Rationales for food refusal in Chinese patients with anorexia nervosa

Abstract

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.

Race, ethnicity, and eating disorders: Considerations for DSM-V

“…Alegria et al's study with Latino/as suggested that the current criteria for AN and BN (e.g., weight criteria in AN, binge frequency criterion) do not adequately capture the expression of eating disorders in this group, and this may be true in Asian and African American populations as well. 6,7 Similarly, the relatively shorter duration of illness for BN and BED in African Americans suggests that typical length of illness, and potential course of illness, may vary among diverse groups. Nicdao and coworkers 4 proposed that greater flexibility is needed in defining the eating disorders diagnoses so as to improve detection in Asian Americans; previous studies 6,8 have indicated that some aspects of the current criteria for AN (e.g., fear of fat) may not be present in Asian women who nevertheless suffer from AN.…”

Classification of eating disorders: Toward DSM-V

“…9 However, there have been cases described of individuals who seem to have a clinically significant disorder but deny weight or shape concerns (i.e., Chinese patients with AN who deny fat-phobic rationales). 32 This topic merits further research.…”

Genetic epidemiology, endophenotypes, and eating disorder classification

“…Fear of fatness or fear of weight gain has been considered to be a key feature of AN, yet family, twin and genetic studies have little to say about the underlying biology of the symptom. Hebebrand et al 18 underscore the lack of reliability and validity of this criterion, difficulty with measurement, absence in non-Western cultures, 38,39 failure to reflect the biology of AN, 40,41 and fluctuations over the course of AN. 42,43 Thus, this criterion is best conceptualized as an environmental feature relevant to understanding maintenance factors for AN, for predicting clinical course, and for understanding cultural manifestations, 44 but not a candidate endophenotype reflective of a core underlying biological process.…”