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Bould H, Sovio U, Koupil I, Dalman C, Micali N, Lewis G, Magnusson C. Do eating disorders in parents predict eating disorders in children? Evidence from a Swedish cohort. Acta Psychiatr Scand 2015; 132:51-9. [PMID: 25572654 DOI: 10.1111/acps.12389] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated whether parental eating disorders (ED) predict ED in children, using a large multigeneration register-based sample. METHOD We used a subset of the Stockholm Youth Cohort born 1984-1995 and resident in Stockholm County in 2001-2007 (N = 286,232), The exposure was a diagnosed eating disorder in a parent; the outcome was any eating disorder diagnosis in their offspring, given by a specialist clinician, or inferred from an appointment at a specialist eating disorder clinic. A final study sample of 158,697 (55.4%) had data on these variables and confounding factors and contributed a total of 886,241 person years to the analysis. RESULTS We found good evidence in support of the hypothesis that ED in either parent are independently associated with ED in their female children (HR 1.97 (95% CI: 1.17-3.33), P = 0.01) and that ED in mothers are independently associated with ED in their female children (HR 2.35 (95% CI: 1.39-3.97) P = 0.001). Numbers were too low to permit separate analysis of ED in parents and their male children. CONCLUSION Eating disorders in parents were associated with ED in children. This study adds to our knowledge about the intergenerational transmission of ED, which will help identify high-risk groups and brings about the possibility of targeted prevention.
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Affiliation(s)
- H Bould
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - U Sovio
- Department of Obstetrics & Gynaecology, The Rosie Hospital, Cambridge, UK
| | - I Koupil
- Centre for Health Equity Studies, Stockholm University/Karolinska Institute, Stockholm, Sweden
| | - C Dalman
- Division of Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - N Micali
- Behavioural and Brain Sciences Unit, UCL Institute of Child Health, London, UK
| | - G Lewis
- Mental Health Sciences Unit, Faculty of Brain Sciences, UCL, London, UK
| | - C Magnusson
- Division of Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Abstract
Anorexia nervosa is an eating disorder characterized by excessive restriction on food intake and irrational fear of gaining weight, often accompanied by a distorted body self-perception. It is clinically diagnosed more frequently in females, with type and severity varying with each case. The current report is a case of a 25-year-old female, married for 5 years, educated up to 10(th) standard, a homemaker, hailing from an upper social class Hindu (Marvadi) family, living with husband's family in Urban Bangalore; presented to our tertiary care centre with complaints of gradual loss of weight, recurrent episodes of vomiting, from a period of two years, menstrual irregularities from 1 year and amenorrhea since 6 months, with a probable precipitating factor being husband's critical comment on her weight. Diagnosis of atypical anorexia nervosa was made, with the body mass index (BMI) being 15.6. A multidisciplinary therapeutic approach was employed to facilitate remission. Through this case report the authors call for the attention of general practitioners and other medical practitioners to be aware of the symptomatology of eating disorders as most patients would overtly express somatic conditions similar to the reported case so as to facilitate early psychiatric intervention.
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Affiliation(s)
- Preeti Srinivasa
- Consultant Psychiatrist, Spandana Nursing Home, Bangalore, Karnataka, India
| | - M Chandrashekar
- Consultant Psychiatrist, Spandana Nursing Home, Bangalore, Karnataka, India
| | - Nikitha Harish
- Psychiatric Rehabilitator, Spandana Health Care, Bangalore, Karnataka, India
| | - Mahesh R Gowda
- Consultant Psychiatrist, Spandana Nursing Home, Bangalore, Karnataka, India
| | - Sumit Durgoji
- DNB Resident, Spandana Nursing Home, Bangalore, Karnataka, India
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Steinhausen HC, Jakobsen H, Helenius D, Munk-Jørgensen P, Strober M. A nation-wide study of the family aggregation and risk factors in anorexia nervosa over three generations. Int J Eat Disord 2015; 48:1-8. [PMID: 24777686 DOI: 10.1002/eat.22293] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/09/2014] [Accepted: 04/17/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This nation-wide register-based study investigated how often anorexia nervosa (AN) and co-morbid disorders occur in affected families compared with control families. Furthermore, the study addressed the impact of sex, year of birth, and degree of urbanization in terms of risk factors. METHOD A total of N = 2,370 child and adolescent psychiatric subjects born between 1951 and 1996 and registered in the Danish Psychiatric Central Research Register (DPCRR) had any mental disorder before the age of 18 and developed AN at some point during their life-time. In addition, N = 7,035 controls without any psychiatric diagnosis before age 18 and matched for age, sex, and residential region were included. Psychiatric diagnoses were also obtained on the first-degree relatives as a part of the Danish Three Generation Study (3GS). A family load component was obtained by using various mixed regression models. RESULTS AN occurred significantly more often in case than in control families. AN Risk factors included having a sibling with AN, affective disorders in family members, and co-morbid affective, anxiety, obsessive-compulsive, personality, or substance use disorders. Furthermore, female sex, and ascending year of birth were significantly associated with having AN. Urbanization was not related to the family load of AN and case-relatives did not develop AN earlier than control relatives. DISCUSSION These findings based on a very large and representative dataset provide evidence for the family aggregation and further risk factors in AN.
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Affiliation(s)
- Hans-Christoph Steinhausen
- Research Unit for Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark; Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Switzerland; Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland
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Slof-Op ‘t Landt MCT, van Furth EF, Meulenbelt I, Slagboom PE, Bartels M, Boomsma DI, Bulik CM. Eating Disorders: From Twin Studies to Candidate Genes and Beyond. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.8.5.467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractSubstantial effort has been put into the exploration of the biological background of eating disorders, through family, twin and molecular genetic studies. Family studies have shown that anorexia (AN) and bulimia nervosa (BN) are strongly familial, and that familial etiologic factors appear to be shared by both disorders. Twin studies often focus on broader phenotypes or subthreshold eating disorders. These studies consistently yielded moderate to substantial heritabilities. In addition, there has been a proliferation of molecular genetic studies that focused on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) AN and BN. Seven linkage regions have been identified in genome-wide screens. Many genetic association studies have been performed, but no consistent association between a candidate gene and AN or BN has been reported. Larger genetic association studies and collaborations are needed to examine the involvement of several candidate genes and biological pathways in eating disorders. In addition, twin studies should be designed to assist the molecular work by further exploring genetic determinants of endophenotypes, evaluating the magnitude of contribution to liability of measured genotypes as well as environmental risk factors related to eating disorders. In this manner twin and molecular studies can move the field forward in a mutually informative way.
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5
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Lilenfeld LRR, Wonderlich S, Riso LP, Crosby R, Mitchell J. Eating disorders and personality: A methodological and empirical review. Clin Psychol Rev 2006; 26:299-320. [PMID: 16330138 DOI: 10.1016/j.cpr.2005.10.003] [Citation(s) in RCA: 288] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Revised: 10/11/2005] [Accepted: 10/11/2005] [Indexed: 11/24/2022]
Abstract
Methodological approaches utilized to evaluate models of the relationship between personality and eating disorders, as well as empirical support for each model, are reviewed. Limited prospective research suggests that negative emotionality, perfectionism, drive for thinness, poor interoceptive awareness, ineffectiveness, and obsessive-compulsive personality traits are likely predisposing factors. Limited family study research suggests that obsessive-compulsive personality disorder (OCPD) and anorexia nervosa share a common familial liability. Potential pathoplastic personality factors include Cluster B personality disorders and OCPD, which predict a poorer course and/or outcome, and histrionic personality traits and self-directedness, which predict a more favorable course and/or outcome. Future research should focus upon sophisticated prospective and family study research in order to best evaluate competing models of the eating disorder-personality relationship.
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Affiliation(s)
- Lisa R R Lilenfeld
- Department of Psychology, Georgia State University, Atlanta 30302-5010, USA.
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Jacobi C, Hayward C, de Zwaan M, Kraemer HC, Agras WS. Coming to Terms With Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy. Psychol Bull 2004; 130:19-65. [PMID: 14717649 DOI: 10.1037/0033-2909.130.1.19] [Citation(s) in RCA: 808] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aims of the present review are to apply a recent risk factor approach (H. C. Kraemer et al., 1997) to putative risk factors for eating disorders, to order these along a timeline, and to deduce general taxonomic questions. Putative risk factors were classified according to risk factor type, outcome (anorexia nervosa, bulimia nervosa, binge-eating disorder, full vs. partial syndromes), and additional factor characteristics (specificity, potency, need for replication). Few of the putative risk factors were reported to precede the onset of the disorder. Many factors were general risk factors; only few differentiated between the 3 eating disorder syndromes. Common risk factors from longitudinal and cross-sectional studies were gender, ethnicity, early childhood eating and gastrointestinal problems, elevated weight and shape concerns, negative self-evaluation, sexual abuse and other adverse experiences, and general psychiatric morbidity. Suggestions are made for the conceptualization of future risk factor studies.
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Affiliation(s)
- Corinna Jacobi
- Department of Psychology, University of Trier, Trier, Germany.
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7
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Abstract
The reported incidence of eating disorders has increased markedly during the past 30 years. Numerous studies have linked a spectrum of eating disorders to serious medical complications resulting in hospitalization and death. The prevalence of such disorders occurs primarily in women of adolescent and childbearing age. This article reviews the published literature alerting the practitioner to the indicators of a condition that is seldom disclosed bythe client or detected by the caregiver. Predisposing factors, behavioral theories, and reproductive outcomes are discussed to provide clear evidence of the link between eating disorders and poor pregnancy outcome. Recommendations are offered for early recognition ofa repeatedly concealed disease and for management of eating disorders during the childbearing cycle.
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Abstract
Adolescence and young adulthood mark the convergence of substantial biologic and social change. Individuals differ in their innate capacity to tolerate change. Research suggests that some of the personality characteristics that are fundamental to individuals with eating disorders may render them particularly vulnerable to the impact of a changing body and changing social demands. The fact that eating disorders emerge primarily during adolescence and often run a protracted course can deprive the afflicted individual of the core social, emotional, and biologic developmental processes that normally occur during this time of life.
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Affiliation(s)
- Cynthia M Bulik
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 East Leigh Street, Richmond, VA 23298-0126, USA.
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9
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Pierrehumbert B, Bader M, Miljkovitch R, Mazet P, Amar M, Halfon O. Strategies of emotion regulation in adolescents and young adults with substance dependence or eating disorders. Clin Psychol Psychother 2002. [DOI: 10.1002/cpp.339] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Kim SA, Choi YM, Park H, Lee H, Han JA, Kang SA, Choue RW, Kwon YK, Kim C, Chung J. Decrease of c‐Fos expression in hippocampus of anorexia(anx/anx)mice. ACTA ACUST UNITED AC 2001. [DOI: 10.1080/12265071.2001.9647598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Stein D, Lilenfeld LR, Plotnicov K, Pollice C, Rao R, Strober M, Kaye WH. Familial aggregation of eating disorders: results from a controlled family study of bulimia nervosa. Int J Eat Disord 1999; 26:211-5. [PMID: 10422611 DOI: 10.1002/(sici)1098-108x(199909)26:2<211::aid-eat11>3.0.co;2-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE While familial aggregation of bulimia nervosa (BN) is known to occur, the extent to which aggregation of a broader spectrum of eating disorders (ED) occurs in the families of individuals with BN is less certain. METHOD Direct interviews and blind best-estimate diagnostic procedures were used to assess lifetime histories of EDs among first-degree relatives (n = 177) of probands with BN (n = 47) and first-degree relatives (n = 190) of non-ED control probands (n = 44). RESULTS Forty-three percent of sisters and 26% of mothers of BN probands had a lifetime ED diagnosis, with eating disorder not otherwise specified (ED-NOS) diagnoses being most common. These rates were significantly higher than among sisters (5%) and mothers (5%) of controls. Few male relatives of either cohort had an ED. CONCLUSIONS Diagnostic assessment using contemporary family-epidemiology methodology revealed very strong familial aggregation of a broad spectrum of EDs among female relatives of women with BN.
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Affiliation(s)
- D Stein
- Western Psychiatric Institute, University of Pittsburgh School of Medicine, Pennsylvania, PA 15213, USA
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12
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Abstract
Anorexia nervosa is a severe and complex disorder with incompletely known vulnerability factors. It is generally recognized that anorexia nervosa is a familial disorder, but the majority of twin studies have shown that the concordance rate for monozygotic twins is higher (on average 44%) than for dizygotic twins (on average 12.5%). This difference in concordance rates shows that genetic factors, more than common familial environment, may explain why the 'anorexia nervosa' phenotype runs in families. In order to estimate the heritability in the broad sense of anorexia nervosa according to published familial and twin studies, we first assessed the intrapair correlation between monozygotic and dizygotic twins, and secondly calculated the deviation threshold of relatives of affected probands from the relative mean. In this review, we obtained an estimation of the heritability at 0.72 according to all published controlled familial studies (six references quoted in MEDLINE(R)), and 0.71 for all published twin studies (59 references quoted in MEDLINE(R)). This estimation is close to the ones previously proposed, between 0. 5 and 0.8. Familial and twin studies may also help to define the boundaries of the phenotype, shedding light on the complex relationship between anorexia nervosa on the one hand, and bulimia nervosa, mood disorders, and alcoholism on the other. Demonstrating the importance of genetic factors in anorexia nervosa, and more specifically for anorexia of the restrictive type, requires not only prospective and adoption studies (which are still lacking), but also genetic polymorphisms analyses, which began very recently.
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Affiliation(s)
- A Kipman
- Hospital Robert Debré, Service de psychopathologie de l'enfant, Paris, France
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Strober M, Freeman R, Bower S, Kigali J. Binge eating in anorexia nervosa predicts later onset of substance use disorder: A ten-year prospective, longitudinal follow-up of 95 adolescents. J Youth Adolesc 1996. [DOI: 10.1007/bf01537546] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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