Should non-fat-phobic anorexia nervosa be included in DSM-V?
OBJECTIVE
Cross-cultural data suggest that rationales for food refusal vary in anorexia nervosa (AN), and a variant, termed non-fat-phobic AN (NFP-AN), has been described. This review evaluates whether data support modification of the requirement for intense fear of weight gain to meet AN criterion B in DSM-V.


METHODS
We performed a systematic search of the Medline and PsychInfo literature and evaluated the relevant publications by Robins and Guze's (Am J Psychiatry 126, 983-987, 1970) criteria as a standard for diagnostic validity. We also performed a meta-analysis comparing the severity of eating pathology in AN to (a) NFP-AN and (b) AN with low drive for thinness (low-DT-AN).


RESULTS
A modest literature indicates that NFP-AN has wide geographic distribution and occurs in both Western and non-Western populations alongside cases of typical AN. Aggregating across eligible studies, patients with NFP-AN or low-DT-AN score at least 2/3 of a standard deviation lower on measures of eating pathology than patients with conventional AN. Transcultural comparison of drive for thinness suggests significantly lower norms in non-Western cultures.


CONCLUSIONS
NFP-AN occurs with wide distribution. Further research is necessary on the course and outcomes of NFP-AN to characterize its congruence with, or distinction from, conventional AN. We discuss several options for including a description of NFP-AN in DSM-V.
Becker
Anne E
AE
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA. anne_becker@hms.harvard.edu
Thomas
Jennifer J
JJ
Pike
Kathleen M
KM
D000856:Anorexia Nervosa / Q000145:classification* / Q000175:diagnosis / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D009765:Obesity / Q000523:psychology*; D010698:Phobic Disorders / Q000145:classification* / Q000523:psychology