Childhood Obsessive-Compulsive Personality Traits in Adult Women With Eating Disorders: Defining a Broader Eating Disorder Phenotype

Abstract

Childhood traits reflecting obsessive-compulsive personality appear to be important risk factors for the development of eating disorders and may represent markers of a broader phenotype for a specific subgroup of patients with anorexia nervosa.

Neurobiology of anorexia and bulimia nervosa

“…Confounding this understanding is the issue that most studies of symptoms have been done when individuals are ill with an ED. Recent studies have shown that the majority of people with AN and BN exhibit childhood perfectionism, obsessivecompulsive personality patterns, and anxiety that predate the onset of AN and BN (16,23,24). Moreover, studies done on 3 continents ( Table 2) have shown that in AN and BN individuals with a lifetime history of an anxiety disorder diagnosis, the anxiety disorder most often began in childhood before the onset of the ED (25)(26)(27)(28).…”

Anorexia nervosa and autism spectrum disorders: Guided investigation of social cognitive endophenotypes.

“…Someone with this diagnosis is frequently constrained, conforming, obsessional, rigid, and perfectionistic" (p. S69). To demonstrate, we present a vignette of an individual with AN ( Figure 2) drawn from an historical account from 1866 (cited in Brumberg, 1988) to highlight features extensively documented in AN both premorbidly and following weight restoration: cognitive and behavioral rigidity (Anderluh et al, 2003;, perfectionism (Bastiani, Rao, Weltzin, & Kaye, 1995;Bulik et al, 2003;Halmi et al, 2000;Woodside et al, 2002), social withdrawal (Diaz-Marsa, Carrasco, & Saiz, 2000; I. C. Gillberg et al, 1995;Godart et al, 2004;Holliday, Uher, Landau, Collier, & Treasure, 2006;Karwautz, Troop, Rabe-Hesketh, Collier, & Treasure, 2003;Kaye et al, 2004), constriction (Geller, Cockell, Hewitt, Goldner, & Flett, 2000), and harm avoidance (Diaz-Marsa et al, 2000;Klump et al, 2000Klump et al, , 2004. In fact, the reliable presentation of this behavioral and personality cluster has been demonstrated to add to the incremental validity of diagnostic accuracy (Westen & Harnden-Fischer, 2001).…”

“…Investigation of the social phenotype in AN is in line with the increased emphasis on the definition of endophenotypes in the study of psychiatric illness (Anderluh, Tchanturia, Rabe-Hesketh, & Treasure, 2003;Bulik et al, in press;Gottesman & Gould, 2003). Endophenotypes are defined as measurable, heritable traits falling midway between the distal genotype and full diagnostic phenotypic expression of a disease (Gottesman & Gould, 2003).…”

The association of anxiety disorders and obsessive compulsive personality disorder with anorexia nervosa: Evidence from a family study with discussion of nosological and neurodevelopmental implications

“…Second, anxiety disorders among individuals with AN usually begin before signs of dietary preoccupation and weight loss, 2 and heritable traits linked to anxiety proneness (e.g., neuroticism, harm avoidance, and low novelty seeking) 3,4 are characteristic of the premorbid state in persons who develop AN. 5,6 Third, subthreshold features of anxiety often persist long after recovery of normal body weight. 7 Fourth, several twin studies [8][9][10][11] have produced evidence of a modest genetic correlation between eating disorders and certain anxiety and depressive disorders, suggesting they comprise a spectrum of inherited phenotypes.…”

“…12,13 The objective of the present study was to inform this hypothesis by comparing the lifetime prevalence of seven anxiety disorders, in addition to obsessive compulsive personality disorder (OCPD), among biological first-degree relatives of probands with AN with the prevalence among relatives of never-ill controls (NICs): generalized anxiety disorder, obsessive compulsive disorder (OCD), social phobia, simple phobia, panic disorder, separation anxiety, and agoraphobia. We included OCPD in this analysis on heuristic grounds, because its clinical features closely resemble premorbid traits associated with AN, 6 it has been shown to have a statistically unique association with OCD compared to other axis I psychiatric disorders, 14 and because recent speculation 15 has argued that similarities between obsessional phenomena and AN, and their strong correlation within individuals, stems from overlapping abnormalities in neuronal circuits that regulate habit patterns and the appraisal of affect relevant stimuli. If transmission of anxiety proneness plays a role in vulnerability to AN, it can be expected that anxiety disorders would aggregate significantly in family members of probands with this illness.…”