Anna Keski-Rahkonen

University of Helsinki | HY · Clinicum, Department of Public Health

Purpose of review: Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, and other eating disorders) affect young people worldwide. This narrative review summarizes key studies conducted on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) eating disorders among young people in 2013-22. Recent f...

Purpose The association of bulimic symptoms with sensation seeking is uncertain; however, both behaviors have been linked to alcohol problems. We assessed in a longitudinal, community-based setting whether sensation seeking in adolescence is associated with bulimic symptoms in early adulthood, also accounting for alcohol problems. Methods Finnish...

Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018–2020 is estimated to be 0.6–1.8% in adult women and 0.3–0.7% in adult men. BED is commonly assoc...

Background Many genes and molecular pathways are associated with obesity, but the mechanisms from genes to obesity are less well known. Eating behaviors represent a plausible pathway, but because the relationships of eating behaviors and obesity may be bi-directional, it remains challenging to resolve the underlying pathways. A longitudinal approac...

Purpose of review: Binge eating disorder (BED) is a new diagnostic and statistic manual of mental disorders, fifth edition (DSM-5) and international classification of diseases, eleventh revision diagnosis. This narrative review provides an overview of the epidemiology of BED, emphasizing studies published in 2018-2021. Recent findings: DSM-5 BED...

Background Genetics and biology may influence the age at onset of anorexia nervosa (AN). The aims of this study were to determine whether common genetic variation contributes to AN age at onset and to investigate the genetic associations between age at onset of AN and age at menarche. Methods A secondary analysis of the Psychiatric Genomics Consor...

Objective We assessed the detection, treatment and outcomes of DSM-5 eating disorders in a nationwide community setting. Method The FinnTwin12 cohort comprises twins born in 1983–1987 in Finland (n = 5,600), with follow-up starting at age 12. We outline treatment and outcomes of the 127 females and 15 males diagnosed with a lifetime DSM-5 eating d...

Background Obesity susceptibility genes are highly expressed in the brain suggesting that they might exert their influence on body weight through eating-related behaviors. Objectives To examine whether the genetic susceptibility to obesity is mediated by eating behavior patterns. Methods Participants were 3977 twins (33% monozygotic, 56% females)...

Short dietary assessment instruments are often included to large-scale twin studies that focus on multiple health behaviors and disease outcomes. Due to their feasibility and low cost, food frequency questionnaires (FFQs) are usually employed to provide data on dietary intake and diet quality. Diet quality have been linked with eating styles such a...

Genome-wide association studies have discovered hundreds of loci associated with complex brain disorders, but it remains unclear in which cell types these loci are active. Here we integrate genome-wide association study results with single-cell transcriptomic data from the entire mouse nervous system to systematically identify cell types underlying...

Eating disorders and substance use disorders frequently co‐occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa and problem alcohol use (genetic correlation [rg], twin‐based = 0.23‐0.53). We estimated the genetic correlation...

Objective: We aimed to assess the lifetime prevalence, 10-year incidence, and peak periods of onset for eating disorders as defined by the Fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-5) among adolescents and young adults born in the 1980s in Finland. Method: Virtually all Finnish twins born in 1983-1987 (n = 5,600) were foll...

The purpose of this review is to provide a detailed and updated description of the FinnTwin16 (FT16) study and its future directions. The Finnish Twin Cohort comprises three different cohorts: the Older Twin Cohort established in the 1970s and the FinnTwin12 and FT16 initiated in the 1990s. FT16 was initiated in 1991 to identify the genetic and env...

We constructed a food-based diet quality score (DQS) and examined its association with obesity measures, eating styles and nutrient intakes. Participants were 3592 individuals (764 dizygotic [DZ] and 430 monozygotic [MZ] twin pairs) from the FinnTwin16 study. The DQS (0–12 points) was constructed from a short 14 item food frequency questionnaire. A...

Eating disorders and substance use disorders frequently co-occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa (BN) and problem alcohol use (genetic correlation [rg], twin-based=0.23-0.53). We estimated the genetic correlati...

Characterized primarily by a low body-mass index, anorexia nervosa is a complex and serious illness¹, affecting 0.9–4% of women and 0.3% of men2–4, with twin-based heritability estimates of 50–60%⁵. Mortality rates are higher than those in other psychiatric disorders⁶, and outcomes are unacceptably poor⁷. Here we combine data from the Anorexia Nerv...

In MRI scans of patients with anorexia nervosa (AN), reductions in brain volume are often apparent. However, it is unknown whether such brain abnormalities are influenced by genetic determinants that partially overlap with those underlying AN. Here, we used a battery of methods (LD score regression, genetic risk scores, sign test, SNP effect concor...

The female athlete triad is a medical condition that involves low energy intake, menstrual dysfunction and low bone mineral density. It is observed in physically active girls and women whose dietary energy intake does not match their energy expenditure. If not recognized and treated, the triad can lead to serious health problems including eating di...

A sense of agency is a transtheoretical concept that increases our understanding of important processes in psychotherapy. Agency can be described in terms of how strongly the person believes that she can have an impact on her problematic experiences and behaviors. In this case study, a patient's sense of agency in relation to symptoms of bulimia ne...

Background and aims: By investigating differences in lifestyle behaviours and BMI in sibling pairs, family-level confounding is minimized and causal inference is improved, compared to cross-sectional studies of unrelated children. Thus, we aimed to investigate within-sibling pair differences in different lifestyle behaviours and differences in BMI...

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed a meta-analysis of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hypera...

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed a meta-analysis of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hypera...

Disorders of the brain can exhibit considerable epidemiological comorbidity and often share symptoms, provoking debate about their etiologic overlap. We quantified the genetic sharing of 25 brain disorders from genome-wide association studies of 265,218 patients and 784,643 control participants and assessed their relationship to 17 phenotypes from...

Objective: The objective of this study was to evaluate disordered eating behaviours (DEBs) in different age groups in a Cypriot non-clinical population sample. Study design: Comparative cross-sectional study. Method: A total of 1716 participants from the Cyprus component of the I.Family study completed the Eating Attitudes Test-26 (EAT-26). Th...

Brainstorming diseases Consistent classification of neuropsychiatric diseases is problematic because it can lead to misunderstanding of etiology. The Brainstorm Consortium examined multiple genome-wide association studies drawn from more than 200,000 patients for 25 brain-associated disorders and 17 phenotypes. Broadly, it appears that psychiatric...

Objective: Binge eating disorder (BED) is a clinical eating disorder that is strongly and bidirectionally related to overweight and obesity. Little is known about how subclinical features of BED relate to weight development in adolescence and young adulthood. Method: Women (n = 2825) and men (n = 2423) from the community-based longitudinal FinnT...

Objectives: To assess factors associated with successful weight maintenance over ten years in a prospective general population sample of young adults. Material and methods: Our study comprised 2452 women and 2227 men born in 1975-1979 (mean age at baseline 24 years, attrition 27.1%). Weight maintenance was defined as weight maintained within ±5%...

Anorexia nervosa (AN) is a complex and serious eating disorder, occurring in ~1% of individuals. Despite having the highest mortality rate of any psychiatric disorder, little is known about the aetiology of AN, and few effective treatments exist. Global efforts to collect large sample sizes of individuals with AN have been highly successful, and a...

Anorexia nervosa (AN) is a complex neuropsychiatric disorder presenting with dangerously low body weight, and a deep and persistent fear of gaining weight. To date, only one genome-wide significant locus associated with AN has been identified. We performed an exome-chip based genome-wide association studies (GWAS) in 2158 cases from nine population...

Objective: The risk of certain psychiatric disorders is elevated among immigrants. To date, no population studies on immigrant health have addressed eating disorders. We examined whether risk of eating disorders in first- and second-generation immigrants differs from native-born Danes and Swedes. Method: All individuals born 1984-2002 (Danish co...

Since medieval times, an association between religiosity and anorexia nervosa has been suggested, but few systematic studies exist. This study examines in a nationwide setting whether personal or family religiosity is associated with lifetime anorexia nervosa among women in adolescence and early adulthood. Women (N = 2,825) from the 1975 to 1979 bi...

Purpose of review: Eating disorders - anorexia nervosa, bulimia nervosa, and binge eating disorder - affect numerous Europeans. This narrative review summarizes European studies on their prevalence, incidence, comorbidity, course, consequences, and risk factors published in 2015 and the first half of 2016. Recent findings: Anorexia nervosa is re...

Background: The objective of this descriptive review is to summarize the current scientific evidence on the effect of prenatal exposure to maternal infection and immune response on the offspring's risk for mental disorders (schizophrenia spectrum disorders, autism spectrum disorders, attention-deficit hyperactivity disorder, anorexia nervosa, and...

Objective: To examine the occurrence, course, and clinical picture of the DSM-5 residual categories 'Other Specified Feeding or Eating Disorder' (OSFED) and 'Unspecified Feeding or Eating Disorder' (UFED), to describe potential subtypes, and to evaluate whether the subdivision of the residual category appears meaningful. Method: We screened wome...

Objectives: Patients with anorexia nervosa (AN) are ideally suited to identify differentially methylated genes in response to starvation. Methods: We examined high-throughput DNA methylation derived from whole blood of 47 females with AN, 47 lean females without AN and 100 population-based females to compare AN with both controls. To account for...

Background: We assessed whether the Eating Disorder Inventory (EDI) is suitable for screening binge eating disorder (BED) in young women. Method: Young women (N=2825) from the 1975-79 birth cohorts of Finnish twins were assessed by questionnaires, including subscales of the EDI. For a subset of women (N=548), we established DSM-5 diagnoses of BE...

The maintenance of normal body weight is disrupted in patients with anorexia nervosa (AN) for prolonged periods of time. Prior to the onset of AN, premorbid body mass index (BMI) spans the entire range from underweight to obese. After recovery, patients have reduced rates of overweight and obesity. As such, loci involved in body weight regulation m...

Objective: Eating disorders and alcohol use disorders often co-occur, but few prospective studies have examined their relationship. Using a large population-based twin sample, we investigated how the drinking behaviors of women with lifetime eating disorders unfold from adolescence to adulthood. Method: We identified 182 women with a lifetime ea...

Objective: To quantify weight ideals of young adults and to examine whether the discrepancy between actual and ideal weight is associated with 10-year body mass index (BMI) change in the population. Methods: This study comprised 4,964 adults from the prospective population-based FinnTwin16 study. They reported their actual and ideal body weight...

INTRODUCTION: We investigated factors affecting treatment outcome and cost of treatment among adolescents treated for anorexia nervosa in specialized care. METHODS: Records of 47 patients with anorexia nervosa treated at the adolescent eating disorder unit were reviewed retrospectively. RESULTS: Individual differences in the need for treatment an...

A common question made by a young person attending a practice concerns her/his ideal body weight. Culture and health may result in a conflicting definition of good weight. Discontent with one's own body can motivate for successful weight control, but may also lead to unnecessary dieting or disturbed eating. Too strict dieting and accentuating of we...

Objective Few studies have assessed outcomes of anorexia nervosa (AN) outside clinical settings. We aimed to assess mortality, recovery, and socio-demographic outcomes of AN in a community sample.Method Women in the nationwide FinnTwin16 cohort (born 1975–1979) were followed for 10 years after baseline diagnostic assessment (mean age at follow-up 3...

There is scant research on the clinical utility of differentiating International Classification of Diseases (ICD) 10 diagnoses F50.0 anorexia nervosa (typical AN) and F50.1 atypical anorexia. We reviewed systematically records of 47 adolescents who fulfilled criteria for ICD-10 F50.0 (n = 34) or F50.1 (n = 13), assessing the impact of diagnostic su...

Objective To assess the population prevalence and incidence of binge eating disorder (BED) among young women.Method In a nationwide longitudinal study of Finnish twins born 1975–1979, the women participated in five surveys from age 16 until their mid-thirties. At Wave 4 (mean age 24 years), the women (N = 2,825) underwent a 2-stage screening for ea...

Objective: The association between eating disorders and migraine remains unclear. Method: We identified women with lifetime diagnoses of anorexia nervosa (AN) (N = 55) and bulimia nervosa (BN) (N = 60) and their co-twins from the FinnTwin16 cohort born in 1975-1979 (N = 2,825 women). Eating disorder and major depressive disorder (MDD) diagnoses...

Objective: The objective of this descriptive review is to summarize the current scientific evidence on various prenatal and perinatal exposures affecting later development of eating disorders among offspring. Method: Studies were searched from PubMed database with the following keywords: eating disorders and disordered eating and anorexia nervos...

Purpose of review: Research in eating disorders in males has been active lately compared to the past. This review aims to provide an overview of the recently published studies of eating disorders in males. Recent findings: Publication of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition has outlined more sex-neutral diagnost...

To examine factors associated with the outcome of anorexia nervosa among women from the general population. Women (N = 2,881) from the 1975-1979 birth cohorts of Finnish twins were screened for lifetime DSM-IV anorexia nervosa (N = 55 cases) using questionnaires and the SCID interview. Potential factors associated with the likelihood of recovery we...

The Wellcome Trust Case Control Consortium 3 anorexia nervosa genome-wide association scan includes 2907 cases from 15 different populations of European origin genotyped on the Illumina 670K chip. We compared methods for identifying population stratification, and suggest list of markers that may help to counter this problem. It is usual to identify...

Anorexia nervosa (AN) is a complex and heritable eating disorder characterized by dangerously low body weight. Neither candidate gene studies nor an initial genome-wide association study (GWAS) have yielded significant and replicated results. We performed a GWAS in 2907 cases with AN from 14 countries (15 sites) and 14 860 ancestrally matched contr...

Background Body mass index (BMI) is associated with subjective well-being. Higher BMI is believed to be related with lower well-being. However, the association may not be linear. Therefore, we investigated whether a nonlinear (U-shaped) trend would better describe this relationship, and whether eating disorders might account for the association in...

Objective: To examine psychiatric comorbidity and factors that influence the outcome of bulimia nervosa (BN) in the general population. Method: Women from the nationwide birth cohorts of Finnish twins were screened for lifetime BN (N = 59) by using questionnaires and the Structured Clinical Interview for DSM-IV. We assessed psychiatric comorbidi...

Eating disorders (EDs) are common, complex psychiatric disorders thought to be caused by both genetic and environmental factors. They share many symptoms, behaviors, and personality traits, which may have overlapping heritability. The aim of the present study is to perform a genome-wide association scan (GWAS) of six ED phenotypes comprising three...

In the current chapter eating disorders are defined, with particular emphasis on the eating disorder not otherwise specified (EDNOS) category. Possible changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for eating disorders are discussed, along with the rationale for these changes. The major prevalence studies are...

Approximately 7% of Finnish women develop an eating disorder before the age of 30. While at least 70% of anorectic women will recover from their illness, normalization of body weight and hormone function usually takes years. Some of the anorexia cases become chronic. Bulimia nervosa has been considered a milder disease than anorexia, but the diseas...

We examined longitudinal associations between individual leisure activities (television viewing, video viewing, computer games, listening to music, board games, musical instrument playing, reading, arts, crafts, socializing, clubs or scouts, sports, outdoor activities) and being overweight using logistic regression and latent class analysis in a co...

To study genetic and environmental factors affecting body mass index (BMI) and BMI phenotypic correlations across adolescence. Prospective, population-based, twin cohort study. We used twin modeling in 2413 monozygotic and same-sex and opposite-sex dizygotic Finnish twin pairs born in 1983-1987 and assessed using self-report questionnaires at 11-12...

The purpose of this study is to analyze the developmental relationships of adolescent-onset Axis I mental disorders and eating disorders (EDs). One thousand three hundred eighteen adolescent twins born from 1983 to 1987 completed a professionally administered semistructured psychiatric interview at the age of 14 years and a questionnaire follow-up...

To examine the epidemiology of anorexia nervosa in men, we screened Finnish male twins born in 1975-79. Men (N = 2122) from FinnTwin16 birth cohorts were screened for lifetime eating disorders by a questionnaire. The screen positives (N = 18), their male co-twins (N = 10) and those with lifetime minimum BMI< or =17.5 (N = 21) were administered the...

Evidence of the relation of complications occurring in the pregnancy, delivery and neonatal periods to the risk of contracting a subsequent eating disorder has been obtained during recent years. Factors associated with parturition and neonatal period seem to predict both anorexia and bulimia, whereas disorders during pregnancy are more clearly asso...

The authors tested the hypothesis that either prenatal feminization or masculinization hormone influences in utero or later socialization affects the risk for anorexia and bulimia nervosa and disordered eating in members of opposite-sex twin pairs. Finnish twins (N=2,426 women, N=1,962 men with known zygosity) from birth cohorts born 1974-1979 were...

Little is known about the epidemiology of bulimia nervosa outside clinical settings. We report the incidence, prevalence and outcomes of bulimia nervosa using for the first time a nationwide study design. To assess the incidence and natural course and outcomes of DSM-IV bulimia nervosa among women from the general population, women (n=2881) from th...

The neurotransmitter serotonin (5-HT) controls several physiological functions, and a disturbance of the 5-HT system is implicated in many psychiatric conditions. Seasonal variation has been suggested in the 5-HT system. We investigated within-subject seasonal variation in brain serotonin transporter (SERT) binding with the SERT-ligand [(123)I]ADAM...

Objectives of review. To summarize the recent advances in the descrip- tive epidemiology of eating disorders, emphasizing studies published between 2005 and 2006. Summary of recent findings. During their lifetime, 0.9-2.2% of women and 0.2-0.3% of men suffer from anorexia nervosa (AN). Its overall incidence in the population has remained stable dur...

To describe patterns, comorbidity, and outcomes from a case series of anorexia nervosa (AN) among young men from the general population and their co-twins. Men (N = 2,122) born between 1975 and 1979 from Finnish twin cohorts were screened for lifetime eating disorders by questionnaire. The administration of the short version of the Structured Clini...

We analysed genetic and environmental influences on self-esteem and its stability in adolescence. Finnish twins born in 1983-1987 were assessed by questionnaire at ages 14 (n = 4132 twin individuals) and 17 years (n = 3841 twin individuals). Self-esteem was measured using the Rosenberg global self-esteem scale and analyzed using quantitative geneti...

To explore how genetic epidemiology has informed the identification of endophenotypes and how endophenotypes may inform future classification of eating disorders. Literature review and synthesis. Although a number of endo- and subphenotypes have been suggested for eating disorders, few reach the rigorous definitions developed for candidate endophen...

Most previous studies of the prevalence, incidence, and outcome of anorexia nervosa have been limited to cases detected through the health care system, which may bias our understanding of the disorder's incidence and natural course. The authors sought to describe the onset and outcomes of anorexia nervosa in the general population. Lifetime prevale...