Controlled Family Study of Anorexia Nervosa and Bulimia Nervosa: Evidence of Shared Liability and Transmission of Partial Syndromes

Strober, Michael; Freeman, Roberta; Lampert, Carlyn; Diamond, Jane; Kaye, Walter H.

doi:10.1176/appi.ajp.157.3.393

Cited by 444 publications

(302 citation statements)

References 40 publications

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“…As noted previously, 16 there were no differences between AN and NIC probands, or between the two groups of relatives, in demographic characteristics. A significantly greater proportion of relatives of NIC probands was interviewed by telephone, but there were no statistically significant differences in the prevalence of any disorder obtained from faceto-face compared to telephone interview.…”

Section: Characteristics Of Probands and Relativessupporting

confidence: 71%

“…Because we showed previously 16 that relatives of AN probands had elevated lifetime risks for full and partial syndromes of AN and BN, and since anxiety and eating disorders co-occur, it could be argued that the differentially increased familial risk of anxiety in AN probands was a consequence of the cosegregation of eating disorder and anxiety disorder among their relatives. However, including lifetime diagnosis of eating disorder in relatives of AN probands in a third logistic regression model had no effect on any of the ORs.…”

Section: Odds Ratiosmentioning

confidence: 94%

“…16 Readers are referred to this report for a description of procedures used in the recruitment of case and control probands, of interview measures, and of best-estimate diagnostic methods applied to the relatives. There were a total of 504 women probands between 18 and 28 years of age: 152 with pure restricting subtype of AN for a minimum of 5 years before study entry, 171 with bulimia nervosa (BN), and 181 without any lifetime psychiatric illness.…”

Section: Participants and Diagnostic Proceduresmentioning

confidence: 99%

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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

Strober

Freeman²,

Lampert³

et al. 2007

Int. J. Eat. Disord.

130

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Background: To investigate the association of anorexia nervosa with anxiety disorders through use of a case-control family study design.Method: Lifetime prevalence of anxiety disorders and obsessive compulsive personality disorder was determined among 574 first-degree relatives of 152 probands with anorexia nervosa and compared to rates observed among 647 first-degree relatives of 181 never-ill control probands.Results: Adjusting for comorbidity of the same illness in the proband, relatives of probands with anorexia nervosa, had a significantly higher prevalence of generalized anxiety, obsessive compulsive disorder, separation anxiety disorder, social phobia, panic disorder, and obsessive compulsive personality disorder compared to relatives of never-ill control probands.Conclusion: Anorexia nervosa may share familial liability factors in common with various anxiety phenotypes. In suggesting that a transmitted propensity for anxiety is a key aspect of vulnerability in anorexia nervosa, the findings point to research developments in the affective neurosciences, specifically the neurocircuitry of fear and anxiety, as a heuristic framework in which to interpret aspects of premorbid temperamental anxieties and clinical symptoms. V V C 2007 by Wiley Periodicals, Inc.

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Section: Characteristics Of Probands and Relativessupporting

confidence: 71%

Section: Odds Ratiosmentioning

confidence: 94%

Section: Participants and Diagnostic Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

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

Strober

Freeman²,

Lampert³

et al. 2007

Int. J. Eat. Disord.

130

View full text Add to dashboard Cite

show abstract

“…These high crossover rates are comparable with the results of other treatment-studies and support the idea that there is considerable overlap among AN, BN, and EDNOS. 16 Several prospective studies of clinical samples found that many participants with AN develop bulimic symptoms within the first 5 years of their disorder. 4,17 Fichter and Quadflieg found that 10% of those with AN developed BN by 2-12 year follow-up.…”

Section: Long-term Stability Of Eating Disorder Diagnoses (Fichter Andmentioning

confidence: 99%

Stability of eating disorder diagnoses: A commentary

Stice

Spoor

2007

Int. J. Eat. Disord.

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Eat ing disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), are one of the most prevalent psychiatric problems for girls and young women, result in subjective distress and functional impairment, and increase risk for future onset of obesity, depression, suicide attempts, anxiety disorders, substance abuse, and health problems. 1,2 Although these eating disorders are clearly associated with functional impairment, less is known about the course of these eating disorder diagnoses over time. The purpose of this commentary is to discuss the findings of two articles on the longitudinal course of eating disorder diagnoses that appear in this special issue to discuss implications for nosology, and to offer suggestions regarding future research in this area.Long-term Stability of Eating Disorder Diagnoses (Fichter, & Norbert) This manuscript reports data on the stability of eating disorders over a 12-year period in a large treatment sample (N 5 311). Assessments were conducted at the beginning of therapy and at 2-year, 6-year, and 12-year follow-ups. The 12-year stability rate was 41.4% for AN, 34.4% for BN, 3.0% for BED, and 3.2% for other eating disorder not otherwise specified diagnoses (EDNOS). Results suggest moderate longitudinal instability of AN and BN, and pronounced longitudinal intability of BED and other EDNOS conditions. This instability was due to recovery, relapse, and diagnostic crossover. Most crossovers occurred from AN to BN and from BED to BN. Long-term outcome for BN and BED was encouraging, with both showing high recovery rates. The long-term outcome for AN was worse relative to BN and BED. Furthermore, the longitudinal course of BN and BED seemed to be nearly identical with similar percentages of remission and relapse. Relapse rates were low in this treatment sample.Before discussing the implications of these findings for nosology and future research directions, it is important to compare the findings from this study with other studies that have been previously published. Although research indicates that the overarching diagnosis of ''eating disorder'' is relatively stable, 3 several studies suggest that there is considerable longitudinal instability of the specific eating disorder diagnoses of AN, BN, and EDNOS in treatment samples, resulting from recovery, relapse, and crossover between and within the eating disorder diagnoses. 3,4-6 The recovery rates for AN and BN were moderate to high at each of the follow-up assessments in Fichter and Quadflieg study, which is similar to the rates reported by 7 who found that at 5-year follow-up, 56% of patients with AN, 74% of patients with BN, and 78% of patients with EDNOS no longer met criteria for any eating disorder diagnosis.Recovery rates of other treatment studies, however, are somewhat lower. For example, Fichter and Quadflieg reported a remission rate of 43.8% in AN and 56.8% in BN over a 2-year period; these recovery rates increased to about 60% for AN and about 70% for BN over a 6-12-year period....

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“…Family and twin studies have consistently demonstrated that EDs are strongly familial 43,[83][84][85][86][87] and that the observed familiality is due primarily to genetic factors. 44,45,[88][89][90][91][92][93] Nonetheless, environment may play an important role in the expression of underlying genetic predispositions.…”

Section: Gene-environment Correlationmentioning

confidence: 99%