Abstract
The purpose of this article is to discuss the proposed criteria of the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for anorexia nervosa (AN) and to compare these with an alternative proposal which is based on a broader conception of the AN phenotype (Hebebrand and Bulik, in press). The proposed DSM-5 criteria seem to only insufficiently resolve the problems inherent to the current classification of AN because (1) the A criterion does not include a reference to allow the clinician to decide if the (young) patient meets the weight criterion, (2) the AN patient first must have evolved the cognitive capacity for complex abstract reasoning in order to fulfill the criteria B and C (Bravender et al. in Eur Eat Disord Rev 18:79–89, 2010), (3) physical symptoms of starvation including the neuroendocrine dysfunction characteristic of AN are not a diagnostic requirement, and (4) the subtypes are not helpful for classification of younger patients who almost all have the restricting type. On these grounds the proposed DSM-5 criteria will perpetuate the diagnostic tradition of a high percentage of patients who are subsumed under the diagnosis of eating disorders not otherwise specified (EDNOS), thus hampering both clinical practice and research. The use of our recently proposed alternative criteria for AN would result in most children and adolescents with an AN-like phenotype receiving a diagnosis of AN. Accordingly, our proposed criteria would be readily applicable to children, adolescents and adults.
Similar content being viewed by others
References
Becker AE, Eddy KT, Perloe A (2009) Clarifying criteria for cognitive signs and symptoms for eating disorders in DSM-V. Int J Eat Disord 42:611–619
Hebebrand J, Bulik CM (2010) Critical appraisal of the provisional DSM-5 criteria for anorexia nervosa and an alternative proposal (in press)
Bravender T, Bryant-Waugh R, Herzog D, Katzman D, Kriepe RD, Lask B et al (2010) Classification of eating disturbance in children and adolescents: proposed changes for the DSM-V. Eur Eat Disord Rev 18:79–89
Eddy KT, Celio Doyle A, Hoste RR, Herzog DB, le Grange D (2008) Eating disorder not otherwise specified in adolescents. J Am Acad Child Adolesc Psychiatry 47(2):156–164
Peláez Fernández MA, Labrador FJ, Raich RM (2007) Prevalence of eating disorders among adolescent and young adult scholastic population in the region of Madrid (Spain). J Psychosom Res 62(6):681–690
Bulik C, PF S, Fear J, Pickering A (1997) Predictors of the development of bulimia nervosa in women with anorexia nervosa. J Nerv Ment Dis 185:704–707
Eddy KT, Dorer DJ, Franko DL, Tahilani K, Thompson-Brenner H, Herzog DB (2008) Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. Am J Psychiatry 165:245–250
Hebebrand J, Casper R, Treasure J, Schweiger U (2004) The need to revise the diagnostic criteria for anorexia nervosa. J Neural Transm 111:827–840
Herpertz-Dahlmann B, Müller B, Herpertz S, Heussen N, Hebebrand J, Remschmidt H (2001) Prospective 10-year follow-up in adolescent anorexia nervosa—course, outcome, psychiatric comorbidity, and psychosocial adaptation. J Child Psychol Psychiatry 42(5):603–612
Peat C, Mitchell JE, Hoek HW, Wonderlich SA (2009) Validity and utility of subtyping anorexia nervosa. Int J Eat Disord 42(7):590–594
Bravender T, Bryant-Waugh R, Herzog D, Katzman D, Kreipe RD, Lask B, Le Grange D, Lock J, Loeb K, Madden S, Nicholls D, O’Toole J, Pinhas L, Rome E, Sokol-Burger M, Wallen U, Zucker N (2007) Workgroup for Classification of Eating Disorders in Children and Adolescents Classification of child and adolescent eating disturbances. Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA). Int J Eat Disord 40:117–122 (review)
Hebebrand J, Muller T, Holtkamp K, Herpertz-Dahlmann B (2007) The role of leptin in anorexia nervosa: clinical implications. Mol Psychiatry 12:23–35
Heymsfield SB, Darby PC, Muhlheim LS, Gallagher D, Wolper C, Allison DB (1995) The calorie: myth, measurement, and reality. Am J Clin Nutr 62:1034S–1041S
Barlow S (2007) Expert Committee. Expect committee recommendations regarding prevention, assessment and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 120:S164–S192
Pinheiro A, Thornton L, Plotonicov K, Tozzi T, Klump K, Berrettini W et al (2007) Patterns of menstrual disturbance in eating disorders. Int J Eat Disord 40:424–434
Peebles R, Hardy KK, Wilson JL, Lock JD (2010) Are diagnostic criteria for eating disorders markers of medical severity? Pediatrics 125(5):e1193–e1201
Centers for Disease Control and Prevention (2000) CDC Growth Charts: United States. CDC National Center for Health Statistics 2000
Acknowledgment
The research leading to these results has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 245009.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Knoll, S., Bulik, C.M. & Hebebrand, J. Do the currently proposed DSM-5 criteria for anorexia nervosa adequately consider developmental aspects in children and adolescents?. Eur Child Adolesc Psychiatry 20, 95–101 (2011). https://doi.org/10.1007/s00787-010-0141-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00787-010-0141-5