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Anorexia nervosa viewed as an extreme weight condition: genetic implications

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In anorexia nervosa, psychopathological features and reduced body weight are inseparable, suggesting a prominent role of behavioral factors in achievement and maintenance of extreme underweight. Due to the considerably higher prevalence of this eating disorder in females, anorexia nervosa contributes to the left end of the distribution of the body mass index, especially in the female sex. By reviewing the relevant literature we examined whether genetic research in anorexia nervosa can profit from considering this disorder as an extreme weight condition. For this purpose we compared genetic studies pertaining to both anorexia nervosa and the heritability of the body mass index. Whereas previous genetic studies in anorexia nervosa have mostly concentrated on the assessment of the familial psychopathology, further studies are warranted that additionally attempt to analyze the complex phenotype body weight in relatives of affected probands. Further insight into pathogenetic mechanisms underlying anorexia nervosa might be gained by contrasting the epidemiological, psychopathological and prognostic factors with those in severe obesity. Thus, epidemiological studies suggest that females are more likely to develop both extreme underweight and extreme obesity. A possible explanation for this phenomenon is that the, on average, higher percentage of total body weight composed of fat mass might predispose females towards the development of both extreme weight conditions.

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  1. Allison DB, Heschka S (1993) Toward an empirically derived typology of obese persons: derivation in a nonclinical sample. Int J Eating Disord 13:93–108

  2. American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders, 3rd edn. APA Washington, D.C.

  3. American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd edn, revised. APA Washington, DC

  4. American Psychiatric Association (1993) Practice guideline for eating disorders. Am J Psychiatry 150:212–228

  5. Andersson L, Haley CS, Ellegren H, Knotts SA, Johansson M, Andersson K, Andersson-Eklund L, Edfors-Lilja I, Fredholm M, Hansson I, Håkansson J, Lundström K (1994) Genetic mapping of quantitative trait loci for growth and fatness in pigs. Science 263:1771–1774

  6. Askevold F, Heiberg A (1979) Anorexia nervosa — two cases in discordant MZ twins. Psychother Psychosom 32:223–228

  7. Biederman J, Rivinus T, Kemper K, Hamilton D, MacFadyen J, Harmatz J (1985) Depressive disorders in relatives of anorexia nervosa patients with and without a current epidose of nonbipolar major depression. Am J Psychiatry 142:1495–1497

  8. Borecki IB, Bonney GE, Rice T, Bouchard C, Rao DC (1993) Influence of genotype-dependent effects of covariates on the outcome of segregation analysis of the body mass index. Am J Hum Genet 53:676–687

  9. Bouchard C (1992) Genetic aspects of human obesities. In: Belfiore F, Jeanrenaud B, Papalia D (eds) Obesity: basic concepts and clinical aspects. Front Diabetes, vol 11. Karger, Basel, pp 28–36

  10. Bouchard C, Pérusse L (1988) Heredity and body fat. Annu Rev Nutr 8:259–277

  11. Bouchard C, Pérusse L (1993) Genetics of obesity. Annu Rev Nutr 13:337–354

  12. Bouchard C, Pérusse L, Leblanc C, Tremblay A, Thériault G (1988) Inheritance of the amount and distribution of human body fat. Int J Obes 12:205–215

  13. Bouchard C, Tremblay A, Després J-P, Nadeau A, Lupien PJ, Thériault G, Dussault J, Moorjani S, Pinault S, Fournier G (1990) The response to long-term overfeeding in identical twins. N Engl J Med 322:1477–1482

  14. Bray GA (1992) Adolescent overweight may be tempting fate. N Engl J Med 327:1379–1380

  15. Burniat WM (1992) The genetics of childhood obesity. In: Giorgi PL, Suskind RM, Catassi C (eds) The obese child. Pediatr Adolesc Med, vol 2. Karger, Basel, pp 21–31

  16. Button EJ, Whitehouse A (1981) Subclinical anorexia nervosa. Psychol Med 11:509–516

  17. Cantwell DP, Sturzenberger S, Burroughs J, Salkin B, Green JK (1977) Anorexia nervosa: an affective disorder? Arch Gen Psychiatry 34:1087–1093

  18. Casper RC (1990) Personality features of women with good outcome from restricting anorexia nervosa. Psychosom Med 52:156–170

  19. Crisp AH, Hsu KLG, Harding B, Hartshome J (1980) Clinical features of anorexia nervosa: a study of consecutive series of 102 female patients. J Psychosom Res 24:179–191

  20. Crisp AH, Hall A, Holland AJ (1985) Nature and nurture in anorexia nervosa: a study of 34 pairs of twins, one pair of triplets, and an adoptive family. Int J Eat Disord 4:15–27

  21. DaCosta M, Halmi KA (1992) Classifications of anorexia nervosa: question of subtypes. Int J Eating Disord 11:305–313

  22. Deutsche Gesellschaft für Ernährung (1992) Ernährungsbericht. Deutschen Gesellschaft für Ernährung e. V. im Auftrag des Bundesministers für Gesundheit und des Bundesministers für Ernährung, Landwirtschaft und Forsten, Frankfurt a.M

  23. Fabsitz RR, Carmelli D, Hewitt JK (1992) Evidence for independent genetic influences on obesity in middle age. Int J Obes 16:657–666

  24. Fahy TA, Osacar A, Marks I (1993) History of eating disorders in female patients with obsessive-compulsive disorder. Int J Eat Dis 14:439–443

  25. Friedman JL, Leibel RL (1992) Tackling a weighty problem. Cell 69:217–220

  26. Friedman JL, Leibel RL, Bahary N (1991) Molecular mapping of obesity genes. Mammalian Genome 1:130–144

  27. Frisch RE, McArthur JW (1974) Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science 185:949–951

  28. Gardner RM, Martinez R, Sandoval Y (1987) Obesity and body image: an evaluation of sensory and non-sensory components. Psychol Med 17:927–932

  29. Garfinkel PE, Garner DM, Rose J, Darby PL, Brandes JS, O'Hanlon J, Walsh N (1983) A comparison of characteristics in the families of patients with anorexia nervosa. Psychol Med 13:821–828

  30. Garrow JS (1981) Treat obesity seriously: a clinical manual. Churchill Livingstone, Edinburgh

  31. Garrow JS (1992) Treatment of obesity. Lancet 340:409–413

  32. Garrow JS, Webster J (1985) Quetelet's index (W/H2) tas a measure of fatness. Int J Obes 9:147–153

  33. Gershon ES, Schreiber JL, Hamovit JR, Dibble ED, Kaye W, Nurnberger JL, Andersen AE, Ebert M (1984) Clinical findings in patients with anorexia nervosa and affective illness in their relatives. Am J Psychiatry 141:1419–1422

  34. Goldsmith SJ, Anger-Friedfeld K, Beren S, Rudolph D, Boeck M, Aronne L (1992) Psychiatric illness in patients presenting for obesity treatment. Int J Eating Disord 12:63–71

  35. Gray DS (1989) Diagnosis and prevalence of obesity. Med Clin orth Am 73:1–13

  36. Hall A, Leibrich J, Walkey FH, Welch G (1986) Investigation of weight pathology of 58 mothers of anorexia nervosa patients and 204 mothers of schoolgirs. Psychol Med 16:71–76

  37. Halmi KA, Struss A, Goldberg SC (1978) An investigation of weights in the parents of anorexia nervosa patients. J Nerv Ment Dis 166:358–361

  38. Halmi KA, Eckert E, Marchi P, Sampugnaro V, Apple R, Cohen J (1991) Comorbidity of psychiatric diagnoses in anorexia nervosa. Arch Gen Psychiatry 48:712–718

  39. Hammer LD, Kraemer HC, Wilson DM, Ritter PL, Dornbusch SM (1991) Standardized percentile curves of body-mass index for children and adolescents. Am J Dis Child 145:259–263

  40. Hasstedt SJ, Ramirez ME, Kuida H, Williams RR (1989) Recessive inheritance of a relative fat pattern. Am J Hum Genet 45:917–925

  41. Hebebrand J, Heseker H, Himmelmann W, Schäfer H, Remschmidt H (1994) Percentiles for the body mass index based on data of the “German National Nutrition Survey” (NVS) and a review of relevant factors with an influence on body weight. Aktuelle Ernährungsmedizin 19:259–265

  42. Holland A, Hall A, Murray R, Russell GFM, Crisp AH (1984) Anorexia nervosa: a study of 34 twin pairs and one set of triplets. Brit J Psychiatry 145:414–419

  43. Holland AJ, Sicotte N, Treasure J (1988) Anorexia nervosa: evidence for a genetic basis. J Psychosom Res 32:561–571

  44. Hsu LK (1982) Is there a disturbance in body image in anorexia nervosa? J Nerv Ment Dis 170:305–307

  45. Hsu LK, Lee S (1993) Is weight phobia always necessary for a diagnosis of anorexia nervosa? Am J Psychiatry 150:1466–1471

  46. Hudson JI, Pope HG, Jonas JM, Yurgelun-Todd D (1983) Family history study of anorexia nervosa and bulimia. Brit J Psychiatry 142:133–138

  47. Jeanrenaud B, Rohner-Jeanrenaud F, Cusin I, Zarjevski N, Assimascopoulos-Jeannet F, Guillaume-Gentil C, Bchini Hooft van Huijsduijnen O, Doyle P (1992) The importance of the brain in the aetiology of obesity and type 2 diabetes. Int J Obes 16:9–12

  48. Lichtman SW, Pisarska K, Berman ER, Pestone M, Dowling H, Offenbacher E, Weisel H, Heshka S, Matthews DE, Heymsfield SB (1992) Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. N Engl J Med 327:1893–1898

  49. Logue CM, Crowe RR, Bean JA (1989) A family study of anorexia nervosa and bulimia. Compr Psychiatry 30:179–188

  50. MacDonald A, Stunkard A (1990) Body-mass indexes of British separated twins. N Engl J Med 322:1530

  51. Maloney MJ, Shepard-Spiro P (1983) Eating attitudes and behaviors of anorexia nervosa patients and their sisters. J Hosp Psychiatry 5:285–288

  52. McKusick VA (1990) Mendelian inheritance in man, 9th edn. Johns Hopkins University Press, Baltimore

  53. Moll PP, Burns TL, Lauer RM (1991) The genetic and environmental sources of body mass index variability: the muscatine ponderosity family study. Am J Hum Genet 49:1243–1255

  54. Mossberg HO (1989) 40-Year follow-up of overweight children. Lancet 26:491–493

  55. Must A, Dallal GE, Dietz WH (1991) Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness1–4. Am J Clin Nutr 53:839–46

  56. Nowlin NS (1983) Anorexia nervosa in twins: case report and review. Clin Psychiatry 44:101–105

  57. Özçelik T, Leff S, Robinson W, Donlon T, Lalande M, Sanjines E, Schinzel A, Francke U (1992) Small nuclear ribonucleoprotein polypeptide N (SNRPN), an expressed gene in the Prader-Willi syndrome critical region. Nat Genet 2:265–269

  58. Patton GC (1988) The spectrum of eating disorder. J Psychosom Res 32:579–584

  59. Pearlson GD, Flournoy LH, Simonson M, Slavney PR (1981) Body image in obese adults. Psychol Med 11:147–154

  60. Penner LA, Thompson JK, Coovert DL (1991) Size estimation among anorexies: much ado about very little? J Abnorm Psychol 100:90–93

  61. Pépin MC, Poithier F, Barden N (1992) Impaired type II glucorticoid receptor function in mice bearing antisense RNA transgene. Nature 235:725–728

  62. Poehlman ET, Tremblay A, Després JP, Fontaine E, Pérusse L, Thériault G, Bouchard C (1986) Genotype-controlled changes in body composition and fat morphology following overfeeding in twins. Am J Clin Nutr 43:723–731

  63. Price RA, Cadoret RJ, Stunkard AJ, Troughton BA (1987) Genetic contributions to human fatness: an adoption study. AM J Psychiatry 144:1003–1008

  64. Price RA, Ness R, Laskarzewski P (1990) Common major gene inheritance of extreme overweight. Hum Biol 62:747–765

  65. Ratnasuriya RH, Eisler I, Szmukler GI, Russell GFM (1991) Anorexia nervosa: outcome and prognostic factors after 20 years. Br J Psychiatry 158:495–502

  66. Rice T, Borecki IB, Bouchard C, Rao DC (1993) Segregation analysis of fat mass and other body composition measures derived from underwater weighing. Am J Hum Genet 52:967–973

  67. Rivinius TM, Biederman J, Herzog DB, Kemper K, Harper GP, Harmatz JS, Houseworth S (1984) Anorexia nervosa and affective disorders: a controlled family history story. Am J Psychiatry 141:1414–1418

  68. Rodin J, Schank D, Striegel-Moore R (1989) Psychological features of obesity. Med Clin North Am 73:47–65

  69. Russell GFM (1985) The changing nature of anorexia nervosa: an introduction to the conference. J Psychiatr Res 19:101–109

  70. Rutherford J, McGuffin P, Katz RJ, Murray RM (1993) Genetic influences on eating attitudes in a normal female twin population. Psychol Med 23:425–436

  71. Schepank H (1992) Genetic determinants in anorexia nervosa: results of studies in twins. In: Herzog W, Deter H-C, Vandereycken W (eds) The course of eating disorders. Springer, Berlin Heidelberg New York, pp 241–256

  72. Schneider R, Eberhardt W, Heseker H, Moch KJ (1992) Die VERA-Stichprobe im Vergleich mit Volkszählung, Mikrozensus und anderen nationalen Untersuchungen, Band II. In: Kübler W, Anders HJ, Heeschen W, Kohlmeier M (eds) VERASchriftenreihe. Wissenschaftlicher Fachverlag Dr. Fleck, Niederkleen

  73. Scott DW (1986) Anorexia nervosa: a review of possible geneticfactors. Int J Eating Disord 5:1–20

  74. Selby JV, Newman B, Quesenberry CP, Fabsitz RR, Carmelli D, Meaney FJ, Slemenda C (1990) Genetic and behavioral influences on body fat distribution. Int J Obes 14:593–602

  75. Sørensen TIA, Price RA, Stunkard AJ, Schulsinger F (1989) Genetics of obesity in adult adoptees and their biological siblings. Br Med J 298:87–90

  76. Sørensen TIA, Holst C, Stunkard AJ, Skovgaard LT (1992) Correlations of body mass index of adult adoptees and their biological and adoptive relatives. Int J Obes 16:227–236

  77. Steinhausen H-C, Rauss-Mason C, Seidl R (1991) Follow-up studies of anorexia nervosa: a review of tour decades of outcome research. Psychol Med 21:447–454

  78. Strain GW, Zumoff B (1992) The relationship of weight-height indices of obesity to body fat content. J Am Coll Nutr 11:715–718

  79. Strober M, Humphrey LL (1987) Familial contributions to the etiology of course of anorexia nervosa and bulimia. J Consult Clin Psychol 55:654–659

  80. Strober M, Morrell W, Burroughs J, Salkin B, Jacobs C (1985) A controlled family study of anorexia nervosa. J Psychiatr Res 119:239–246

  81. Strober M, Lampert C, Morrell W, Burroughs J, Jacobs C (1990) A controlled family study of anorexia nervosa: evidence of familial aggregation and lack of shared transmission with affective disorders. Int J Eating Disord 9:239–253

  82. Stunkard AJ, Wadden TA (1992) Psychological aspects of severe obesity. Am J Clin Nutr 55:524S-532S

  83. Stunkard AJ, Foch TT, Hrubec Z (1986a) A twin study of human obesity. J Am Med Assoc 256:51–54

  84. Stunkard AJ, Sørensen TIA, Hanis C, Teasdale TW, Chakraborty R, Schull WJ, Schulsinger F (1986b) An adoption study of human obesity. N Engl J Med 314:193–198

  85. Stunkard AJ, Harris JR, Pedersen NL, McClearn GE (1990) The body-mass index of twins who have been reared apart. N Engl J Med 322:1483–1487

  86. Sullivan M, Karlsson J, Sjöström L, Backman L, Bengtsson C, Bouchard C, Dahlgren S, Jonsson E, Larsson B, Lindstedt S, Näslund I, Olbe L, Wedel H (1993) Swedish obese subjects (SOS) — an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined. Int J Obes 1:503–512

  87. Teasdale TW, Sørensen TIA, Stunkard AJ (1990) Genetic and early environmental components in sociodemographic influences on adult body fatness. Br Med J 300:1615–8

  88. Theander S (1970) Anorexia nervosa: a psychiatric investigation of 44 female cases. Acta Psychiatr Scand 214:1–194

  89. Tiller J, Schmidt U, Treasure J (1993) Compulsory treatment for anorexia nervosa: compassion or coercion? Br J Psychiatry 162:679–680

  90. Vandereycken W, Pierloot R (1981) Anorexia nervosa in twins. Psychother Psychosom 35:55–63

  91. Warden CH, Fisler JS, Pace MJ, Svenson KL, Lusis AJ (1993) Coincidence of genetic loci for plasma cholesterol levels and obesity in a multifactorial mouse model. J Clin Invest 92:773–779

  92. Whitaker A, Davies M, Shaffer D, Johnson J, Abrams S, Walsh BT, Kalikow K (1989) The struggle to be thin: a survey of anorexic and bulimic symptoms in a non-referred adolescent population. Psychol Med 19:143–163

  93. Winokur A, March V, Mendels J (1980) Primary effective disorder in relatives of patients with anorexia nervosa. Am J Psychiatry 137:695–698

  94. Woodside B, Field L, Garfinkel PE, Heinmaa M (1993) Familygenetic studies in eating disorders (abstract). Psychiatr Genet 3:177 updated at the 1993 World Congress on Psychiatric Genetics

  95. World Health Organization (1992) The ICD-10 classification of mental and behavioral disorders — clinical descriptions and diagnostic guidelines. WHO, Geneva

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Hebebrand, J., Remschmidt, H. Anorexia nervosa viewed as an extreme weight condition: genetic implications. Hum Genet 95, 1–11 (1995).

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  • Body Mass Index
  • Obesity
  • Anorexia Nervosa
  • Eating Disorder
  • Severe Obesity