Denial of illness in anorexia nervosa—a conceptual review: part 1 diagnostic significance and assessment

Objective: To analyse in a systematic way the concept of denial of illness in anorexia nervosa, especially (part 1) with regard to its clinical and diagnostic significance. Method: A detailed review of the available literature on the subject. Results: There is no consensus on the diagnostic significance of denial of illness but many clinicians consider it an important feature in the differentiation of anorexia nervosa from other forms of weight loss. Denial is no mere lack of insight referring to a delusional disorder, but seems better understood as being part of an overvalued idea. The multidimensionality of the notion is reflected in the wide variety of attempts to assess denial in anorexics. No instrument has been found to be reliable and valid, mainly because most studies have been done with patients referred to a specialised centre. Most patients in the denial phase will either not be detected or avoid any health care. Discussion: Denial of illness is a serious stumbling block for both the detection and further clinical assessment of anorexia nervosa. The concept is in serious need of refinement in order to inspire more fruitful research. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.