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Anorexia nervosa trios: behavioral profiles of individuals with anorexia nervosa and their parents

Published online by Cambridge University Press:  26 June 2008

M. J. Jacobs ,
S. Roesch ,
S. A. Wonderlich ,
R. Crosby ,
L. Thornton ,
D. E. Wilfley ,
W. H. Berrettini ,
H. Brandt ,
S. Crawford  and
M. M. Fichter
...Show all authors
M. J. Jacobs*
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
S. Roesch
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
S. A. Wonderlich
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
R. Crosby
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
L. Thornton
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
D. E. Wilfley
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
W. H. Berrettini
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
H. Brandt
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
S. Crawford
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
M. M. Fichter
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
K. A. Halmi
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
C. Johnson
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
A. S. Kaplan
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
M. LaVia
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
J. E. Mitchell
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
A. Rotondo
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
M. Strober
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
D. B. Woodside
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
W. H. Kaye
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
C. M. Bulik
Affiliation:
University of California, San Diego (UCSD) Eating Disorders Treatment and Research Center, La Jolla, CA, USA
*
*Address for correspondence: M. J. Jacobs, Ph.D., UCSD Eating Disorders Treatment and Research Center, 8950 Villa La Jolla, C-207, La Jolla, CA 92037, USA. (Email: [email protected])
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Abstract

Background

Anorexia nervosa (AN) is associated with behavioral traits that predate the onset of AN and persist after recovery. We identified patterns of behavioral traits in AN trios (proband plus two biological parents).

Method

A total of 433 complete trios were collected in the Price Foundation Genetic Study of AN using standardized instruments for eating disorder (ED) symptoms, anxiety, perfectionism, and temperament. We used latent profile analysis and ANOVA to identify and validate patterns of behavioral traits.

Results

We distinguished three classes with medium to large effect sizes by mothers' and probands' drive for thinness, body dissatisfaction, perfectionism, neuroticism, trait anxiety, and harm avoidance. Fathers did not differ significantly across classes. Classes were distinguished by degree of symptomatology rather than qualitative differences. Class 1 (~33%) comprised low symptom probands and mothers with scores in the healthy range. Class 2 (~43%) included probands with marked elevations in drive for thinness, body dissatisfaction, neuroticism, trait anxiety, and harm avoidance and mothers with mild anxious/perfectionistic traits. Class 3 (~24%) included probands and mothers with elevations on ED and anxious/perfectionistic traits. Mother–daughter symptom severity was related in classes 1 and 3 only. Trio profiles did not differ significantly by proband clinical status or subtype.

Conclusions

A key finding is the importance of mother and daughter traits in the identification of temperament and personality patterns in families affected by AN. Mother–daughter pairs with severe ED and anxious/perfectionistic traits may represent a more homogeneous and familial variant of AN that could be of value in genetic studies.

Keywords

Anorexia nervosaeating disordergeneticstemperament
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 3 , March 2009 , pp. 451 - 461
Copyright
Copyright © 2008 Cambridge University Press

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References

Agras, WS, Brandt, HA, Bulik, CM, Dolan-Sewell, R, Fairburn, CG, Halmi, KA, Herzog, DB, Jimerson, DC, Kaplan, AS, Kaye, WH, Le Grange, D, Lock, J, Mitchell, JE, Rudorfer, MV, Street, LL, Striegel-Moore, R, Vitousek, KM, Walsh, BT, Wilfley, DE (2004). Report of the National Institutes of Health workshop on overcoming barriers to treatment research in anorexia nervosa. International Journal of Eating Disorders 35, 509–521.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Barratt, ES (1983). The biological basis of impulsiveness: the significance of timing and rhythm. Personality and Individual Differences 4, 387–391.Google Scholar
Bulik, CM, Hebebrand, J, Keski-Rahkonen, A, Klump, KL, Mazzeo, SE, Reichborn-Kjennerud, T, Wade, TD (2007). Genetic epidemiology, endophenotypes, and eating disorder classification. International Journal of Eating Disorders 40 (Suppl.), S52–S60.CrossRefGoogle ScholarPubMed
Bulik, CM, Sullivan, PF, Fear, JL, Joyce, PR (1997). Eating disorders and antecedent anxiety disorders: a controlled study. Acta Psychiatrica Scandinavica 96, 101–107.CrossRefGoogle ScholarPubMed
Bulik, CM, Sullivan, PF, Kendler, KS (2000). An empirical study of the classification of eating disorders. American Journal of Psychiatry 157, 886–895.Google Scholar
Cloninger, CR, Przybeck, TR, Svrakic, DM, Wetzel, RD (1994). The Temperament and Character Inventory (TCI): A Guide to its Development and Use. Center for Psychobiology of Personality: Washington University, St Louis, MO.Google Scholar
Cloninger, CR, Svrakic, DM, Przybeck, TR (1993). A psychobiological model of temperament and character. Archives of General Psychiatry 50, 975–990.Google Scholar
Costa, PT, McCrae, RR (1992). NEO PI-R Professional Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Deep, AL, Nagy, LM, Weltzin, TE, Rao, R, Kaye, WH (1995). Premorbid onset of psychopathology in long-term recovered anorexia nervosa. International Journal of Eating Disorders 17, 291–297.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Devlin, B, Bacanu, SA, Klump, KL, Bulik, CM, Fichter, MM, Halmi, KA, Kaplan, AS, Strober, M, Treasure, J, Woodside, DB, Berrettini, WH, Kaye, WH (2002). Linkage analysis of anorexia nervosa incorporating behavioral covariates. Human Molecular Genetics 11, 689–696.Google Scholar
Eddy, KT, Keel, PK, Dorer, DJ, Delinsky, SS, Franko, DL, Herzog, DB (2002). Longitudinal comparison of anorexia nervosa subtypes. International Journal of Eating Disorders 31, 191–201.Google Scholar
Espina, A (2003). Alexithymia in parents of daughters with eating disorders: its relationships with psychopathological and personality variables. Journal of Psychosomatic Research 55, 553–560.CrossRefGoogle ScholarPubMed
Fairburn, C, Cooper, Z, Doll, H, Welch, S (1999). Risk factors for anorexia nervosa: three integrated case-control comparisons. Archives of General Psychiatry 56, 468–476.CrossRefGoogle ScholarPubMed
Fassino, S, Svrakic, D, Abbate-Daga, G, Leombruni, P, Amianto, F, Stanic, S, Rovera, GG (2002). Anorectic family dynamics: temperament and character data. Comprehensive Psychiatry 43, 114–120.CrossRefGoogle ScholarPubMed
Fichter, MM, Herpetz, S, Quadflieg, N, Herpetz-Dahlmann, B (1998). Structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10: updated (third) revision. International Journal of Eating Disorders 24, 227–249.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1996). Structured Clinical Interview for Axis I DSM-IV Disorders. Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Frost, RO, Marten, P, Lahart, C, Rosenblate, R (1990). The dimensions of perfectionism. Cognitive Therapy and Research 14, 449–468.Google Scholar
Garner, DM (1990). Eating Disorder Inventory-2 Professional Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Garner, DM, Olmsted, MP, Polivy, J (1983). Development and validation of a multidimensional eating disorder inventory for anorexia and bulimia nervosa. International Journal of Eating Disorders 2, 15–34.Google Scholar
Goldner, EM, Srikameswaran, S, Schroeder, ML, Livesley, WJ, Birmingham, CL (1999). Dimensional assessment of personality pathology in patients with eating disorders. Psychiatry Research 85, 151–159.Google Scholar
Goodman, WH, Price, LH, Rasmussen, SA, Mazure, C, Fleischmann, RL, Hill, CL, Heninger, GR, Chamey, DS (1989). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS): I. Development, use, and reliability. Archives of General Psychiatry 46, 1006–1011.CrossRefGoogle Scholar
Halmi, KA, Sunday, SR, Strober, M, Kaplan, A, Woodside, DB, Fichter, M, Treasure, J, Berrettini, WH, Kaye, WH (2000). Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. American Journal of Psychiatry 157, 1799–1805.Google Scholar
Hebebrand, J, Himmelmann, GW, Heseker, H, Schafer, H, Remschmidt, H (1996). Use of percentiles for the body mass index in anorexia nervosa: diagnostic, epidemiological, and therapeutic considerations. International Journal of Eating Disorders 19, 359–369.3.0.CO;2-K>CrossRefGoogle ScholarPubMed
Herzog, DB, Field, AE, Keller, MB, West, JC, Robbins, WM, Staley, J, Colditz, GA (1996). Subtyping eating disorders: is it justified? Journal of the American Academy of Child and Adolescent Psychiatry 35, 928–936.CrossRefGoogle ScholarPubMed
Jacobi, C, Hayward, C, de Zwaan, M, Kraemer, HC, Agras, WS (2004). Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin 130, 19–65.Google Scholar
Jang, KL, Livesley, WJ, Vernon, PA (1996). Heritability of the big five personality dimensions and their facets: a twin study. Journal of Personality 64, 577–591.CrossRefGoogle ScholarPubMed
Jonnal, AH, Gardner, CO, Prescott, CA, Kendler, KS (2000). Obsessive and compulsive symptoms in a general population sample of female twins. American Journal of Medical Genetics 96, 791–796.Google Scholar
Karwautz, A, Troop, NA, Rabe-Hesketh, S, Collier, DA, Treasure, JL (2003). Personality disorders and personality dimensions in anorexia nervosa. Journal of Personality Disorders 17, 73–85.CrossRefGoogle ScholarPubMed
Kaye, WH, Barbarich, NC, Putnam, K, Gendall, KA, Fernstrom, J, Fernstrom, M, McConaha, CW, Kishore, A (2003). Anxiolytic effects of acute tryptophan depletion in anorexia nervosa. International Journal of Eating Disorders 33, 257–267.Google Scholar
Kaye, WH, Bulik, CM, Thornton, L, Barbarich, N, Masters, K, Group, PFC (2004 a). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry 161, 2215–2221.Google Scholar
Kaye, WH, Devlin, B, Barbarich, N, Bulik, CM, Thornton, L, Bacanu, SA, Fichter, MM, Halmi, KA, Kaplan, AS, Strober, M, Woodside, DB, Bergen, AW, Crow, S, Mitchell, J, Rotondo, A, Mauri, M, Cassano, G, Keel, P, Plotnicov, K, Pollice, C, Klump, K, Lilenfeld, LR, Ganjei, JK, Quadflieg, N, Berrettini, WH (2004 b). Genetic analysis of bulimia nervosa: methods and sample description. International Journal of Eating Disorders 35, 556–570.CrossRefGoogle ScholarPubMed
Kaye, WH, Lilenfeld, LR, Berrettini, WH, Strober, M, Devlin, B, Klump, KL, Goldman, D, Bulik, CM, Halmi, KA, Fichter, MM, Kaplan, A, Woodside, DB, Treasure, J, Plotnicov, KH, Pollice, C, Rao, R, McConaha, CW (2000). A search for susceptibility loci for anorexia nervosa: methods and sample description. Biological Psychiatry 47, 794–803.Google Scholar
Kaye, WH, Weltzin, TE, Hsu, LKG, Bulik, C, McConaha, C, Sobkiewicz, T (1992). Patients with anorexia nervosa have elevated scores on the Yale-Brown Obsessive Compulsive Scale. International Journal of Eating Disorders 12, 57–62.3.0.CO;2-7>CrossRefGoogle Scholar
Keel, PK, Fichter, M, Quadflieg, N, Bulik, CM, Baxter, MG, Thornton, L, Halmi, KA, Kaplan, AS, Strober, M, Woodside, DB, Crow, SJ, Mitchell, JE, Rotondo, A, Mauri, M, Cassano, G, Treasure, J, Goldman, D, Berrettini, WH, Kaye, WH (2004). Application of a latent class analysis to empirically define eating disorder phenotypes. Archives of General Psychiatry 61, 192–200.CrossRefGoogle ScholarPubMed
Lilenfeld, LR, Kaye, WH, Greeno, CG, Merikangas, KR, Plotnicov, K, Pollice, C, Rao, R, Strober, M, Bulik, C, Nagy, L (1998). A controlled family study of anorexia nervosa and bulimia nervosa. Archives of General Psychiatry 55, 603–610.Google Scholar
Mazure, CM, Halmi, KA, Sunday, SR, Romano, SJ, Einhorn, AM (1994). The Yale-Brown-Cornell Eating Disorder Scale: development, use, reliability, and validity. Journal of Psychiatric Research 28, 425–445.CrossRefGoogle ScholarPubMed
Muthen, BO, Muthen, LK (2004). Mplus User's Guide, Version 3. Muthen & Muthen: Los Angeles.Google Scholar
Ormel, J, Rosmalen, J, Farmer, A (2004). Neuroticism: a non-informative marker of vulnerability to psychopathology. Social Psychiatry and Psychiatric Epidemiology 39, 906–912.Google Scholar
Pato, MT, Eisen, J, Pato, CN (1994). Rating scales for obsessive compulsive behavior. In Current Insights in Obsessive Compulsive Disorder (ed. Hollander, E., Zohar, J., Marassati, D. and Olivier, B.), pp. 77–91. John Wiley & Sons: New York.Google Scholar
Price Foundation Collaborative Group (2001). Deriving behavioral phenotypes in an international, multi-centre study of eating disorders. Psychological Medicine 31, 635–645.Google Scholar
Rosenfeld, R, Reuven, D, Anderson, D, Kobak, KA, Greist, JH (1992). A computer-administered version of the Yale-Brown Obsessive-Compulsive Scale. Psychological Assessment 4, 329–332.Google Scholar
Sohlberg, S, Strober, M (1994). Personality in anorexia nervosa: an update and a theoretical integration. Acta Psychiatrica Scandinavica 378, 1–15.Google Scholar
Spielberger, CD, Gorsuch, RL, Lushene, RE (1970). STAI Manual for the Stait Trait Personality Inventory. Consulting Psychologists Press: Palo Alto.Google Scholar
Srinivasagam, NM, Plotnicov, KH, Greeno, CG, Weltzin, TE, Rao, R, Kaye, WH (1995). Persistent perfectionism, symmetry, and exactness in anorexia nervosa after long-term recovery. American Journal of Psychiatry 152, 1630–1634.Google Scholar
Strober, M (2004). Pathologic fear conditioning and anorexia nervosa: on the search for novel paradigms. International Journal of Eating Disorders 35, 504–508.CrossRefGoogle ScholarPubMed
Sunday, SR, Halmi, K (2000). Comparison of the Yale-Brown-Cornell Eating Disorders Scale in recovered eating disorder patients, restrained dieters, and nondieting controls. International Journal of Eating Disorders 28, 455–459.Google Scholar
Sunday, SR, Halmi, KA, Einhorn, A (1995). The Yale-Brown-Cornell Eating Disorder Scale: a new scale to assess eating disorder symptomatology. International Journal of Eating Disorders 18, 237–245.3.0.CO;2-1>CrossRefGoogle Scholar
Tozzi, F, Aggen, SH, Neale, BM, Anderson, CB, Mazzeo, SE, Neale, MC, Bulik, CM (2004). The structure of perfectionism: a twin study. Behavior Genetics 34, 483–494.CrossRefGoogle ScholarPubMed
Vervaet, M, van Heeringen, C, Audenaert, K (2004). Personality-related characteristics in restricting versus binging and purging eating disorders. Comprehensive Psychiatry 45, 37–43.Google Scholar
Ward, A, Campbell, IC, Brown, N, Treasure, J (2003). Anorexia nervosa subtypes: differences in recovery. Journal of Nervous and Mental Disease 191, 197–201.CrossRefGoogle ScholarPubMed
Westen, D, Harnden-Fischer, J (2001). Personality profiles in eating disorders: rethinking the distinction between Axis I and Axis II. American Journal of Psychiatry 158, 547–562.Google Scholar
Woodside, DB, Bulik, CM, Halmi, KA, Fichter, MM, Kaplan, A, Berrettini, WH, Strober, M, Treasure, J, Lilenfeld, LR, Klump, K, Kaye, WH (2002). Personality, perfectionism, and attitudes toward eating in parents of children with eating disorders. International Journal of Eating Disorders 31, 290–299.Google Scholar