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

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.