Roberto Christina A, Steinglass Joanna, Mayer Laurel E S, Attia Evelyn, Walsh B Timothy
Department of Psychology, Yale University, New Haven, CT 06520, USA.
Int J Eat Disord. 2008 Sep;41(6):559-63. doi: 10.1002/eat.20534.
Amenorrhea is a DSM-IV criterion for the diagnosis of anorexia nervosa (AN). Several studies have reported few differences between patients who meet the full DSM-IV criteria for AN and those who meet all but the amenorrhea criterion. Although this suggests that the absence of menses does not provide critical diagnostic information, many of these studies are limited by small sample sizes. This study aims to examine the clinical utility of amenorrhea as a criterion for the diagnosis of AN.
A chart review was conducted of 240 consecutive patients admitted for inpatient treatment at the NY State Psychiatric Institute from 1993 to 2006. Menstrual data were collected from the Eating Disorder Examination conducted upon admission. Independent samples t-tests were performed to evaluate differences in clinical variables, including age, lifetime lowest body mass index (BMI), admission and discharge BMI, previous number of hospitalizations, duration of illness, Beck Depression Inventory total score, Beck Anxiety Inventory total score, and Eating Disorder Examination subscale scores.
The amenorrheic and menstruating groups differed significantly only on lowest lifetime BMI and admission BMI, with individuals with amenorrhea having lower BMIs on both measures.
These results indicate that amenorrhea does not distinguish between groups on a number of important measures of clinical severity. It may be that amenorrhea reflects weight and nutritional status, rather than providing useful diagnostic information. Future studies are needed to examine the potential prognostic value of menstrual status.
闭经是《精神疾病诊断与统计手册》第四版（DSM-IV）中神经性厌食症（AN）的诊断标准之一。多项研究报告称，符合AN完整DSM-IV标准的患者与除闭经标准外其他标准均符合的患者之间差异不大。尽管这表明月经缺失并未提供关键的诊断信息，但这些研究大多受样本量较小的限制。本研究旨在探讨闭经作为AN诊断标准的临床实用性。
对1993年至2006年在纽约州精神病研究所连续住院治疗的240例患者进行病历回顾。月经数据从入院时进行的饮食失调检查中收集。进行独立样本t检验以评估临床变量的差异，包括年龄、终生最低体重指数（BMI）、入院和出院时的BMI、既往住院次数、病程、贝克抑郁量表总分、贝克焦虑量表总分以及饮食失调检查分量表得分。
闭经组和月经正常组仅在终生最低BMI和入院BMI上存在显著差异，闭经患者在这两项指标上的BMI较低。
这些结果表明，闭经在一些重要的临床严重程度指标上并不能区分不同组。闭经可能反映的是体重和营养状况，而非提供有用的诊断信息。未来需要进一步研究来探讨月经状态的潜在预后价值。
