Lifetime course of eating disorders: Design and validity testing of a new strategy to define the eat disorders phenotype

Eating Disorders Unit, Institute of Psychiatry, King's College London, London, UK.
Psychological Medicine (Impact Factor: 5.43). 05/2008; 39(1). DOI: 10.1017/S0033291708003292
Source: PubMed

ABSTRACT Aetiological studies of eating disorders would benefit from a solution to the problem of instability of eating disorder symptoms. We present an approach to defining an eating disorders phenotype based on the retrospective assessment of lifetime eating disorders symptoms to define a lifetime pattern of illness. We further validate this approach by testing the most common lifetime categories for differences in the prevalence of specific childhood personality traits.
Ninety-seven females participated in this study, 35 with a current diagnosis of restricting anorexia nervosa, 32 with binge/purging subtype of anorexia nervosa and 30 with bulimia nervosa. Subjects were interviewed by a newly developed EATATE Lifetime Diagnostic Interview for a retrospective assessment of the lifetime course of eating disorders symptoms and childhood traits reflecting obsessive-compulsive personality.
The data illustrate the extensive instability of the eating disorders diagnosis. Four most common lifetime diagnostic categories were identified that significantly differ in the prevalence of childhood traits. Perfectionism and rigidity were more common in groups with a longer duration of underweight status, longer episodes of severe food restriction, excessive exercising, and shorter duration of binge eating.
The assessment of lifetime symptoms may produce a more accurate definition of the eating disorders phenotype. Obsessive-compulsive traits in childhood may moderate the course producing longer periods of underweight status. These findings may have important implications for nosology, treatment and future aetiological studies of eating disorders.

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Available from: Kate Tchanturia, Aug 26, 2015
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    • "This instrument has been validated and has demonstrated good inter-rater reliability in terms of diagnoses (k 0.82–1.0) and illness history variables (0.80–0.99) (Anderluh et al. 2009). All interviewers were trained in using the interview. "
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    ABSTRACT: Using a sister-pair design, we aimed to investigate the role of maternal anxiety in pregnancy and parental overprotection as risk factors for anorexia nervosa (AN) and bulimia nervosa (BN). We were also interested in investigating anxious personality traits in patients with AN and BN compared to their healthy sisters, and their possible association to overprotection. One-hundred-and-fifty-seven females (AN = 94; BN = 63) and their healthy sisters from four European centres were recruited. Data on temperament and childhood characteristics were obtained from cases and their sisters using the Temperament and Character Interview Revised (TCI-R) and the Oxford Risk Factor Interview (ORFI); maternal anxiety and overprotection were obtained from retrospective parental report. Both AN and BN women displayed significantly higher levels of separation anxiety in childhood in comparison to their sisters, but only women with AN showed anxious temperamental traits. Mothers of women with AN reported higher levels of anxiety during the index pregnancy (p < .01), compared to when pregnant with the healthy daughter. The age in months at which women with AN were first left with another adult for a night was also higher compared to their sisters (respectively medians: 12 (range 1–120), 9 (range 1–96), p < .05). This was not the case for women with BN. Maternal overprotection was not associated with index daughter temperament. This finding is suggestive of an association between AN and maternal stress and anxiety in utero and later overprotective care, whilst BN was not associated with maternal anxiety or overprotection.
    Cognitive Therapy and Research 08/2013; 37(4). DOI:10.1007/s10608-012-9518-8 · 1.70 Impact Factor
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    • "Because of the relatively low base rates of these illnesses, community-based prospective studies are extremely challenging to perform. Thus, retrospective designs have often been used instead (Anderluh et al. 2009; Fairburn et al. 1997, 1998, 1999), which, however, are vulnerable to the biases inherent in retrospective reporting. Another less than ideal alternative methodological approach that has been used to test the predispositional model is a recovered study design where individuals who have recovered from an ED (though definitions of recovery have not been universally agreed upon, which poses an additional challenge) are studied as a proxy for a premorbid state since they are assumedly no longer experiencing the physiological effects of the ED. "
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    ABSTRACT: The assessment of personality and temperament in the context of eating disorders (EDs) poses unique challenges because of the physiological symptoms and sequelae of these illnesses. Four models of the relationship between personality and EDs are presented, along with a discussion of the different methodological designs which can evaluate these models. Current data support the likelihood that neuroticism and perfectionism are risk factors for EDs. Perfectionism and the related obsessive-compulsive personality disorder may also share a common cause with anorexia nervosa. High harm avoidance and low self-directedness also characterize all EDs, though more data are needed to confirm their role as risk factors; importantly however, this combination of traits may diminish one's ability to cope with stressful life events. At the other end of the spectrum, considering impulsivity multidimensionally may be important to understanding the role of this personality trait in EDs, though existing data do not yet allow for conclusions regarding its role as a risk factor versus a consequence of the ED. All of the identified traits that may be risk factors are also exacerbated as a consequence of having, or having had, an ED. Finally, the role of personality disorders in influencing the course and outcome of EDs is still unclear. A fruitful avenue for future research in this area is to utilize personality and temperament to classify individuals in a way that allows for the best chance of identifying genetic loci that confer increased risk for EDs.
    01/2011; 6:3-16. DOI:10.1007/7854_2010_86
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    • "An alternative strategy is to focus on underlying mechanisms such as maintaining factors and biological markers. The search for such markers is particularly applicable to the eating disorders (ED) given their unstable diagnostic categories (Anderluh et al., 2009) and the current lack of targeted and effective treatment (Bulik et al., 2007; Shapiro et al., 2007; Steinhausen, 2009; Treasure et al., 2009). One medium used to explore such mechanisms is that of neuropsychology (Gottesman and Gould, 2003; Ritsner and Gottesman, 2009), where standardised and systematic assessment allows for detailed exploration of altered cognitive functioning. "
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    ABSTRACT: Poor set-shifting has been implicated as a risk marker, maintenance factor and candidate endophenotype of eating disorders (ED). This study aimed to add clarity to the cognitive profile of set-shifting by examining the trait across ED subtypes, assessing whether it is a state or trait marker, and whether it runs in families. A battery of neuropsychological tasks was administered to 270 women with current anorexia (AN) and bulimia nervosa (BN), women recovered from AN, unaffected sisters of AN and BN probands, and healthy control women. Set-shifting was examined using both individual task scores and a composite variable (poor/intact/superior shifting) calculated from four neuropsychological tasks. Poor set-shifting was found at a higher rate in those with an ED particularly binge/purging subtypes. Some evidence for poor set-shifting was also present in those recovered from AN and in unaffected sisters of AN and BN. Clinically, poor set-shifting was associated with a longer duration of illness and more severe ED rituals but not body mass index. In sum, poor set-shifting is a transdiagnostic feature related to aspects of the illness but not to malnutrition. In part it is a familial trait, and is likely involved in the maintenance of the illness.
    Journal of Psychiatric Research 10/2010; 44(14):964-70. DOI:10.1016/j.jpsychires.2010.03.001 · 4.09 Impact Factor
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