Cited by 631Eating Disorders and BehaviorsNutrition, Health and Food BehaviorBody Image and Dysmorphia Studies

The genetic epidemiology of bulimia nervosa.

Kenneth S. Kendler, C MacLean, Michael Churton Neale, Ronald C. Kessler, Andrew C. Heath, Lindon J. Eaves·1991·American Journal of Psychiatry

Abstract

OBJECTIVE: The authors seek to clarify, from both an epidemiologic and genetic perspective, the major risk factors for bulimia nervosa and to understand the relationship between narrowly defined bulimia and bulimia-like syndromes. METHOD: Personal structured psychiatric interviews were conducted with 2,163 female twins from a population-based register. Psychiatric disorders were assessed using DSM-III-R criteria. RESULTS: Lifetime prevalence and risk for narrowly defined bulimia were 2.8% and 4.2%, respectively. Including bulimia-like syndromes increased these estimates to 5.7% and 8.0%, respectively. Risk factors for bulimia included 1) birth after 1960, 2) low paternal care, 3) a history of wide weight fluctuation, dieting, or frequent exercise, 4) a slim ideal body image, 5) low self-esteem, 6) an external locus of control, and 7) high levels of neuroticism. Significant comorbidity was found between bulimia and anorexia nervosa, alcoholism, panic disorder, generalized anxiety disorder, phobia, and major depression. Proband-wise concordance for narrowly defined bulimia was 22.9% in monozygotic and 8.7% in dizygotic twins. The best-fitting model indicated that familial aggregation was due solely to genetic factors with a heritability of liability of 55%. A multiple threshold model indicated that narrowly defined bulimia nervosa and bulimia-like syndromes represented different levels of severity on the same continuum of liability. CONCLUSIONS: The liability to fully syndromal bulimia nervosa, which affects around one in 25 women at some point in their lives, is substantially influenced by both epidemiologic and genetic risk factors. The same factors that influence the risk for narrowly defined bulimia also influence the risk for less severe bulimia-like syndromes.

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Crossref · 10.1176/ajp.148.12.1627

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Authors
Kendler, K. S., MacLean, C., Neale, M. C., Kessler, R. C., Heath, A. C., & Eaves, L. J.
Affiliations
  • Virginia Commonwealth University Medical Center (US)
  • Virginia Commonwealth University (US)
Venue
American Journal of Psychiatry
Published
1991-12-01
Volume
148
Issue
12
Pages
1627-1637
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
OpenAlex
W349839223
Cited by
631
References
65
Citations by year
2025: 3 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 3 · 2017: 6 · 2016: 7 · 2015: 9 · 2014: 16 · 2013: 13 · 2012: 15
FWCI
26.36
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01hd026746-05)
  • National Institute of Mental Health (R01MH040828, MH 40828)
  • National Institute of Neurological Disorders and Stroke (NS-25630)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD 26746)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
Keywords
bulimia nervosa, genetic epidemiology, heritability, monozygotic and dizygotic twins, familial aggregation, risk factors, comorbidities, anorexia nervosa, neuroticism, self-esteem, body image, lifetime prevalence
MeSH terms
Adolescent, Adult, Anorexia Nervosa, Anxiety Disorders, Body Image, Body Weight, Bulimia, Depressive Disorder, Diet, Reducing, Diseases in Twins, Family, Female, Humans, Internal-External Control, Middle Aged, Models, Genetic, Psychiatric Status Rating Scales, Risk Factors, Self Concept, Comorbidity, Prevalence

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