Anorexia Nervosa in Identical Triplets

Abstract

The cause of anorexia nervosa (AN) is unclear, but is likely multifactorial, including psychological, familial, environmental, societal, genetic, and other biological factors. This case report of identical 12-year-old female triplets simultaneously concordant for AN illustrates the importance of addressing all these components in evaluation and treatment, and the difficulty of determining the relative importance of each factor in the cause of an individual's eating disorder. An overly close relationship and competitiveness between the girls, treated at times as a triplet group rather than as individuals, as well as stressful family dynamics, were probably important antecedents to the girls' AN. The girls encouraged each other and competed to lose weight. Brief individual and family psychotherapy, parent counseling, nutritional counseling, and psychoeducation led to successful treatment. The triplets were encouraged in treatment to compete with and encourage each other to obtain treatment goals, including eating more healthily and achieving healthy weights. A literature review of AN twins studies is also presented, as these studies add to our understanding of the relative importance of shared genes and shared environment in the development of AN. These studies also add insight into treating individuals from families with multiple affected relatives.

Evidence of complex involvement of serotonergic genes with restrictive and binge purge subtypes of anorexia nervosa

“…Occurring predominantly during adolescence (Halmi et al 1979) the disease is characterised by a pathological obsession for thinness through the control of eating behaviour. Evidence from family and twin studies have suggested that both genetic and environmental components contribute to the development of AN (Vandereycken and Pierloot 1981;Garfi nkel and Garner 1982;Lilenfeld et al 1998;Fairburn et al 1999;Sokol et al 2009). The genetic component has been estimated through meta analysis of twin studies as contributing up to 76% of the susceptibility to AN (Treasure and Holland 1990;Klump and Culbert 2007).…”

Competing for perfection: A scoping review evaluating relationships between competitiveness and eating disorders or disordered eating behaviours

“…Additionally, three studies involved qualitative interviews with individuals with EDs and found participants perceive competition with their siblings as a possible factor in the development and maintenance of their ED (Bachner‐Melman, 2005; De Bruin & Oudejans, 2018; Rowland, 2009). Similarly, four case studies highlighted general competitive attitudes towards siblings in people with EDs, including a set of triplets who competed with each other to be the thinnest (Halperin, 1996; Lazerson, 1984; Smith, 2011; Sokol et al., 2009).…”