Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 5, 175

Constitutional Thinness and Anorexia Nervosa: A Possible Misdiagnosis?


Constitutional Thinness and Anorexia Nervosa: A Possible Misdiagnosis?

Bruno Estour et al. Front Endocrinol (Lausanne).


Clinical and biological aspects of restrictive anorexia nervosa (R-AN) are well documented. More than 10,000 articles since 1911 and more than 600 in 2013 have addressed R-AN psychiatric, somatic, and biological aspects. Genetic background, ineffectiveness of appetite regulating hormones on refeeding process, bone loss, and place of amenorrhea in the definition are widely discussed and reviewed. Oppositely, constitutional thinness (CT) is an almost unknown entity. Only 32 articles have been published on this topic since 1953. Similar symptoms associating low body mass index, low fat, and bone mass are reported in both CT and R-AN subjects. Conversely, menses are preserved in CT women and almost the entire hormonal profile is normal, except for leptin and PYY. The aim of the present review is to alert the clinician on the confusing clinical presentation of these two situations, a potential source of misdiagnosis, especially since R-AN definition has changed in DSM5.

Keywords: DSM IV; DSM5; anorexia nervosa; constitutional thinness; phenotyping.


Figure 1
Figure 1
Psychiatric, hormonal, and energy balance differences between CT and AN.

Similar articles

See all similar articles

Cited by 6 articles

See all "Cited by" articles


    1. Attia E, Becker AE, Bryant-Waugh R, Hoek HW, Kreipe RE, Marcus MD, et al. Feeding and eating disorders in DSM-5. Am J Psychiatry (2013) 170:1237–9.10.1176/appi.ajp.2013.13030326 - DOI - PubMed
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; (1994). 943 p.
    1. Germain N, Galusca B, Caron-Dorval D, Martin J, Pujos-Guillot E, Boirie Y, et al. Specific appetite, energetic and metabolomics responses to fat overfeeding in resistant-to-bodyweight-gain constitutional thinness. Nutr Diabetes (2014) 4:e126.10.1038/nutd.2014.17 - DOI - PMC - PubMed
    1. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser (1995) 854:1–452. - PubMed
    1. Chopra IJ, Smith SR. Circulating thyroid hormones and thyrotropin in adult patients with protein-calorie malnutrition. J Clin Endocrinol Metab (1975) 40:221–7.10.1210/jcem-40-2-221 - DOI - PubMed

LinkOut - more resources