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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    • "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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    • "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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