In defense of weight phobia as the central organizing motive in anorexia nervosa: historical and cultural arguments for a culture-sensitive psychological conception.

OBJECTIVE

Recently several proposals at dropping weight phobia as the central criterion for the differential diagnosis of anorexia nervosa have been advanced, aiming at establishing a new diagnostic category including any self-induced weight loss. The validity of weight phobia as a diagnostic criterion is defended.

METHODS

After summarizing clinical arguments, four groups of culturally or historically remote cases of self-induced weight loss or refusal of food are analyzed in regard to the presence of weight phobia and clinical similarity to modern anorexia nervosa (extreme fasting in the Third World, in the European late Middle Ages, early modern times, and late 19th century).

RESULTS

It is demonstrated that modern Western anorexia nervosa with weight phobia is clearly distinct from other groups of cases of extreme fasting without weight phobia.

DISCUSSION: It is concluded that the psychological motive of weight phobia should remain the central criterion for the differential diagnosis of anorexia nervosa.