Diagnostic Criteria for Atypical Anorexia Nervosa: A Proposal

To review the history of the term atypical anorexia nervosa and the challenges surrounding its current description and to propose a new name and diagnostic criteria.

We review the use of the term "atypical" in the literature on eating disorders and in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) and note several terms in the current description that are in need of clarification. We also describe how the ICD-11 has grappled with atypical anorexia nervosa.

The first use of atypical anorexia nervosa was by Hilde Brȕch to describe individuals who had lost substantial weight but who lacked the characteristic psychological features of anorexia nervosa. In the section on Eating Disorders Not Otherwise Specified, the DSM-IV included a description of a disorder very similar to the description of atypical anorexia nervosa; the DSM-5 slightly changed the wording and applied the term atypical anorexia nervosa. Features in the description in need of definition include "significant weight loss" and "normal or above normal weight," and the current name is problematic.

We discuss these issues and several potential options for defining features in the current description and for a new name. Following other examples in the DSM-5-TR, we propose the disorder be named "anorexia nervosa-like eating disorder (weight in normal or above normal range)" (acronym: ANLED) and suggest diagnostic criteria which could be included in the DSM-5-TR section on Conditions for Further Study.