Childhood anxiety associated with low BMI in women with Anorexia Nervosa

Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 09/2009; 48(1):60-7. DOI: 10.1016/j.brat.2009.09.009
Source: PubMed


Extremely low body mass index (BMI) values are associated with increased risk for death and poor long-term prognosis in individuals with anorexia nervosa (AN). The present study explores childhood personality characteristics that could be associated with the ability to attain an extremely low BMI.
Participants were 326 women from the Genetics of Anorexia Nervosa (GAN) Study who completed the Structured Interview for Anorexia Nervosa and Bulimic Syndromes and whose mother completed the Child Behavioral Checklist and/or Revised Dimensions of Temperament Survey.
Children who were described as having greater fear or anxiety by their mothers attained lower BMIs during AN (p < 0.02). Path analysis in the GAN and a validation sample, Price Foundation Anorexia Nervosa Trios Study, confirmed the relation between early childhood anxiety, caloric restriction, qualitative food item restriction, excessive exercise, and low BMI. Path analysis also confirmed a relation between childhood anxiety and caloric restriction, which mediated the relation between childhood anxiety and low BMI in the GAN sample only.
Fearful or anxious behavior as a child was associated with the attainment of low BMI in AN and childhood anxiety was associated with caloric restriction. Measures of anxiety and factors associated with anxiety-proneness in childhood may index children at risk for restrictive behaviors and extremely low BMIs in AN.

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    • "Improving adherence to and outcomes of eating disorder interventions remain important goals, and patients with comorbid anxiety disorders appear especially in need of enhanced interventions as they tend to have poorer illness courses and outcomes (Dellava et al. 2010; Herpertz- Dahlmann et al. 2001; Thornton et al. 2011; Yackobovitch- Gavan et al. 2009). The purpose of this special series is to highlight some of the latest work on the relation between anxiety and disordered eating, with the overarching goal of identifying promising areas of research that may ultimately lead to better interventions. "
    Cognitive Therapy and Research 10/2013; 37(5):887-889. DOI:10.1007/s10608-013-9565-9 · 1.70 Impact Factor
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    • "Furthermore, individuals identified through medication status, who had a more severe illness history had significantly higher trait and social anxiety than ED offspring who were not taking medication and had a less severe illness. These results are consistent with findings that childhood anxiety and anxiety comorbidity have a negative effect on the course and outcome of EDs (Dellava et al. 2010; Herpertz-Dahlmann et al. 2001; Thornton et al. 2011; Yackobovitch-Gavan et al. 2009). "
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    ABSTRACT: Anxiety, altered attention for social stimuli and poor recognition of emotions were examined as putative intermediate phenotypes of eating disorders (EDs). Three hundred and forty two participants (65 ED offspring; 52 healthy offspring; 124 parents of ED offspring; 101 parents of healthy offspring) completed self report and behavioural measures of anxiety, attention for social stimuli and emo-tion recognition. ED offspring and their parents had higher trait anxiety in comparison to healthy controls. Social anxiety co-segregated with the illness in parents. ED off-spring did not show Stroop interference for social stimuli. Subtle alterations in response to social stimuli were observed in ED fathers. ED groups did not have difficulties recognising complex emotions. In conclusion, trait and social anxiety fulfil some of the criteria for intermediate phenotypes in EDs. There was less evidence for behav-ioural measures of anxiety and social processing. This may be a consequence of sample characteristics, low power or task sensitivity.
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    • "These findings, especially the meaning of internalizing problems as risk factors for the development of AN-R and internalizing and externalizing problems as risk factors for the development of ED-BN can help to identify the risk groups and contribute to better prevention strategies and/or help to start with the treatment at an early stage of the disease. Our results are consistent with the literature in which high negative affectivity (Fairburn et al., 1999; Pike et al., 2008), emotional instability, anxiety, depression, guilt and low self-esteem, (Bulik et al., 2006; Peñas-Lledó et al., 2010) and internalizing psychopathology (anxiety, depression, somatization) have been found (Dellava et al., 2010; García-Alba, 2004; McDermott et al., 2006; Muratori et al., 2004) as relevant for AN and BN pathology. Table 3 Comparison of patients before onset of bulimic disorders and their healthy sister (n=46 pairs) "
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    ABSTRACT: We wanted to clarify whether there is any clinically relevant behavioural psychopathology in patients before onset of an eating disorder (ED) compared with their healthy sisters and if there are differences in behavioural problems between the ED subtypes anorexia nervosa-restricting type (AN-R) and EDs with bulimic behaviour. Behavioural psychopathology was examined by parental report using the Child Behaviour Checklist retrospectively in 83 sister pairs discordant for an ED (37 with AN-R and 46 with bulimic EDs) by means of conditional logistic regression. Participants who later developed an ED had significantly higher internalizing and externalizing behavioural abnormality scores before onset of the ED than their unaffected sisters. Conditional logistic regression revealed significantly higher internalizing behaviour scores in AN-R and significantly higher internalizing and externalizing scores in the bulimic disorders. Internalizing problems (anxiety, depression and somatization) preceded the development of AN, whereas both internalizing and externalizing behaviour problems (aggressive and delinquent behaviour) preceded bulimic disorders.
    European Eating Disorders Review 03/2012; 20(2):116-20. DOI:10.1002/erv.1152 · 2.46 Impact Factor
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