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Should Amenorrhea be part of the DSM for Anorexia?

Blog Forums Eating Disorders Should Amenorrhea be part of the DSM for Anorexia?

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    Mali Korsten

    I read this interesting article the other day:

    I personally believe that requiring Amenorrhea (lack of menstrual cycle) for a diagnosis of Anorexia prevents a lot of eating disorders from getting noticed or taken seriously. I’ve known of people with higher “lowest BMIs” than mine to lose their periods, yet I never lost mine. (I know that BMI is a load of rubbish, but considering it’s also used as a diagnostic tool, it’s relevant). So why is Amenorrhea considered necessary for an Anorexia diagnosis, particularly when Anorexia is a mental illness rather than a physical one (although clearly it has physical symptoms/manifestations)?

    I think that this outdated diagnostic criteria is preventing many from getting the help they need. I read another study which said that although the presence of a menstrual cycle may indicate a better nutritional status, it was not found to be reflective of weight/body fat %, nor the seriousness of the disorder on a mental level.

    And what about Anorexia in males? Clearly lack of menstruation is not going to be a factor in diagnosing them!

    I believe that ALL eating disorders should be taken seriously, regardless of the severity of physical symptoms.

    Anyone else have any thoughts on this?


    Makes me think of Chief’s idea of ‘chronic fatass syndrome,’ mentioned in a comment here: which is separate from scale weight. You can be in conservation mode, with all the hormonal and appetite-related adaptations for fat gain/lean tissue loss, even if you haven’t put on much weight yet, or are still in the ‘healthy weight range.’

    Waiting for a sometimes useful but possibly misleading marker (loss of menstruation, BMI over 30, etc.), can miss the boat and ignore the underlying issue for some time.

    And yeah, good point about dudes, for whom amenorrhea is an irrelevant marker.


    As I Psychology student finishing up Grad school I feel that the DSM V has really missed the mark again regarding eating disorders. Diagnostic criteria has its benefits no doubt, but the stringent guidelines leave many suffering individual in no man’s zone. It should be tailored to the unqiue aspects of the individual. Lack of a montly period makes sense for SOME individuals as it can represent a dramatic decrease in body fat, but again this doesn’t apply for everyone. Anorexia is also seen in prepubescent girls, men, women after menapause, etc.

    Mali Korsten

    Glad to know I’m not the only one who thinks this is an unhelpful aspect of the diagnostic criteria! For some reason, lots of people don’t view eating disorders as serious unless you’re in hospital, about to die. But maybe if eating disorders were taken more seriously in the less life-threatening stages, less people would get to that point.

    I also think that anorexia is competitive in nature (even if the competition is really with yourself), and that many people might see loss of menstrual cycle as something to aspire to, if they suffer with all the psychological aspects of the illness but haven’t yet had this physical development occur. In the mind of an anorexic, loss of menses could be seen as a sign that you’re doing something “right”, and that if you’re still menstruating, you must still be too fat.

    I’m not really sure why the presence of ANY physical symptoms are necessary for the diagnosis of a mental illness. Each body will respond differently to the same set of circumstances, and the individual physical responses are not really an indicator of the psychological goings on!

    Great point, @BauerPower. Apparently in prepubescent girls they look out for “delayed menses” as an indication of Anorexia? But does that mean they won’t diagnose until the patient is 17 and definitely should’ve started menstruating already? That’s misleading, because you can’t really gauge what’s “delayed” or not if you don’t know when menarche would’ve occurred otherwise.

    – Absolutely! I think I’ve been in chronic conservation mode my whole life, yet I’ve never been overweight! But maybe my body is just weird and reacts atypically to everything…

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