Age dependency of body mass index distribution in childhood and adolescent inpatients with anorexia nervosa with a focus on DSM-5 and ICD-11 weight criteria and severity specifiers

Abstract

Both DSM-5 and ICD-11 have provided weight cut-offs and severity specifiers for the diagnosis of anorexia nervosa (AN) in childhood, adolescence and adulthood. The aims of the current study focusing on inpatients aged < 19 years were to assess (1) the relationship between age and body mass index (BMI; kg/m2), BMI-centiles, BMI-standard deviation scores (BMI-SDS) and body height-SDS at referral, (2) the percentages of patients fulfilling the DSM-5 and ICD-11 weight criteria and severity categories for AN, and (3) the validity of the AN severity specifiers via analysis of both weight related data at discharge and inpatient treatment duration. The German Registry for Anorexia Nervosa encompassed complete data sets for 469 female patients (mean age = 15.2 years; range 8.9–18.9 years) with a diagnosis of AN (n = 404) or atypical AN (n = 65), who were ascertained at 16 German child and adolescent psychiatric hospitals. BMI at referral increased up to age 15 to subsequently plateau. Approximately one tenth of all patients with AN had a BMI above the fifth centile. The ICD-11 specifier based on a BMI-centile of 0.3 for childhood and adolescent AN entailed two equally sized groups of patients. Discharge data revealed limited validity of the specifiers. Height-SDS was not correlated with age thus stunting had no impact on our data. We corroborate the evidence to use the tenth instead of the fifth BMI-centile as the weight criterion in children and adolescents. Weight criteria should not entail major diagnostic shifts during the transition from adolescence to adulthood. The severity specifiers based on BMI or BMI-centiles do not seem to have substantial clinical validity.

Suicidality in Adolescents With Onset of Anorexia Nervosa: From the Conceptualization of the Symptom to Clinical Practice

“…Thus, an assessment of the relationships between general psychopathology, ED symptoms and childhood suicidality could clarify the implications of psychopathological and speci c ED symptoms with respect to suicidality in young people with a short illness duration. In our sample there were no signi cant differences in the frequency of psychiatric comorbidities and suicidality between patients with R-AN and A-AN, consistent with literature [14,15,16].…”

“…In fact, as described by some authors [14,15, 16], it is possible to diagnose, depending on the diagnostic criteria used in the evaluation of body mass index (BMI), R-AN rather than A-AN. According to the same authors, however, there are no differences between the two forms of ED in terms of psychopathology and psychiatric comorbidity, independent of the BMI [14,15, 16].…”

“…A further factor at play in complicating the interpretation of the existing literature on the topic is the inconsistency of the criteria used to differentiate AN patients into R-AN and atypical AN (A-AN), especially considering that those de nitions differ between subjects in developmental age and the adults. In fact, as described by some authors [14,15, 16], it is possible to diagnose, depending on the diagnostic criteria used in the evaluation of body mass index (BMI), R-AN rather than A-AN. According to the same authors, however, there are no differences between the two forms of ED in terms of psychopathology and psychiatric comorbidity, independent of the BMI [14,15, 16].The overarching objective of this study is to better clarify the relationship between suicidality, AN type and severity of ED symptoms.…”

“…In fact, as described by some authors [14,15, 16], it is possible to diagnose, depending on the diagnostic criteria used in the evaluation of body mass index (BMI), R-AN rather than A-AN. According to the same authors, however, there are no differences between the two forms of ED in terms of psychopathology and psychiatric comorbidity, independent of the BMI [14,15, 16].The overarching objective of this study is to better clarify the relationship between suicidality, AN type and severity of ED symptoms. In detail, we aimed to: a) evaluate how the diagnosis of the AN subtype varies depending on the adoption of the different currently existing diagnostic criteria; b) estimate the distribution of the two diagnostic subtypes in a sample of adolescents suffering from AN; c) determine the prevalence of suicidality among children and adolescents admitted to the Child and Adolescent Psychiatry Unit (CAPU) of the Children's Hospital A. Meyer in Florence and diagnosed with R-AN or A-AN; and d) study the association between severity of ED symptoms, psychiatric comorbidity and suicidality, overall and in relation to the diagnostic subtype (R-AN vs. A-AN).Our initial hypothesis was that suicidality were related neither to weight changes nor to malnutrition, as assessed by BMI, but rather, primarily to patients psychopathological aspects.…”

Reasons for admission and variance of body weight at referral in female inpatients with anorexia nervosa in Germany

“…BMI at admission represents a prognostic marker for mortality, chronicity and future body weight [10][11][12]. BMI at admission for inpatient treatment of pediatric patients with AN has recently been shown in a large register-based data set to age-dependently increase up to age 15 years with a subsequent plateau [13]. Apart from age, BMI at admission also depends on premorbid body weight [14][15][16] with a higher premorbid BMI predicting a higher BMI at admission.…”