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Reivan Ortiz GG, Rivera Tapia CJ, Elizalde Martínez BA, Icaza D. Mediating Mechanisms of Perfectionism: Clinical Comorbidity of OCD and ED. Front Psychiatry 2022; 13:908926. [PMID: 35911249 PMCID: PMC9329670 DOI: 10.3389/fpsyt.2022.908926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) and eating disorders (ED) share common causal factors and often represent similar entities. Studies on obsessive-compulsive disorders and eating disorders reveal a significant correlation between maladaptive perfectionism. The objective of this study is to evaluate the predictive variables of perfectionism in patients diagnosed with Anorexia Nervosa (AN), Bulimia Nervosa (BN) and OCD using a structural equation model (SEM). The sample consisted of 187 participants (60.9% women, 39.1% men) with a mean age of 26.68 (SD = 10.97). The findings reveal that the model is the same in all the disorders evaluated, achieving an adequate fit: χ2 = 7.95 (p = 0.000), RMSEA = 0.087 (95% confidence interval: 0.00 to 0.02), CFI = 0.991, TLI = 0.951 and with an overall predictive capacity of around 30% (CD = 0.318). It is recommended that future studies address the subtypes of disorders evaluated using longitudinal designs.
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Affiliation(s)
- Geovanny Genaro Reivan Ortiz
- Laboratory of Basic Psychology, Behavioral Analysis and Programmatic Development (PAD-LAB), Universidad Católica de Cuenca, Cuenca, Ecuador
| | | | | | - Daniel Icaza
- Laboratory of Basic Psychology, Behavioral Analysis and Programmatic Development (PAD-LAB), Universidad Católica de Cuenca, Cuenca, Ecuador
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Schwartz NE, Hecht LM, Haedt-Matt AA. Nutrition knowledge moderates the association between perfectionism and shape/weight concerns. Eur J Clin Nutr 2021; 75:1433-1439. [PMID: 33649527 DOI: 10.1038/s41430-021-00866-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/29/2020] [Accepted: 01/13/2021] [Indexed: 01/30/2023]
Abstract
Perfectionistic traits have been associated with stronger weight and diet concerns. Maladaptive perfectionism is tied to critical evaluation tendencies such as excessive concern about making mistakes, increasing one's risk for eating disorder pathology. Knowledge about healthy diet and nutrition may be one factor influencing associations between perfectionistic tendencies, as individuals with eating disorders may be more attuned to sources of nutrients. The current study examined whether nutrition knowledge moderates the association between one facet of perfectionism, concern over mistakes, and shape/weight concerns and the association between concern over mistakes and global eating pathology. College women (N = 122) completed questionnaires on disordered eating attitudes, nutrition knowledge, and perfectionism. Concern over mistakes was positively related to shape/weight concerns and global eating pathology. Nutrition knowledge significantly moderated the association between concerns over mistakes and shape/weight concerns, such that the association was stronger among those with higher levels of nutrition knowledge. Furthermore, nutrition knowledge displayed trend-level significance for the moderation of the association between concern over mistakes and global eating pathology. College women displaying high levels of concern over mistakes who are more informed about nutrition knowledge may be more vulnerable to developing concerns about body shape/weight and eating disorder pathology.
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Affiliation(s)
- Natalie E Schwartz
- Illinois Institute of Technology, 201 Tech Central, 3424 South State Street, Chicago, IL, 60616, USA.
| | - Leah M Hecht
- Illinois Institute of Technology, 201 Tech Central, 3424 South State Street, Chicago, IL, 60616, USA
| | - Alissa A Haedt-Matt
- Illinois Institute of Technology, 201 Tech Central, 3424 South State Street, Chicago, IL, 60616, USA
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O'Connor SM, Burt SA, McGue M, Iacono W, Klump KL. Elucidating factors underlying parent-offspring similarity in eating pathology in pre- and early puberty: Exploring the possibility of passive gene-environment correlation. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 128:658-670. [PMID: 31535887 DOI: 10.1037/abn0000466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Familial resemblance in eating pathology is typically attributed to parents providing an environment that leads to the development of eating pathology. However, offspring raised by biological parents receive both their environment and genes from their parents, raising the possibility that genetic influences, environmental influences, and/or gene-environment interplay may account for familial resemblance. Past studies have not explored the possibility of parents' genes influencing the environment they provide (i.e., passive gene-environment correlations or "passive rGE"). If present, passive rGE is most likely to "hide" in estimates of shared environmental influence in classical twin models. The current study used a nuclear twin family design to explore the possibility of passive rGE during pre- and early puberty when past studies have demonstrated the importance of shared environmental influence. Additionally, the present study explored whether sibling-specific (i.e., influences specific to the twin generation) or family-specific (i.e., "cultural" influences within the home) environmental influences account for shared environmental influences found in past studies. Participants included preearly pubertal same-sex female twins and their biological parents (N = 547 families) from the Minnesota Twin Family Study and the Michigan State University Twin Registry. Disordered eating was assessed with self-report measures in the twins and parents. Pubertal status was determined using an established cut-off on a self-report measure. Passive rGE was not indicated in this study of pre- and early pubertal twins. Instead, sibling-specific shared environmental and nonshared environmental influences were most influential. Future research should work to identify the sibling-specific environmental influences that contribute to sibling similarity in disordered eating. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Waszczuk MA, Waaktaar T, Eley TC, Torgersen S. Etiological influences on continuity and co-occurrence of eating disorders symptoms across adolescence and emerging adulthood. Int J Eat Disord 2019; 52:554-563. [PMID: 30729562 DOI: 10.1002/eat.23040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The role of common and symptom-specific genetic and environmental influences in maintaining eating disorder symptoms across development remains unclear. This study investigates the continuity and change of etiological influences on drive for thinness, bulimia, and body dissatisfaction symptoms and their co-occurrence, across adolescence and emerging adulthood. METHOD In total, 2,629 adolescent twins (mean age = 15.20, SD = 1.95) reported eating disorders symptoms across three waves of data collection. Biometric common pathways model was fitted to estimate genetic and environmental contributions to the continuity of each symptom over time, as well as time- and symptom-specific influences. RESULTS Drive for thinness and body dissatisfaction symptoms showed a pattern of high continuity across development and high correlations with each other, whereas bulimia symptoms were moderately stable and less associated with the other two symptoms. Latent factors reflecting continuity of each symptom were largely under genetic influence (Al = 0.60-0.82). New genetic influences contributing to change in the developmental course of symptoms were observed in emerging adulthood. Genetic influences correlated considerably between the three symptoms. Non-shared environmental influences were largely time-and symptom-specific, but some contributed moderately to the continuity across development (El = 0.18-0.40). The etiological overlap was larger between drive for thinness and body dissatisfaction symptoms than with bulimia symptoms. DISCUSSION The results provide preliminary evidence that stable as well as newly emerging genetic influences contribute to the co-occurrence of drive for thinness, bulimia, and body dissatisfaction symptoms across adolescence and emerging adulthood. Conversely, environmental influences were less stable and contributed to change in symptoms over time.
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Affiliation(s)
- Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Trine Waaktaar
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Thalia C Eley
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Suisman JL, O’Connor SM, Sperry S, Thompson JK, Keel PK, Burt SA, Neale M, Boker S, Sisk C, Klump KL. Genetic and environmental influences on thin-ideal internalization. Int J Eat Disord 2012; 45:942-8. [PMID: 23034902 PMCID: PMC3523121 DOI: 10.1002/eat.22056] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Current research on the etiology of thin-ideal internalization focuses on psychosocial influences (e.g., media exposure). The possibility that genetic influences also account for variance in thin-ideal internalization has never been directly examined. This study used a twin design to estimate genetic effects on thin-ideal internalization and examine if environmental influences are primarily shared or nonshared in origin. METHOD Participants were 343 postpubertal female twins (ages: 12-22 years; M = 17.61) from the Michigan State University Twin Registry. Thin-ideal internalization was assessed using the Sociocultural Attitudes toward Appearance Questionnaire-3. RESULTS Twin modeling suggested significant additive genetic and nonshared environmental influences on thin-ideal internalization. Shared environmental influences were small and non-significant. DISCUSSION Although prior research focused on psychosocial factors, genetic influences on thin-ideal internalization were significant and moderate in magnitude. Research is needed to investigate possible interplay between genetic and nonshared environmental factors in the development of thin-ideal internalization.
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Affiliation(s)
- Jessica L. Suisman
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | | | - Steffanie Sperry
- Department of Psychology, University of South Florida, Tampa, Florida
| | - J. Kevin Thompson
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - S. Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Michael Neale
- Department of Psychiatry and Human Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Steven Boker
- Department of Psychology, University of Virginia, Charlottesville, Virginia
| | - Cheryl Sisk
- Department of Psychology, Michigan State University, East Lansing, Michigan,Neuroscience Program, Michigan State University, East Lansing, Michigan
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan
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Slane JD, Burt SA, Klump KL. Genetic and environmental influences on disordered eating and depressive symptoms. Int J Eat Disord 2011; 44:605-11. [PMID: 21997423 DOI: 10.1002/eat.20867] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Research suggests that shared genetic factors underlie relationships between eating disorder and depression diagnoses, but no studies to date have examined these associations using dimensional symptom measures. This study examined whether genetic associations observed between eating disorder and depression diagnoses extend to continuous measures of these phenotypes. METHOD The sample consisted of 292 young adult female twins from the Michigan State University Twin Registry. Disordered eating was measured using the Minnesota Eating Behavior Survey. Depressive symptoms were assessed using the Beck Depression Inventory. RESULTS Univariate twin models indicated that genetic factors accounted for 55% to 60% of the variance in disordered eating and depressive symptoms, with the remaining variance accounted for by nonshared environmental effects. Bivariate models indicated that genetic factors primarily accounted for associations between disordered eating and depressive symptoms (r(a) = .70). DISCUSSION Phenotypic associations between disordered eating and depressive symptoms appear to be due to common genetic factors.
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Affiliation(s)
- Jennifer D Slane
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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Wade TD, Zhu G, Martin NG. Undue influence of weight and shape: is it distinct from body dissatisfaction and concern about weight and shape? Psychol Med 2011; 41:819-828. [PMID: 20507670 DOI: 10.1017/s0033291710001066] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Three cognitive constructs are risk factors for eating disorders: undue influence of weight and shape, concern about weight and shape, and body dissatisfaction (BD). Undue influence, a diagnostic criterion for eating disorders, is postulated to be closely associated with self-esteem whereas BD is postulated to be closely associated with body mass index (BMI). We understand less about the relationships with concern about weight and shape. The aim of the current investigation was examine the degree of overlap across these five phenotypes in terms of latent genetic and environmental risk factors in order to draw some conclusions about the similarities and differences across the three cognitive variables. METHOD A sample of female Australian twins (n=1056, including 348 complete pairs), mean age 35 years (S.D.=2.11, range 28-40), completed a semi-structured interview about eating pathology and self-report questionnaires. An independent pathways model was used to investigate the overlap of genetic and environmental risk factors for the five phenotypes. RESULTS In terms of variance that was not shared with other phenotypes, self-esteem emerged as being separate, with 100% of its variance unshared with the other phenotypes, followed by undue influence (51%) and then concern (34%), BD (28%) and BMI (32%). CONCLUSIONS In terms of shared genetic risk, undue influence and concern were more closely related than BD, whereas BMI and BD were found to share common sources of risk. With respect to environmental risk factors, concern, BMI and BD were more closely related to each other than to undue influence.
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Affiliation(s)
- T D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia.
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Munn MA, Stallings MC, Rhee SH, Sobik LE, Corley RP, Rhea SA, Hewitt JK. Bivariate analysis of disordered eating characteristics in adolescence and young adulthood. Int J Eat Disord 2010; 43:751-61. [PMID: 20957703 PMCID: PMC2980580 DOI: 10.1002/eat.20854] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We examined the etiology of two disordered eating characteristics. METHOD Participants included 1,470 female adolescent and young adult twins and their female nontwin siblings. Phenotypic factor analyses of a seven-item eating pathology screening tool yielded two factors: weight and shape concerns and behaviors (WSCB) and binge eating (BE). Univariate and bivariate extended twin analyses (including cotwins and nontwin siblings) were used to estimate the magnitude of genetic and environmental influences on these characteristics. RESULTS Analyses indicated that individual differences in WSCB and BE could be explained by additive genetic influences (a² = 0.43 (95% CI: 0.33-0.52) and 0.49 (95% CI: 0.36-0.58), respectively), with the remaining variance due to nonshared environmental influences. The genetic correlation between WSCB and BE was estimated at 0.64; the nonshared environmental correlation was estimated at 0.27. DISCUSSION These results corroborate previous findings on genetic and environmental influences on disordered eating characteristics and suggest that findings can be extended to nontwin populations.
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Affiliation(s)
- Melissa A. Munn
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, Institute for Behavioral Genetics, University of Colorado, Boulder, CO,To whom correspondence should be addressed: Institute for Behavioral Genetics, University of Colorado, 447 UCB, Boulder, CO 80503; Phone: 303-735-2428; Fax: 303-492-8063;
| | - Michael C. Stallings
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, Institute for Behavioral Genetics, University of Colorado, Boulder, CO
| | - Soo Hyun Rhee
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, Institute for Behavioral Genetics, University of Colorado, Boulder, CO
| | | | - Robin P. Corley
- Institute for Behavioral Genetics, University of Colorado, Boulder, CO
| | - Sally Ann Rhea
- Institute for Behavioral Genetics, University of Colorado, Boulder, CO
| | - John K. Hewitt
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, Institute for Behavioral Genetics, University of Colorado, Boulder, CO
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Klump KL, Burt SA, Spanos A, McGue M, Iacono WG, Wade TD. Age differences in genetic and environmental influences on weight and shape concerns. Int J Eat Disord 2010; 43:679-88. [PMID: 19950189 PMCID: PMC2891330 DOI: 10.1002/eat.20772] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous research has shown important developmental shifts ingenetic and environmental influences for disordered eating. However, little research has examined age differences for weight/shape concerns, two key components of eating disorders. The goal of this study was to investigate these age differences in preadolescent, adolescent, young adult, and mid-adult twins. METHOD Participants included 2,618 female twins (ages of 10-41 years) from three large twin registries. Shape and weight concerns were assessed with the Eating Disorders Examination Questionnaire. RESULTS Genetic influences were modest in preadolescent twins, but significant from early-adolescence through middle adulthood. Shared environmental factors showed the opposite pattern, with the largest shared environmental contributions occurring in the youngest age group. Nonshared environmental effects remained relatively constant across age. DISCUSSION Findings highlight the importance of age differences in genetic and environmental influences. Possible mechanisms include gene x environment interactions and biological changes associated with key developmental stages.
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Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan 48824-1116, USA.
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Abstract
BACKGROUND Twin studies have suggested that additive genetic factors significantly contribute to liability to bulimia nervosa (BN). However, the diagnostic criteria for BN remain controversial. In this study, an item-factor model was used to examine the BN diagnostic criteria and the genetic and environmental contributions to BN in a population-based twin sample. The validity of the equal environment assumption (EEA) for BN was also tested. METHOD Participants were 1024 female twins (MZ n=614, DZ n=410) from the population-based Mid-Atlantic Twin Registry. BN was assessed using symptom-level (self-report) items consistent with DSM-IV and ICD-10 diagnostic criteria. Items assessing BN were included in an item-factor model. The EEA was measured by items assessing similarity of childhood and adolescent environment, which have demonstrated construct validity. Scores on the EEA factor were used to specify the degree to which twins shared environmental experiences in this model. RESULTS The EEA was not violated for BN. Modeling results indicated that the majority of the variance in BN was due to additive genetic factors. There was substantial variability in additive genetic and environmental contributions to specific BN symptoms. Most notably, vomiting was very strongly influenced by additive genetic factors, while other symptoms were much less heritable, including the influence of weight on self-evaluation. These results highlight the importance of assessing eating disorders at the symptom level. CONCLUSIONS Refinement of eating disorder phenotypes could ultimately lead to improvements in treatment and targeted prevention, by clarifying sources of variation for specific components of symptomatology.
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Affiliation(s)
- S E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284-2018, USA.
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Klump KL, Suisman JL, Burt SA, McGue M, Iacono WG. Genetic and environmental influences on disordered eating: An adoption study. JOURNAL OF ABNORMAL PSYCHOLOGY 2010; 118:797-805. [PMID: 19899849 DOI: 10.1037/a0017204] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Twin studies indicate significant genetic, but little shared environmental, influences on eating disorders. However, critics argue that study limitations constrain the conclusions that can be drawn. Adoption studies avoid many of these limitations, but to date, no adoption studies of eating pathology have been conducted. The current study was the first adoption study to examine genetic/environmental effects for disordered eating. Participants included 123 adopted and 56 biological female sibling pairs. Disordered eating (i.e., overall eating pathology, body dissatisfaction, weight preoccupation, binge eating) was assessed with the Minnesota Eating Behaviors Survey (Klump, McGue, & Iacono, 2000; von Ranson, Klump, Iacono, & McGue, 2005). Biometric model fitting indicated significant genetic influences (59%-82%) on all forms of disordered eating, with nonshared environmental factors accounting for the remaining variance. Shared environmental factors did not contribute significantly to any disordered eating symptom. Our findings bolster those from twin studies and provide critical evidence of significant genetic effects on disordered eating symptoms.
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Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, 48824-1116, USA.
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Spanos A, Burt SA, Klump KL. Do weight and shape concerns exhibit genetic effects? Investigating discrepant findings. Int J Eat Disord 2010; 43:29-34. [PMID: 19235850 DOI: 10.1002/eat.20666] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Unlike twin studies of general weight and shape concerns, studies examining the heritability of the undue influence of weight and shape concerns on self-evaluation have found little evidence for genetic effects. The present study sought to resolve these discrepancies by examining the heritability of both types of weight and shape concerns in a young adult twin sample. METHOD Participants included 270 female twins from the Michigan State University Twin Registry. General weight and shape concerns were assessed with subscales from the Eating Disorder Examination Questionnaire (EDEQ). Similar to previous research, the undue influence of weight and shape on self-evaluation was assessed using averaged scores from two EDEQ items. RESULTS The heritability of all weight and shape measures was estimated at 49-66%. DISCUSSION General weight and shape concerns and the undue influence of these concerns on self-evaluation are influenced by genetic factors in young adult female twins.
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Affiliation(s)
- Alexia Spanos
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Abstract
Family, twin, and adoption studies of anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and the proposed purging disorder presentation (PD) have consistently demonstrated that genetic factors contribute to the variance in liability to eating disorders. In addition, endophenotypes and component phenotypes of eating disorders have been evaluated and provide further insight regarding genetic factors influencing eating disorders and eating disorder diagnostic criteria. Many of these phenotypes have demonstrated substantial heritability. This chapter reviews biometrical genetic methods and current findings from family and twin studies that investigate the role of genes and environment in the etiology of eating disorders. We review the methodology used to estimate heritability, the results of these studies, and discuss the implications of this research for the basic conceptualization of eating disorders and the future value of twin modeling in the molecular genetic era.
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Abstract
OBJECTIVE Cross-cultural data suggest that rationales for food refusal vary in anorexia nervosa (AN), and a variant, termed non-fat-phobic AN (NFP-AN), has been described. This review evaluates whether data support modification of the requirement for intense fear of weight gain to meet AN criterion B in DSM-V. METHOD We performed a systematic search of the Medline and PsychInfo literature and evaluated the relevant publications by Robins and Guze's (Am J Psychiatry 126, 983-987, 1970) criteria as a standard for diagnostic validity. We also performed a meta-analysis comparing the severity of eating pathology in AN to (a) NFP-AN and (b) AN with low drive for thinness (low-DT-AN). RESULTS A modest literature indicates that NFP-AN has wide geographic distribution and occurs in both Western and non-Western populations alongside cases of typical AN. Aggregating across eligible studies, patients with NFP-AN or low-DT-AN score at least 2/3 of a standard deviation lower on measures of eating pathology than patients with conventional AN. Transcultural comparison of drive for thinness suggests significantly lower norms in non-Western cultures. DISCUSSION NFP-AN occurs with wide distribution. Further research is necessary on the course and outcomes of NFP-AN to characterize its congruence with, or distinction from, conventional AN. We discuss several options for including a description of NFP-AN in DSM-V.
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Affiliation(s)
- Anne E Becker
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Kaye WH, Fudge JL, Paulus M. New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci 2009; 10:573-84. [PMID: 19603056 DOI: 10.1038/nrn2682] [Citation(s) in RCA: 553] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Individuals with anorexia nervosa have a relentless preoccupation with dieting and weight loss that results in severe emaciation and sometimes death. It is controversial whether such symptoms are secondary to psychosocial influences, are a consequence of obsessions and anxiety or reflect a primary disturbance of brain appetitive circuits. New brain imaging technology provides insights into ventral and dorsal neural circuit dysfunction - perhaps related to altered serotonin and dopamine metabolism - that contributes to the puzzling symptoms found in people with eating disorders. For example, altered insula activity could explain interoceptive dysfunction, and altered striatal activity might shed light on altered reward modulation in people with anorexia nervosa.
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Affiliation(s)
- Walter H Kaye
- Eating Disorder Treatment & Research Program, Department of Psychiatry, University of California, San Diego, La Jolla Village Professional Center, 8950 Villa La Jolla Drive, Suite C-207, La Jolla, California 92037, USA.
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Mazzeo SE, Mitchell KS, Bulik CM, Reichborn-Kjennerud T, Kendler KS, Neale MC. Assessing the heritability of anorexia nervosa symptoms using a marginal maximal likelihood approach. Psychol Med 2009; 39:463-473. [PMID: 18485259 PMCID: PMC2640444 DOI: 10.1017/s0033291708003310] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Assessment of eating disorders at the symptom level can facilitate the refinement of phenotypes. We examined genetic and environmental contributions to liability to anorexia nervosa (AN) symptoms in a population-based twin sample using a genetic common pathway model. METHOD Participants were from the Norwegian Institute of Public Health Twin Panel (NIPHTP) and included all female monozygotic (MZ; 448 complete pairs and four singletons) and dizygotic (DZ; 263 complete pairs and four singletons) twins who completed the Composite International Diagnostic Interview (CIDI) assessing DSM-IV Axis I and ICD-10 criteria. Responses to items assessing AN symptoms were included in a model fitted using the marginal maximum likelihood (MML) approach. RESULTS Heritability of the overall AN diagnosis was moderate [a2=0.22, 95% confidence interval (CI) 0.0-0.50] whereas heritabilities of the specific items varied. Heritability estimates for weight loss items were moderate (a2=0.31-0.34) and items assessing weight concern when at a low weight were smaller (0.18-0.29). Additive genetic factors contributed little to the variance of amenorrhea, which was most strongly influenced by unshared environment (a2=0.16, e2=0.71). CONCLUSIONS AN symptoms are differentially heritable. Specific criteria such as those related to body weight and weight loss history represent more biologically driven potential endophenotypes or liability indices. The results regarding weight concern differ somewhat from those of previous studies, highlighting the importance of assessing genetic and environmental influences on variance of traits within specific subgroups of interest.
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Affiliation(s)
- S E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284-2018, USA.
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Mazzeo SE, Bulik CM. Environmental and genetic risk factors for eating disorders: What the clinician needs to know. Child Adolesc Psychiatr Clin N Am 2009; 18:67-82. [PMID: 19014858 PMCID: PMC2719561 DOI: 10.1016/j.chc.2008.07.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients and families often are aware of research on genetic factors influencing eating disorders. Accurate interpretations of research on environmental and genetic risk factors can be empowering to patients and families; however, misinterpretations could prove detrimental. Clinicians who are not versed in genetic research may believe they are ill prepared to discuss the nuances of genetic research with patients and families. In this article the authors discuss what is known about genetic and environmental risk factors with an emphasis on gene-environment interplay to improve clinicians' comfort level in discussing these complex issues with their patients.
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Affiliation(s)
- Suzanne E. Mazzeo
- Departments of Psychology and Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Cynthia M. Bulik
- Departments of Psychiatry and Nutrition, University of North Carolina, Chapel Hill, NC, USA
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Slof-Op 't Landt MCT, Bartels M, van Furth EF, van Beijsterveldt CEM, Meulenbelt I, Slagboom PE, Boomsma DI. Genetic influences on disordered eating behaviour are largely independent of body mass index. Acta Psychiatr Scand 2008; 117:348-56. [PMID: 18081919 DOI: 10.1111/j.1600-0447.2007.01132.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Prior studies suggest eating disorders and related characteristics are moderately to substantially heritable. We are interested in identifying the genes underlying disordered eating behaviour (DEB), and want to know how much of the genetic influence underlying DEB is attributable to genetic influences on body mass index (BMI). METHOD Bivariate analyses were performed, in adolescent twins and siblings, to estimate the genetic and environmental contributions for DEB, BMI, and their overlap. RESULTS Shared genetic risk factors explained the overlap between BMI and DEB (genetic correlation was 0.43 in women, 0.51 in men). DEB was highly heritable in women (a(2) = 0.65; a(2) independent of BMI = 0.53) and moderately heritable in men (a(2) = 0.39; a(2) independent of BMI = 0.29). BMI was highly heritable in both men (a(2) = 0.76) and women (a(2) = 0.80). CONCLUSION The entire correlation between DEB and BMI was explained by shared genetic risk, but the majority of genetic influences on DEB were due to genetic effects independent of BMI.
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Bulik CM, Hebebrand J, Keski-Rahkonen A, Klump KL, Reichborn-Kjennerud T, Mazzeo SE, Wade TD. Genetic epidemiology, endophenotypes, and eating disorder classification. Int J Eat Disord 2007; 40 Suppl:S52-60. [PMID: 17573683 DOI: 10.1002/eat.20398] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To explore how genetic epidemiology has informed the identification of endophenotypes and how endophenotypes may inform future classification of eating disorders. METHOD Literature review and synthesis. RESULTS Although a number of endo- and subphenotypes have been suggested for eating disorders, few reach the rigorous definitions developed for candidate endophenotypes. CONCLUSION Further study of endophenotypes and subphenotypes for eating disorders may assist with developing a more homogenous classification system that more closely reflects underlying biological mechanisms, and provides a clearer focus for the development of coherent models and treatments.
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Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7160, USA.
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20
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Abstract
Categorical models dominate the eating disorder field, but the tandem use of categorical and dimensional models has been proposed. A transdiagnostic dimensional model, number of lifetime eating disorder behaviors (LEDB), was examined with respect to (1) its relationship to a variety of indicators of the individual's functioning, (2) the degree to which it was influenced by genetic and environmental risk factors, and (3) exposure to specific environmental risk factors. Data from self-report and interview from 1002 female twins (mean age = 34.91 years, SD = 2.09) were examined. While 15.4% women met criteria for a lifetime eating disorder, 29% had at least one LEDB. The dimensional measure provided an indicator of associated functioning, and was influenced primarily by the nonshared environment. The number of LEDB was associated with the degree of impaired functioning. This impairment was associated with conflict between parents and criticism from parents when growing up.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
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21
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Elfhag K, Linné Y. Gender differences in associations of eating pathology between mothers and their adolescent offspring. ACTA ACUST UNITED AC 2005; 13:1070-6. [PMID: 15976150 DOI: 10.1038/oby.2005.125] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To study the association of eating pathology between mothers and their adolescent offspring in a population sample. RESEARCH METHODS AND PROCEDURES The participants were 481 women (mean age, 47+/-SD 5 years; BMI, 25+/-4 kg/m2) and their 481 adolescent children 16 to 17 years old (BMI, 21+/-3 kg/m2) of the Stockholm Weight Development Study. Assessment methods were the Three-Factor Eating Questionnaire Revised 18 and the Eating Disorder Inventory 2. RESULTS A higher body weight was most related to cognitive restraint for adolescents and to emotional eating for adult women. A mother-daughter link could be identified for eating pathology, with the strongest link found for emotional eating. No mother-son link could be identified. Age subgroup analyses revealed a stronger mother-daughter link for body attitudes in younger mothers and for cognitive restraint in older mothers. DISCUSSION Gender differences revealed that eating pathology was shared by mothers and daughters but not by mothers and sons. A psychological strategy such as eating as a response to negative emotions was most interrelated between mothers and daughters. Younger mothers shared more attitudes toward the body with their daughters, whereas older mothers shared more restrictive eating behaviors with their daughters. The mother-daughter links found may be due to gender-specific genetic and psychological family transmission and gender-specific environmental influences. The sons' eating behaviors seem to be more independent and would be formed by other factors than for the girls.
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Affiliation(s)
- Kristina Elfhag
- Obesity Unit, M73, Karolinska University Hospital, SE-141 86 Stockholm, Sweden.
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22
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de Castro JM, Lilenfeld LRR. Influence of heredity on dietary restraint, disinhibition, and perceived hunger in humans. Nutrition 2005; 21:446-55. [PMID: 15811764 DOI: 10.1016/j.nut.2004.07.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2003] [Accepted: 07/24/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Dietary restraint, disinhibition, and perceived hunger have been shown to affect food intake and body weight and are thought to be risk factors for eating disorders, but little is known about their origins. We investigated the influence of heredity, shared (familial) environment, and individual environment on dietary restraint disinhibition, perceived hunger and their relation to body size and food intake. METHODS Scores on the Three Factor Eating Questionnaire and the Restraint Scale in addition to height, weight, body mass index, and 7-d diary reported nutrient intakes were obtained from 39 identical, 60 fraternal same-sex, and 50 fraternal opposite-sex adult twin pairs who were living independently. Linear structural modeling was applied to investigate the nature and degree of genetic and environmental influences. RESULTS Analysis showed significant genetic and individual environmental, but not shared (familial) environmental, influences on cognitive restraint, perceived hunger, and Restraint Scale scores, with genes accounting for 44%, 24%, and 58% of the variance, respectively. In contrast, disinhibition was found to be significantly influenced by the shared (familial) environment, accounting for 40% of the variance. Further analysis showed that cognitive restraint and perceived hunger heritabilities could not be accounted for by significant heritabilities of body weight, height, or body mass index. In contrast, the heritability of Restraint Scale scores was found to be related to body size. Cognitive restraint was negatively correlated with nutrient intake, and differences in cognitive restraint were found to be related to differences in the body sizes of identical twin pairs. CONCLUSIONS Dietary restraint appears to be another component in a package of genetically determined physiologic, sociocultural, and psychological processes that regulate energy balance, whereas dietary disinhibition may be the intermediary between upbringing and the development of overweight and/or eating disorders.
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Affiliation(s)
- John M de Castro
- Department of Psychology, The University of Texas at El Paso, El Paso, Texas, USA.
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Keski-Rahkonen A, Bulik CM, Neale BM, Rose RJ, Rissanen A, Kaprio J. Body dissatisfaction and drive for thinness in young adult twins. Int J Eat Disord 2005; 37:188-99. [PMID: 15822080 DOI: 10.1002/eat.20138] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We explored correlates of the Eating Disorder Inventory subscales Body Dissatisfaction (BD) and Drive for Thinness (DT) and genetic and environmental influences on these traits. METHOD In a population-based sample of 4,667 Finnish twins aged 22-27 years, we conducted twin modeling to explore genetic and environmental contributions to body dissatisfaction and drive for thinness. Logistic regression was used for the correlational analysis. RESULTS Various eating and body size-related factors and psychosomatic symptoms were significantly associated with high body dissatisfaction and drive for thinness in both genders. In women, early puberty onset, early initiation of sexual activity, and multiple sex partners were statistically significant risk factors of body dissatisfaction. In gender-specific univariate twin models, additive genes accounted for 59.4% (95% confidence interval [CI] = 53.2-64.7%) of the variance in body dissatisfaction and for 51.0% (95% CI = 43.7-57.5%) of the variance in drive for thinness among females, but for none of the variance among males. DISCUSSION There are very distinct gender differences in the heritability patterns of body dissatisfaction and drive for thinness in young adults.
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Kaye WH, Devlin B, Barbarich N, Bulik CM, Thornton L, Bacanu SA, Fichter MM, Halmi KA, Kaplan AS, Strober M, Woodside DB, Bergen AW, Crow S, Mitchell J, Rotondo A, Mauri M, Cassano G, Keel P, Plotnicov K, Pollice C, Klump KL, Lilenfeld LR, Ganjei JK, Quadflieg N, Berrettini WH. Genetic analysis of bulimia nervosa: methods and sample description. Int J Eat Disord 2004; 35:556-70. [PMID: 15101071 DOI: 10.1002/eat.10271] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Twin and family studies suggest that genetic variants contribute to the pathogenesis of bulimia nervosa (BN) and anorexia nervosa (AN). The Price Foundation has supported an international, multisite study of families with these disorders to identify these genetic variations. The current study presents the clinical characteristics of this sample as well as a description of the study methodology. METHOD All probands met modified criteria for BN or bulimia nervosa with a history of AN (BAN) as defined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). All affected relatives met DSM-IV criteria for BN, AN, BAN, or eating disorders not otherwise specified (EDNOS). Probands and affected relatives were assessed diagnostically using both trained-rater and self-report assessments. DNA samples were collected from probands, affected relatives, and available biologic parents. RESULTS Assessments were obtained from 163 BN probands and 165 BAN probands. Overall, there were 365 relative pairs available for linkage analysis. Of the affected relatives of BN probands, 62 were diagnosed as BN (34.8%), 49 as BAN (27.5%), 35 as AN (19.7%), and 32 as EDNOS (18.0%). For the relatives of BAN probands, 42 were diagnosed as BN (22.5%), 67 as BAN (35.8%), 48 as AN (25.7%), and 30 as EDNOS (16.0%). DISCUSSION This study represents the largest genetic study of eating disorders to date. Clinical data indicate that although there are a large number of individuals with BN disorders, a range of eating pathology is represented in the sample, allowing for the examination of several different phenotypes in molecular genetic analyses.
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Affiliation(s)
- Walter H Kaye
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Reichborn-Kjennerud T, Bulik CM, Kendler KS, Roysamb E, Tambs K, Torgersen S, Harris JR. Undue influence of weight on self-evaluation: a population-based twin study of gender differences. Int J Eat Disord 2004; 35:123-32; discussion 133-5. [PMID: 14994348 DOI: 10.1002/eat.10252] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore the extent to which genetic and environmental factors contribute to liability to placing undue importance on weight as an indicator of self-evaluation and to determine whether differences exist across genders in the nature and magnitude of these effects. METHOD Self-report data were collected on 8,045 same-sex and opposite-sex twins, aged 18-31 years, from a population-based registry of Norwegian twins. Structural equation modeling was utilized to estimate the relative contribution of genetic and environmental factors to liability for undue influence of weight on self-evaluation, allowing for gender-specific effects. RESULTS Individual variation in undue influence of weight on self-evaluation was best explained by shared and individual environmental influences. No significant gender differences were found. Shared environmental factors accounted for 31% of the variance. DISCUSSION These results raise the possibility that there may be distinct sources of familial resemblance for different symptoms of bulimia nervosa as codified in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994).
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Ricciardelli LA, McCabe MP. A Biopsychosocial Model of Disordered Eating and the Pursuit of Muscularity in Adolescent Boys. Psychol Bull 2004; 130:179-205. [PMID: 14979769 DOI: 10.1037/0033-2909.130.2.179] [Citation(s) in RCA: 233] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review provides an evaluation of the correlates and/or risk factors associated with disordered eating and the pursuit of muscularity among adolescent boys. One of the main conclusions is that similar factors and processes are associated with both behavioral problems. Several factors found to be consistently associated with disordered eating among boys are also similar to those found with girls. These include body mass index, negative affect, self-esteem, perfectionism, drug use, perceived pressure to lose weight from parents and peers, and participation in sports that focus on leanness. However, as many of the findings have only been verified using cross-sectional designs, prospective studies are now needed.
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27
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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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28
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Reichborn-Kjennerud T, Bulik CM, Kendler KS, Røysamb E, Maes H, Tambs K, Harris JR. Gender differences in binge-eating: a population-based twin study. Acta Psychiatr Scand 2003; 108:196-202. [PMID: 12890274 DOI: 10.1034/j.1600-0447.2003.00106.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess whether genetic and environmental effects on liability to binge-eating (BE) are of equal importance for males and females and whether the same genetic risk factors predispose to BE in the two sexes. METHOD Questionnaire data on 8045 same sex and opposite sex twins, aged 19-31 years, from a population-based Norwegian registry, was used to estimate the relative contribution of genetic and environmental factors to liability for BE utilizing structural equation modeling. RESULTS In the best-fitting model, the magnitude of genetic and environmental effects on BE was the same for males and females. Heritability was 51%. The correlation between genetic risk factors in men and women was estimated to be +0.57. CONCLUSION Binge-eating appears to be equally heritable in males and females. Although the majority of the genetic risk factors are shared between the sexes, there may exist gender-specific genetic effects on liability.
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Abraham SF. Dieting, body weight, body image and self-esteem in young women: doctors' dilemmas. Med J Aust 2003; 178:607-11. [PMID: 12797845 DOI: 10.5694/j.1326-5377.2003.tb05382.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2002] [Accepted: 05/22/2003] [Indexed: 11/17/2022]
Abstract
Many young women feel that body image and exercise are important for their self-esteem, want to lose weight, are afraid they might gain weight, and feel fat. Interventions that improve self-esteem, encourage communication and help adolescents to be supportive of each other may prevent some of these women from developing eating disorders. If an eating disorder is suspected, it may be useful for physicians to ask about fear of loss of control over the body, eating, weight and shape; and preoccupation with food, eating, nutrition, body weight and shape, as these issues may differentiate those at greater risk.
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Affiliation(s)
- Suzanne F Abraham
- Department of Obstetrics and Gynaecology, University of Sydney, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
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Klump KL, McGue M, Iacono WG. Differential heritability of eating attitudes and behaviors in prepubertal versus pubertal twins. Int J Eat Disord 2003; 33:287-92. [PMID: 12655625 DOI: 10.1002/eat.10151] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Differential heritability of eating pathology in prepubertal, pubertal, and 17-year-old twins was examined using a population-based twin sample. METHOD Participants included 530 11-year-old (452 prepubertal, 78 pubertal twins) and 602 17-year-old female twins from the Minnesota Twin Family Study. Puberty was assessed with the Pubertal Development Scale, and general eating pathology was assessed with the total score from the Minnesota Eating Disorders Inventory (M-EDI). RESULTS M-EDI total score intraclass correlations for the pubertal 11-year-old group were more similar to the 17-year-old twins' than the prepubertal 11-year-old twins, suggesting similar levels of genetic influence in the pubertal and older adolescent cohort. Model-fitting corroborated these impressions, indicating that genetic factors accounted for 0% of the variance in 11-year-old prepubertal twins but 54% of the variance in 11-year-old pubertal and 17-year-old twins. DISCUSSION Findings suggest that a portion of the genetic influence on eating pathology may become activated during puberty.
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Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, 129 Psychology Research Building, East Lansing, MI 48824, USA.
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Abstract
Many variables have been suggested as possible risk factors for eating disorders (ED), although the validity of these suggestions has seldom been tested causally. The current study tested a pathway model for the development of ED using prospective data from a randomly selected sample of 807 women, aged 18-32 years, from the general population of Sweden. Data was collected using self-report questionnaires with well-established psychometric properties. The cardinal symptoms of binge eating, purging, and fear of weight gain according to the DSM-IV characterized ED. Data supported the hypothesized model suggesting that low self-esteem, low perceived social support from the family, high levels of body concern, and high relative use of escape avoidance coping constitute a risk profile for later development of ED. Given the results and the fact that these risk factors can be modified, their practical utility and clinical significance should be examined in prevention studies.
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Affiliation(s)
- Ata Ghaderi
- Department of Psychology, Uppsala University, P.O. Box 1225, SE-751 42, Uppsala, Sweden.
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Klump KL, McGue M, Iacono WG. Genetic relationships between personality and eating attitudes and behaviors. JOURNAL OF ABNORMAL PSYCHOLOGY 2002; 111:380-9. [PMID: 12003459 DOI: 10.1037/0021-843x.111.2.380] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Genetic and environmental factors underlying relationships between personality traits and disordered eating were examined in 256 female adolescent twin pairs (166 monozygotic, 90 dizygotic). Eating behaviors were assessed with the Total Score, Body Dissatisfaction, Weight Preoccupation, Binge Eating, and Compensatory Behavior subscales from the Minnesota Eating Disorders Inventory (M-EDI; K. L. Klump, M. McGue, & W. G. Iacono, 2000). Personality characteristics were assessed with the Negative Emotionality, Positive Emotionality, and Constraint scales from the Multidimensional Personality Questionnaire (MPQ; A. Tellegen, 1982). Model-fitting analyses indicated that although genetic factors were more likely to contribute to MPQ and M-EDI phenotypic associations than environmental factors, shared genetic variance between the 2 phenotypes was limited. MPQ personality characteristics may represent only some of several genetic risk factors for eating pathology.
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Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing 48824, USA.
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Klump KL, Wonderlich S, Lehoux P, Lilenfeld LRR, Bulik CM. Does environment matter? A review of nonshared environment and eating disorders. Int J Eat Disord 2002; 31:118-35. [PMID: 11920974 DOI: 10.1002/eat.10024] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Nonshared environmental influences are experiences that are unique to siblings reared in the same family. We review studies highlighting the importance of nonshared factors for the development of eating disorders and suggest areas for future research. METHODS Findings from behavioral genetic studies of eating disorders as well as methodological issues are reviewed. RESULTS Twin studies suggest that approximately 17%-46% of the variance in both anorexia nervosa (AN) and bulimia nervosa (BN) can be accounted for by nonshared environmental factors. Studies directly examining these influences are scarce, although initial data indicate that differential paternal relationships, body weight teasing, peer group experiences, and life events may account for the development of eating pathology in one sibling versus another. DISCUSSION Additional research is needed to identify specific nonshared environmental influences on eating disorders such as differential parental and sibling treatment, disparate peer group characteristics, and differential experience of life events such as physical and sexual abuse.
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Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan 48824, USA.
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Patel P, Wheatcroft R, Park RJ, Stein A. The children of mothers with eating disorders. Clin Child Fam Psychol Rev 2002; 5:1-19. [PMID: 11993543 DOI: 10.1023/a:1014524207660] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
There is good evidence that children of parents with psychological disorders are themselves at increased risk of disturbances in their development. Although there has been considerable research on a variety of disorders such as depression and alcohol, research on the children of parents with eating disorders has been relatively recent. This paper aims to review the evidence and covers a number of areas, including genetic factors, pregnancy, the perinatal and postpartum period, infancy, and the early years of life, focusing on feeding and mealtimes, general parenting functions, and growth. This is followed by a consideration of psychopathology in the children, parental attitudes to children's weight and shape, and adolescence. What is clear is that although there are numerous case reports and case series, the number of systematic controlled studies is relatively small, and almost nothing has been written about the children of fathers with eating disorders. What is evident from the available evidence is that children of mothers with eating disorders are at increased risk of disturbance, but that the risk depends on a variety of factors, and that difficulties in the children are far from invariable. The paper concludes by summarizing five broad categories of putative mechanisms, based on the evidence to date, by which eating disturbance in parents can influence child development.
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Wade TD, Bulik CM, Kendler KS. Investigation of quality of the parental relationship as a risk factor for subclinical bulimia nervosa. Int J Eat Disord 2001; 30:389-400. [PMID: 11746300 DOI: 10.1002/eat.1100] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Previous literature suggests a link between the quality of the parental relationship and disordered eating in offspring. We investigated the relationship between offspring pyschopathology and the parental relationship using a population-based twin registry that contained 766 complete twin pairs. METHOD We used reports of twin lifetime psychopathology from the twins and quality of parental relationship and parental lifetime psychopathology from both parents. RESULTS Poorer quality of the marital relationship predicted the presence of subclinical bulimia nervosa (SBN) using both mother's (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.71-0.97) and father's (OR = 0.78, 95% CI: 0.62-0.97) reports. It also predicted the presence of generalized anxiety disorder (GAD) and alcohol dependence. SBN was still strongly predicted by the marital relationship when parental psychopathology was included as a covariate. DISCUSSION These results are supportive of the notion that a conflictual and distant marital relationship can, at least partially, act as an environmental risk factor for SBN.
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Affiliation(s)
- T D Wade
- School of Psychology, Flinders University of South Australia, Adelaide, Australia.
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Abstract
BACKGROUND Although weight and shape concerns are considered to be integral to the psychopathology of anorexia and bulimia nervosa, uncertainties remain about developmental aspects of the aetiology of these concerns and their relationship to eating disorders. AIMS To review the recent literature on weight and shape concern, with particular emphasis on aetiology, to identify a possible developmental pathway from weight concern through abnormal eating behaviour to disorder. METHOD Literature review of Medline and Psychlit databases using the keywords 'eating disorder', 'weight concern', 'shape concern' and 'aetiology'. Inclusion criteria were based on the strength of quantitative research findings, originality of ideas and recent publication. RESULTS Weight and shape concerns follow a developmental pathway arising before the typical age for the development of eating disorders. The origins are multifactorial, with biological, family and sociocultural features predominating. CONCLUSIONS Although weight and shape concern seems commonly to underlie the development of eating disorders, an alternative pathway appears to exist through impulsivity and fear of loss of control. Prevention strategies may usefully focus on the attitudes and concerns that lead to dieting behaviour.
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Affiliation(s)
- S G Gowers
- Section of Adolescent Psychiatry, University of Liverpool, UK
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Abstract
Data described earlier are clear in establishing a role for genes in the development of eating abnormalities. Estimates from the most rigorous studies suggest that more than 50% of the variance in eating disorders and disordered eating behaviors can be accounted for by genetic effects. These high estimates indicate a need for studies identifying the specific genes contributing to this large proportion of variance. Twin and family studies suggest that several heritable characteristics that are commonly comorbid with AN and BN may share genetic transmission with these disorders, including anxiety disorders or traits, body weight, and possibly major depression. Moreover, some developmental research suggests that the genes involved in ovarian hormones or the genes that these steroids affect also may be genetically linked to eating abnormalities. Molecular genetic research of these disorders is in its infant stages. However, promising areas for future research have already been identified (e.g., 5-HT2A receptor gene, UCP-2/UCP-3 gene, and estrogen receptor beta gene), and several large-scale linkage and association studies are underway. These studies likely will provide invaluable information regarding the appropriate phenotypes to be included in genetic studies and the genes with the most influence on the development of these disorders.
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Affiliation(s)
- K L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA.
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38
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Abstract
OBJECTIVE We studied monozygotic (MZ) twins who were discordant for bulimia nervosa in order to identify environmental factors that could have contributed to the expression of bulimia nervosa in only one member of these genetically identical twin pairs. METHOD Female twin pairs from the Virginia Twin Registry were identified. One twin met DSM-III-R criteria for bulimia nervosa (excluding the frequency and duration criterion) and the co-twin either reported some symptoms of bulimia nervosa but never met full diagnostic criteria (n = 20 pairs) or reported no symptoms of bulimia nervosa (n = 10). We compared the twins on demographic, developmental, personality, and psychiatric dimensions using self- and maternal report. RESULTS Affected twins were more likely to report lifetime generalized anxiety disorder and were described by their mothers as more anxious and fearful as children. They also had significantly lower mastery, optimism, and self-esteem, and significantly greater obsessive and compulsive symptoms than their unaffected co-twins. Affected twins recalled greater discord in their families but viewed their parents as more warm toward them than toward their unaffected co-twin. DISCUSSION Given that MZ twins are genetically identical and share a common family background, differences between them must be attributable to unique environmental factors. Although it is difficult to disentangle predisposing risk factors from sequelae of psychiatric illness in a retrospective co-twin control design, the affected twins were perceived to have been more anxious as children by their mothers-possibly reflecting a predisposing trait. More extensive interviews are required to determine the nature of environmental events that contribute to the expression of the observed personality, behavioral, anxious, and eating-related traits in the affected twins.
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Affiliation(s)
- C M Bulik
- Virginia Institute for Psychiatric and Behavioral Genetics, Medical College of Virginia of Virginia Commonwealth University, Richmond, Virginia.
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Kaye WH, Lilenfeld LR, Berrettini WH, Strober M, Devlin B, Klump KL, Goldman D, Bulik CM, Halmi KA, Fichter MM, Kaplan A, Woodside DB, Treasure J, Plotnicov KH, Pollice C, Rao R, McConaha CW. A search for susceptibility loci for anorexia nervosa: methods and sample description. Biol Psychiatry 2000; 47:794-803. [PMID: 10812038 DOI: 10.1016/s0006-3223(99)00240-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Eating disorders have not traditionally been viewed as heritable illnesses; however, recent family and twin studies lend credence to the potential role of genetic transmission. The Price Foundation funded an international, multisite study to identify genetic factors contributing to the pathogenesis of anorexia nervosa (AN) by recruiting affective relative pairs. This article is an overview of study methods and the clinical characteristics of the sample. METHODS All probands met modified DSM-IV criteria for AN; all affected first, second, and third degree relatives met DSM-IV criteria for AN, bulimia nervosa (BN), or eating disorder not otherwise specified (NOS). Probands and affected relatives were assessed diagnostically with the Structured Interview for Anorexia and Bulimia. DNA was collected from probands, affected relatives and a subset of their biological parents. RESULTS Assessments were obtained from 196 probands and 237 affected relatives, over 98% of whom are of Caucasian ancestry. Overall, there were 229 relative pairs who were informative for linkage analysis. Of the proband-relative pairs, 63% were AN-AN, 20% were AN-BN, and 16% were AN-NOS. For family-based association analyses, DNA has been collected from both biological parents of 159 eating-disordered subjects. Few significant differences in demographic characteristics were found between proband and relative groups. CONCLUSIONS The present study represents the first large-scale molecular genetic investigation of AN. Our successful recruitment of over 500 subjects, consisting of affected probands, affected relatives, and their biological parents, will provide the basis to investigate genetic transmission of eating disorders via a genome scan and assessment of candidate genes.
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Affiliation(s)
- W H Kaye
- The Price Foundation Collaborative Group, Eating Disorders Module, Western Psychiatric Institute & Clinic, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA
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Genetic and environmental risk factors shared between disordered eating, psychological and family variables. PERSONALITY AND INDIVIDUAL DIFFERENCES 2000. [DOI: 10.1016/s0191-8869(99)00134-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Klump KL, McGue M, Iacono WG. Age differences in genetic and environmental influences on eating attitudes and behaviors in preadolescent and adolescent female twins. JOURNAL OF ABNORMAL PSYCHOLOGY 2000. [DOI: 10.1037/0021-843x.109.2.239] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
OBJECTIVE Twin methodology has been used to delineate etiological factors in many medical disorders and behavioral traits including eating disorders. Although twin studies are powerful tools, their methodology can be arcane and their implications easily misinterpreted. METHOD The goals of this study are to (a) review the theoretical rationale for twin studies; (b) provide a framework for their interpretation and evaluation; (c) review extant twin studies on eating disorders; and (d) explore the implications for understanding etiological issues in eating disorders. DISCUSSION On the basis of this review, it is not possible to draw firm conclusions regarding the precise contribution of genetic and environmental factors to anorexia nervosa. Twin studies confirm that bulimia nervosa is familial and reveal significant contributions of additive genetic effects and of unique environmental factors in liability to bulimia nervosa. The magnitude of the contribution of shared environment is less clear, but in the studies with the greatest statistical power, it appears to be less prominent than additive genetic factors.
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Affiliation(s)
- C M Bulik
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA 23298-0126, USA.
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