Lifetime course of eating disorders: design and validity testing of a new strategy to define the eating disorders phenotype

• Published in: Psychological medicine Vol. 39; no. 1; pp. 105 - 114
• Main Authors: Anderluh, M., Tchanturia, K., Rabe-Hesketh, S., Collier, D., Treasure, J.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.01.2009
• Subjects: Adult; Adult and adolescent clinical studies; Assessment; Biological and medical sciences; Childhood; Chronic Disease; Comorbidity; Diagnosis; Eating behavior disorders; Eating disorders; Feeding and Eating Disorders - diagnosis; Feeding and Eating Disorders - epidemiology; Feeding and Eating Disorders - psychology; Female; Genotype & phenotype; Humans; Interview, Psychological - methods; Interview, Psychological - standards; lifetime course; lifetime diagnostic categories; London - epidemiology; Medical sciences; Miscellaneous; Nosology. Terminology. Diagnostic criteria; Obsessive-Compulsive Disorder - epidemiology; Obsessive-Compulsive Disorder - psychology; Obsessive-Compulsive neuroses; Personality Assessment - statistics & numerical data; Prevalence; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Reproducibility of Results; Retrospective Studies; Severity of Illness Index; Techniques and methods; Time Factors; London; lifetime diagnostic categories; lifetime course; Eating disorders; Human; Evaluation; Nosology; Infantile experience; Personality; Eating disorder; Retrospective; Phenotype; Criterion; Classification; Strategy; Diagnosis; Woman
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291708003292

Aetiological studies of eating disorders would benefit from a solution to the problem of instability of eating disorder symptoms. We present an approach to defining an eating disorders phenotype based on the retrospective assessment of lifetime eating disorders symptoms to define a lifetime pattern of illness. We further validate this approach by testing the most common lifetime categories for differences in the prevalence of specific childhood personality traits. Ninety-seven females participated in this study, 35 with a current diagnosis of restricting anorexia nervosa, 32 with binge/purging subtype of anorexia nervosa and 30 with bulimia nervosa. Subjects were interviewed by a newly developed EATATE Lifetime Diagnostic Interview for a retrospective assessment of the lifetime course of eating disorders symptoms and childhood traits reflecting obsessive-compulsive personality. The data illustrate the extensive instability of the eating disorders diagnosis. Four most common lifetime diagnostic categories were identified that significantly differ in the prevalence of childhood traits. Perfectionism and rigidity were more common in groups with a longer duration of underweight status, longer episodes of severe food restriction, excessive exercising, and shorter duration of binge eating. The assessment of lifetime symptoms may produce a more accurate definition of the eating disorders phenotype. Obsessive-compulsive traits in childhood may moderate the course producing longer periods of underweight status. These findings may have important implications for nosology, treatment and future aetiological studies of eating disorders.