Objective To study the rationales for food refusal among Chinese patients with typical and atypical anorexia nervosa. Method Forty‐eight consecutive patients with broadly defined anorexia nervosa underwent evaluation with a self‐report rationale for food refusal questionnaire, the 12‐item General Health Questionnaire (GHQ‐12), the 21‐item Beck Depression Inventory (BDI‐21), the Hamilton Depression Rating Scale (HDRS), and other clinical assessments. Results Fat‐phobic patients (N = 32) had a significantly higher premorbid body mass index than non–fat‐phobic patients (N = 16), but they did not differ on other clinical parameters, GHQ‐12, BDI‐21, and HDRS scores. At clinical presentation, 3 months, and 1 year prior to presentation, fat phobia and stomach bloating were the most common rationales for food refusal among fat‐phobic and non–fat‐phobic patients, respectively. A total of 31% of fat‐phobic patients endorsed non‐fat‐phobic rationales at the time of clinical presentation, whereas non–fat‐phobic patients adhered to non–fat‐phobic attributions more consistently. Discussion The rationales used by anorexic patients to explain noneating are more varied than implied in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders and the ICD‐10 Classification of Mental and Behavior Disorders: Clinical Descriptions and Diagnostic Guidelines. A broadened conceptualization of anorexia nervosa may enhance an understanding of patients' illness experiences and enliven research on eating disorders. © 2001 by John Wiley & Sons, Inc. Int J Eat Disord 29: 224–229, 2001.

The variability of anorexic phenomenology challenges the current fat phobia paradigm and has implications on the diagnosis, treatment and psychometric assessment of eating disorders.