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Comment
. 2023 Apr;56(4):838-840.
doi: 10.1002/eat.23924. Epub 2023 Feb 28.

Atypical anorexia nervosa diagnosis should exclude those with lifetime anorexia nervosa: Commentary on Walsh, Hagan, and Lockwood (2022)

Kamryn T Eddy  1   2 , Lauren Breithaupt  1   2
Affiliations
Comment

Atypical anorexia nervosa diagnosis should exclude those with lifetime anorexia nervosa: Commentary on Walsh, Hagan, and Lockwood (2022)

Kamryn T Eddy et al. Int J Eat Disord. 2023 Apr.

Abstract

Atypical anorexia nervosa (AN) is not well-defined. Walsh, Hagan, and Lockwood (2022) review the data on atypical AN published in the last decade demonstrating overwhelming clinical similarities between atypical AN and AN. As written, atypical AN includes at least three clinical presentations that may not have the same underlying illness, and in turn, may have different prognoses and treatment needs: (1) higher-weight AN; (2) prodromal AN; and (3) partial remission from AN. While useful for the first two presentations, we suggest that the atypical AN diagnosis is not appropriate for those in partial remission from AN. Extant data document symptom fluctuation is part of illness course in AN rather than crossover to a distinct disorder. Further, lifetime AN carries the greatest risk for relapse to low-weight, premature death, and medical morbidities. Finally, emerging data support unique biobehavioral mechanisms in AN suggesting its combination with atypical AN is premature. Therefore, at this time, we recommend that the atypical AN diagnosis be reserved for those without lifetime AN. We encourage research to test and validate operational definitions of atypical AN and partial remission from AN, and further suggest documentation of lifetime AN across the eating disorders given its prognostic value.

Keywords: DSM-5; anorexia nervosa; atypical anorexia nervosa; diagnosis; partial remission.

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References

REFERENCES

    1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
    1. Breithaupt, L., Kahn, D. L., Slattery, M., Plessow, F., Mancuso, C., Izquierdo, A., Dreier, M. J., Becker, K., Franko, D. L., Thomas, J. J., Holsen, L., Lawson, E. A., Misra, M., & Eddy, K. T. (2022). Eighteen-month course and outcome of adolescent restrictive eating disorders: Persistence, crossover, and recovery. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 51(5), 715-725. https://doi.org/10.1080/15374416.2022.2034634
    1. Bulik, C. M., Coleman, J. R. I., Hardaway, J. A., Breithaupt, L., Watson, H. J., Bryant, C. D., & Breen, G. (2022). Genetics and neurobiology of eating disorders. Nature Neuroscience, 25(5), 543-554. https://doi.org/10.1038/s41593-022-01071-z
    1. Eddy, K. T., Swanson, S. A., Crosby, R. D., Franko, D. L., Engel, S., & Herzog, D. B. (2010). How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa? Psychological Medicine, 40(10), 1735-1744. https://doi.org/10.1017/S0033291709992200
    1. Walsh, B. T., Hagan, K. E., & Lockwood, C. (2022). A systematic review comparing atypical anorexia nervosa and anorexia nervosa. The International Journal of Eating Disorders, 56(4), 798-820. https://doi.org/10.1002/eat.23856

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