Differentiating constitutional thinness from anorexia nervosa in DSM 5 era

Area of Science:

• Endocrinology
• Psychiatry
• Nutritional Science

Background:

• Constitutional Thinness (CT) and Anorexia Nervosa (AN) share thinness but differ in menstruation and eating behaviors.
• The DSM-5's removal of amenorrhea from AN criteria risks misdiagnosing CT as AN.
• Accurate differentiation is vital to prevent misdiagnosis and inappropriate treatment.

Purpose of the Study:

• To compare biological, anthropometric, and psychological markers in CT, AN, and control groups.
• To identify reliable markers for distinguishing AN from CT.
• To inform diagnostic criteria and treatment strategies.

Main Methods:

• Evaluated body composition, nutritional markers, pituitary hormones, bone markers, and psychological scores in 56 CT, 40 AN, and 54 control women.
• Utilized Receiver Operator Characteristics (ROC) curve analysis to assess marker accuracy.
• Compared three groups using various biological and psychological assessments.

Main Results:

• CT subjects were largely similar to controls but distinct from AN subjects across most parameters.
• DEBQ Restrained Eating subscale score was the sole psychological marker differentiating AN from CT.
• Free-T3 and Leptin demonstrated high sensitivity and specificity, proving powerful differentiators between AN and CT.

Conclusions:

• Psychological testing alone is insufficient for differentiating AN from CT.
• Measuring Free-T3 levels, a cost-effective and accessible marker, is recommended to avoid misdiagnosis.
• Accurate diagnosis prevents ineffective treatments and social stigma for women with CT.