title: Bone density, body composition, and psychopathology of anorexia nervosa spectrum disorders in DSM-IV vs DSM-5.
abstract: DSM-5 revised the diagnostic criteria for anorexia nervosa (AN) by eliminating the amenorrhea requirement, liberalizing weight and psychological criteria, and adding the formal diagnosis of "atypical AN" for individuals with AN psychological symptoms without low weight. We sought to determine whether bone density (BMD) is impaired in women diagnosed with AN using the new, more liberal, DSM-5 criteria.
  
  
  
  Cross-sectional study of 168 women, 18 - 45y: (1) AN by DSM-IV (DSM-IV AN) (n = 37), (2) AN by DSM-5 but not DSM-IV criteria (DSM-5 AN) (n = 33), (3) atypical AN (ATYPICAL AN) (n = 77), (4) healthy comparison group (HC) (n = 21). Measurements included dual energy X-ray absorptiometry, Eating Disorder Examination-Questionnaire, Eating Disorder Inventory-2, Hamilton Depression and Anxiety Rating Scales.
  
  
  
  BMD Z-score <-1.0 was present in 78% of DSM-IV, 82% of DSM-5, and 69% of ATYPICAL. Mean Z-scores were comparably low in DSM-IV and DSM-5, intermediate in ATYPICAL, and highest in HC. Lack of prior low weight or amenorrhea was, but history of overweight/obesity was not, protective against bone loss. Mean lean mass and percent fat mass were significantly lower in all AN groups than HC. DSM-IV, DSM-5, and ATYPICAL had comparable psychopathology.
  
  
  
  Despite liberalizing diagnostic criteria, many women diagnosed with AN and atypical AN using DSM-5 criteria have low BMD. Presence or history of low weight and/or amenorrhea remain important indications for DXA. Loss of lean mass, in addition to fat mass, is present in all AN groups, and may contribute to low BMD. The deleterious effect of eating disorders on BMD extends beyond those with current low weight and amenorrhea. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:343-351).
authors.affiliation: Massachusetts General Hospital, Neuroendocrine Unit, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Melanie
authors.initials: M
authors.lastname: Schorr
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Massachusetts General Hospital, Eating Disorders Clinical and Research Program, Boston, Massachusetts.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Thomas
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Massachusetts General Hospital, Eating Disorders Clinical and Research Program, Boston, Massachusetts.
authors.forename: Kamryn T
authors.initials: KT
authors.lastname: Eddy
authors.affiliation: Massachusetts General Hospital, Neuroendocrine Unit, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Dichtel
authors.affiliation: Massachusetts General Hospital, Neuroendocrine Unit, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Lawson
authors.affiliation: Massachusetts General Hospital, Neuroendocrine Unit, Boston, Massachusetts.
authors.forename: Erinne
authors.initials: E
authors.lastname: Meenaghan
authors.affiliation: Massachusetts General Hospital, Neuroendocrine Unit, Boston, Massachusetts.
authors.forename: Margaret
authors.initials: M
authors.lastname: Lederfine Paskal
authors.affiliation: Massachusetts General Hospital, Neuroendocrine Unit, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Pouneh K
authors.initials: PK
authors.lastname: Fazeli
authors.affiliation: Massachusetts General Hospital, Neuroendocrine Unit, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Faje
authors.affiliation: Massachusetts General Hospital, Neuroendocrine Unit, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Madhusmita
authors.initials: M
authors.lastname: Misra
authors.affiliation: Massachusetts General Hospital, Neuroendocrine Unit, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Anne
authors.initials: A
authors.lastname: Klibanski
authors.affiliation: Massachusetts General Hospital, Neuroendocrine Unit, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Miller
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000503:physiopathology / Q000523:psychology; D000856:Anorexia Nervosa / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D001007:Anxiety / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D001823:Body Composition / Q000502:physiology*; D001835:Body Weight; D015519:Bone Density / Q000502:physiology*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008875:Middle Aged; D055815:Young Adult
keywords: anorexia nervosa; bone density; osteoporosis