Underweight eating disorder without over-evaluation of shape and weight: Atypical anorexia nervosa?

Introduction Underweight patients with eating disorder not otherwise specified without the over-evaluation of shape and weight (EDNOS-W) represent a diagnostic challenge. We aimed to evaluate their clinical characteristics and treatment outcome, compared with anorexia nervosa (AN) cases. Method 88 consecutive patients (81 females; age range, 13-50 years, 71 AN and 17 EDNOS-W) were studied. The differential diagnosis of AN and EDNOS-W was based on the Eating Disorder Examination. Results Compared with AN, EDNOS-W cases had a milder eating disorder psychopathology, but no differences in anthropometric and clinical data. The response to inpatient cognitive behavioral treatment was good and similar between groups, and no differences in the dropout rate or time-to-dropout were observed. The normalization of body weight in EDNOS-W cases was not associated with the appearance of the over-evaluation of shape and weight. Conclusion The data give preliminary support to the proposal to include EDNOS-W in the diagnosis of AN