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: 5.94). 05/2008; 39(1). DOI: 10.1017/S0033291708003292
Source: PubMed


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.

Download full-text


Available from: Kate Tchanturia
  • Source
    • "Comorbidity is found to be high between AN and OCD (Halmi et al., 1991) OCD is reported to be most prevalent in the restrictive subtype of AN (Fornari et al., 1992; Lilenfeld et al., 1998), although reported prevalence has been inconsistent across studies (Godart et al., 2002). The presence of obsessive–compulsive symptoms is a risk factor for developing AN (Anderluh et al., 2008); and the level of such symptoms remains elevated to some extent even after recovery (Holtkamp et al., 2005). Familiality is reported, with the first degree relatives of individuals with AN showing an elevated risk for OCD (Bellodi et al., 2001). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The compulsive nature of weight loss behaviors central to anorexia nervosa (AN), such as relentless self-starvation and over-exercise, has led to the suggestion of parallels between AN and other compulsive disorders such as obsessive-compulsive disorder (OCD) and addictions. There is a huge unmet need for effective treatments in AN, which has high rates of morbidity and the highest mortality rate of any psychiatric disorder, yet a grave paucity of effective treatments. Viewing compulsivity as a transdiagnostic concept, seen in various manifestations across disorders, may help delineate the mechanisms responsible for the persistence of AN, and aid treatment development. We explore models of compulsivity that suggest dysfunction in cortico-striatal circuitry underpins compulsive behavior, and consider evidence of aberrancies in this circuitry across disorders. Excessive habit formation is considered as a mechanism by which initially rewarding weight loss behavior in AN may become compulsive over time, and the complex balance between positive and negative reinforcement in this process is considered. The physiological effects of starvation in promoting compulsivity, positive reinforcement, and habit formation are also discussed. Further research in AN may benefit from a focus on processes potentially underlying the development of compulsivity, such as aberrant reward processing and habit formation. We discuss the implications of a transdiagnostic perspective on compulsivity, and how it may contribute to the development of novel treatments for AN.
    Full-text · Article · Jul 2014 · Frontiers in Psychology
  • Source
    • "Previously, we could observe that the presence of obsessive-compulsive disorders was significantly associated with a longer duration of the ED, in addition we found no difference between the prevalence of obsessive-compulsive disorder in AN compared to BN [21]. Some studies underline the important role of obsessive-compulsive traits for the course of ED (e.g., [22-24]) Anderluh and colleagues reported retrospectively that obsessive-compulsive traits in childhood were linked to a longer duration of underweight status, longer episodes of severe food restriction, and shorter duration of binge eating [22,25]. It is possible that rigidity (as obsessive-compulsive disorder or as trait) may contribute to an increased fixation of the ED symptoms and, thereby, reduced diagnostic instability. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Eating disorders (ED) are classified into Anorexia Nervosa, Bulimia Nervosa, and eating disorder not otherwise specified. Prospectively, the diagnostic instability within ED is high, but it is not clear which factors may account for this instability. So far, there is no evidence of whether psychiatric comorbidity may play a role in ED diagnostic crossover. We sought to determine possible influences of comorbidities of axis I and II on diagnostic crossover within ED. Longitudinal data of 192 female patients were collected. All patients had a diagnosis of a current ED at study entry (baseline, T0). Diagnoses were re-established both 12 months (T1) and 30 months (T2) after T0. Comorbid psychiatric diagnoses were grouped into axis I and axis II according to DSM-IV. Patients with instable ED diagnoses had lifetime axis-I comorbidity more frequently than patients with stable ED diagnoses (chi2 = 4.74, df = 1, p < 0.05). Post-hoc exploratory tests suggested that the effect was mainly driven by affective disorders like major depression. There was no difference for axis-II comorbidity between stable and instable diagnostic profiles. Following previous reports of diagnostic crossover in ED, the present investigation points to an influence of a life-time psychiatric comorbidity, in particular of axis I, on follow-up diagnoses of ED. Comorbid affective disorders like major depression might facilitate a switching between clinical phenotypes. The understanding of mechanisms and causes of the symptoms fluctuation will be subject of future studies.
    Full-text · Article · Nov 2013 · BMC Psychiatry
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Aug 2013 · Cognitive Therapy and Research
Show more