Shared Temperament Risk Factors for Anorexia Nervosa: A Twin Study

Abstract

Objective: To answer two questions about the nature of the relationship between anorexia nervosa (AN) and dimensional temperament traits: Which traits are comorbid with AN? Which traits share transmitted liabilities with AN? Methods: A community sample of 1002 same-gender female twins was selected with respect to participation in two earlier waves of data collection. Measures of eating disorder diagnoses and features were ascertained through interview and continuous measures of temperament were ascertained from self-report measures. Results: Four temperaments were comorbid with AN, namely, higher levels of perfectionism (concern over mistakes, personal standards, doubt about actions), and higher need for organization. Comparison between the female co-twins of AN probands and controls (who had never had an eating disorder) showed that the former group reported higher levels of personal standards, organization, and reward dependence. The association between personal standards and reward dependence remained when controlling for the temperament of the proband or control in monozygotic twins. Conclusions:The evidence overall supports the suggestion that AN may represent the expression of a common underlying familial liability to a temperament style that reflects a striving for perfectionism, a need for order, and a sensitivity to praise and reward. The nature of the shared risk factors is likely to be, in part, genetic.

Bulimia nervosa with history of anorexia nervosa: Could the clinical subtype of anorexia have implications for clinical status and treatment response?

“…32 Our BN/AN1 patients also had higher levels of perfectionism and higher reward dependence, two traits strongly associated to AN. 31,33 These findings are in accordance with the fact that, even having recovered from their past condition, BN/ AN1 patients tend to retain some traits from AN. In addition, they had more severe bulimic symptoms at the beginning of the treatment (higher initial scores in the BITE and the PSRs) and a greater tendency to present a lack of response after 6 months of treatment (29% of BN/AN1 patients vs. 6% of BN/AN2 did not respond).…”

Bulimia nervosa symptoms in the Multimodal Treatment Study of Children with ADHD

“…58 Perfectionism, by contrast, has been conceptualized to be distinct from impulsivity and most relevant for restricting eating disorders. 59 Our finding that childhood impulsivity, and not inattention or hyperactivity, appeared to be most predictive of adolescent BN pathology supports this hypothesized mechanism. Future research with ADHD samples, however, should consider other types of eating pathology for which impulsivity may be relevant, such as bingeeating disorder.…”

Have Personality Disorders Been Overdiagnosed among Eating Disorder Patients?

“…Once the ED obsessional behaviour is removed from the scoring of obsessional PD, this is no longer a common PD among ED patients [31]. Rather, AN patients have features of obsessional PD, but their obsessionality is largely restricted to their eating and weight behaviours [32,33]. …”