Definicion de Anorexia en El Dsm-V

EMPIRI CAL ARTICLE Comparing Operational Definitions of DSM-5 Anorexia Nervosa for Research Contexts Tiffany A. Brown, MS Lauren A. Holland, MS Pamela K. Keel, PhD* ABSTRACT Objective: DSM-5 anor exia nervosa (AN) criteria include several changes that incre ase reliance on clinic al judgment. However, research contexts require operational definitions that can be applied reliably and that demonstrate validity. The present study evaluated dif fer ent ope ra- tional definitions for DSM-5 AN. Method: DSM -5 AN crit eria w er e applied to diagnostic interview data from 364 women varying two fea- tures: threshold for determining low wei ght for Criterion A (body mass index [BMI] <17.0 kg/m 2 vs. <18.5 kg/m 2 ) and explici t endo rsement of weight phobia (Criterion B expl icit vs. inferred). Resul ting groups of indi vi dual s wi th D SM -5 AN were compared on esti mated frequency. In addit ion, AN groups were compared to non-ea ting dis order con- trol s and individual s with an other spec ified feeding or eati ng disorder (OSFED) on external validators. Results: All oper atio nal DSM-5 defi ni- tions produced higher lifetime frequency esti mat es tha n rep ort ed for DSM-IV AN, with a par ticu lar ly larg e increase associated with the broadest definition. All definitions produced signi fica nt differe nces in comparison to controls on external val- idat or s th at were associated wi th medium to large effect sizes. Only definitions that required a lower weight threshold or ex plicit endorse me nt of wei gh t phobia demons trated signi fican t differ en- ces compared to OSFED on external vali- da tor s, and the se wer e of small ef fe ct siz e. Th e sp eci fic com bi na tio n of BMI <18.5 kg/m 2 with inferred weight phobia exh ibit ed few meaningful dist inction s from the OSFED group. Discussion: To balance inc lusi vity , syn- droma l reliabil ity, and validity, an operational definition for DSM-5 AN in re se ar ch cont ex ts should de fine low weight as BMI <18.5 kg/m 2 and requir e measurable rather than inferred weight phobia. V C 2013 Wiley Periodicals, Inc. Keywords: anorexia nervosa; DSM-5; oper a ti on al de fini ti on s; e at in g disorder (Int J Eat Disord 2014; 47:76–84) Introduction With the recent release of the fifth iteration of the Diag nosti c and Sta tist ical Manu al (DSM-5), 1 diagnostic cr it eria for anor ex ia ne rv osa (AN) ha ve undergone several changes to help reduce the pre- pond erance of DSM- IV eating diso rde r not othe r- wise specified (EDNOS). These changes 1 include clarifications for DSM-IV Criteria A (low weight; see Ref. 2) and B (weight phobia; see Ref. 3), as well as the removal of Criterion D (amenorrhea; see Ref. 4). No changes have been made to Criterion C (body image disturb ance , undu e influence of weight or shape on self-evaluation, or the denial of serious- ness of low weight). In considering these changes, it is important to ascertain that increasing the number of individuals who are diagnosed with AN does not decrease the ability to distinguish these individuals from those without an eating disorder or those diagnosed with a DSM-5 other specified feeding or eating di so rd er (OSF ED). Sever al st ud ie s ha ve demo nstra ted that remo ving the requ ire ment for amen orrhea will reduc e the pre vale nce of OSFED without altering validity of AN. 5–7 However, to our know led ge, no stud ies have empi rica lly examined the impact of different interpretations of Criteria A and B on the validity of the AN diagnosis. While Criterion A in the DSM-IV required a refusal to maintain body weight at or above mini- mal expectations (e.g., <85% expected body weight Accepted 6 August 2013 Portions of this work were presented at the 2011 Annual Meeting of the Eating Disorde rs Researc h Societ y in Edinbu rgh, Scotland. Supported by Contract grant sponsor: National Institute of Men- tal Health; contract grant number: R01 MH63758. *Correspondence to: Pamela K. Keel, Ph.D., Department of Psy- chology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306. E-mail: [email protected] Department of Psychology, Florida State University, Tallahas- see, Florida Published online 6 September 2013 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/eat.22184 V C 2013 Wiley Periodicals, Inc. 76 International Journal of Eating Disorders 47:1 76–84 2014

Definicion de Anorexia en El Dsm-V

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