factors including mental illnesses that can have serious physical and psychological consequences. Accordingly, the present study aimed to compare the clinical and metabolic features of patients with AN and BN and identify potential biomarkers for distinguishing between the two disorders...

PURPOSE: This paper advocates for the inclusion of patient perspectives in the diagnosis and treatment of eating disorders (EDs) for ethical, epistemological, and pragmatic reasons. We build upon the ideas of a recent editorial published in this journal. Using EDs as their example, the authors argue against dominant DSM-oriented approaches in favor of an increased focus on understanding patients' subjective experiences. We argue that their analysis stops too soon for the development of practical-and actionable-insights into how to effect the integration of first-person and third-person accounts of EDs...

PURPOSE: Current eating disorder treatment approaches for youth were developed for use with cisgender girls, which limits the understanding of effectiveness for cisgender boys and transgender and gender expansive (TGE) youth. Here, we compare treatment outcomes for cisgender boys and TGE youth with cisgender girls receiving family-based treatment for an eating disorder. METHODS: Patients were aged 6-24 and either active in treatment or discharged from September 1, 2020, to November 1, 2022 (N = 1,235)...

The Editor in Chief and the Publisher are issuing an expression of concern to alert readers to the fact that the Special Issue titled "Omics sciences in the personalization of diagnosis and therapy" and, in particular, the following articles: ·      J. Kaftalli, K. Donato, G. Bonetti, K. Dhuli, A. Macchia, P.E. Maltese, K. Louise Herbst, S. Michelini, P. Chiurazzi, M. Hill, S. Michelini, S. Michelini, G. Marceddu, A. Bernini, M. Bertelli. Aldo-keto reductase 1C2 (AKR1C2) as the second gene associated to non-syndromic primary lipedema: investigating activating mutation or overexpression as causative factors...

OBJECTIVE: Research on the natural course of symptoms of atypical anorexia nervosa (AN) relative to AN and bulimia nervosa (BN) is limited yet needed to inform nosology and improve understanding of atypical AN. This study aimed to 1) characterize trajectories of eating disorder and internalizing (anxiety, depression) symptoms in college students with and without a history of atypical AN, AN, and BN; and 2) compare sex and race/ethnicity distributions across groups. METHOD: United States college students who participated in Spit for Science™, a prospective cohort study, were classified as having a history of atypical AN (n = 125), AN (n = 160), BN (n = 617), or as non-eating-disorder controls (NCs, n = 5876)...

OBJECTIVE: This study investigated whether mental health providers have different diagnostic impressions and treatment recommendations for patients with restrictive eating disorders, depending on the patient's body weight. METHOD: Participants were given one of three versions of a vignette depicting a patient who meets DSM-5 criteria for anorexia nervosa (AN) or atypical AN with the patient's weight described as either below, within, or above the average range for her age and height...

OBJECTIVE: While menstrual irregularities are acknowledged in restrictive-type eating disorders (EDs), the menstrual characteristics specific to atypical anorexia nervosa (AAN) remain inadequately defined. This study aims to compare the menstrual features of anorexia nervosa (AN) and AAN. METHOD: Adolescents diagnosed with AN or AAN who exhibited secondary amenorrhoea at presentation and had their menstrual cycles restored during follow-up were eligible for this study...

BACKGROUND: Eating disorder (ED) and bipolar disorder (BD) exhibit certain phenomenological similarities rooted in eating behavior and emotional regulation. However, despite the growing body of research on the comorbidity of ED and BD, scientific data on the concurrent course of these disorders has remained poorly systematized. AIM: To conduct a scoping review of published data on the prevalence of various types of ED among patients with BD types I and II in the context of the sex and clinical features of the concurrent course of these disorders...

OBJECTIVE: There is a lack of consensus in defining "significant weight loss" when diagnosing atypical anorexia nervosa (atypical AN) and no guidelines exist for setting target weight (TW). The current study aimed to identify community providers' practices related to the diagnosis of atypical AN and the determination of TW. A secondary aim was to evaluate whether professional discipline impacted "significant weight loss" definitions. METHOD: A variety of providers (N = 141; 96...

OBJECTIVE: Bone mineral density (BMD) is typically reduced in patients with female athlete triad (FAT) and anorexia nervosa (AN). However, bone health in most patients with functional hypothalamic amenorrhoea (FHA), who may not suffer from severe energy deficiency, has not received adequate attention in clinical practice. This study aimed to investigate BMD and its association with clinical and endocrine features in individuals with FHA and to provide clinical evidence for improving bone loss and preventing osteoporosis in FHA...

Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different? Abstract: Objective: Primary adrenal insufficiency (Addison's disease) is a rare differential diagnosis of anorexia nervosa. This case report presents important differential diagnostic aspects. Methods: We prepared a case report of a 14-year-old female patient according to the CARE guidelines, taking the patient's and the child's parents' view into consideration...