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These include limited insight, minimization, or denial, as well as intentional concealment related to perceived stigma, social desirability, or investment in maintaining behavioral symptoms. We also identified reasons that the word \u201crefusal\u201d in AN criterion A may render its application problematic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion:<\/jats:title><jats:p>We conclude that specific guidance for ascertainment of cognitive signs for AN and BN in the absence of patient disclosure or endorsement, longitudinal evaluation, and\/or collateral data may improve clinical utility of these diagnostic criteria. \u00a9 2009 American Psychiatric Association. 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