Denial and minimization in adolescents with anorexia nervosa

Abstract

Denial and minimization appear to be common processes occurring in adolescents with AN and present difficulties in assessment.

Epidemiology of eating disorders: Creating opportunities to move the current classification paradigm forward

“…12 A recent study identified 41.9% of clinical adolescent cases as exhibiting denial or minimization with respect to their dietary restraint. 13 Self-reported current dietary restraint in women who had lifetime AN was significantly lower than women who had never had an eating disorder but this former group also had a current BMI that was significantly lower than the unaffected women, 4 suggesting some lack of awareness as to the extent of their dietary restraint.…”

Clarifying criteria for cognitive signs and symptoms for eating disorders in DSM‐V

“…49 Investment in symptoms and/or lack of insight can lead to concealment, non-disclosure, minimization, and/or denial. Although only a handful of studies address prevalence of non-disclosure and/or denial among individuals with eating disorders 43,44,45,47,50,58 these support the notion that a sizeable minority to a majority of patients manifest some degree of denial about their illness. Indeed, the possibility of denial of serious consequences of behaviors is already intrinsic to AN criterion C. 12 Whereas a majority of individuals may eventually admit to their symptoms, a substantial number choose not to disclose symptoms even when queried by a health care provider.…”

“…63 Supporting this claim, the limited research on eating disorders in children and adolescents suggests that a sizeable minority of young eating disorder patients deny the cognitive criteria for AN. 47,64,65 For these younger patients, the differential diagnosis between eating disorders and feeding disorders is already difficult, 66 and denial of cognitive criteria poses an additional diagnostic challenge. Increased attention to these issues is warranted.…”

Should non‐fat‐phobic anorexia nervosa be included in DSM‐V?

“…Observed differences in eating pathology in fat-phobic versus NFP-AN may reflect bias related to response style such as denial and minimization, which are common among individuals with AN. 71,72 Individuals with AN who wish to provide a misleadingly positive account of their illness due to the egosyntonic nature of low body weight or the demand for social desirability may score low on both attitudinal and behavioral measures of eating pathology. 48 Moreover, findings of similar treatment outcomes for AN and low-DT-AN following inpatient CBT, 54 and the diagnostic crossover between NFP-AN and conventional AN in longitudinal studies 38 provide preliminary evidence that subtyping AN in this way may not be diagnostically valid.…”