Cited by 3Eating Disorders and BehaviorsMental Health Research TopicsNutrition, Health and Food Behavior

Comorbidity Between Internalizing Symptoms and Disordered Eating Is Primarily Driven by Genetic Influences on Emotion Regulation in Adult Female Twins

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Mikhail, Megan E., Burt, S. Alexandra, Neale, Michael C., Keel, Pamela K., Katzman, Debra K., Klump, Kelly L.·2024·Clinical Psychological Science

Abstract

Internalizing (e.g., anxiety, depression) and disordered eating (DE; e.g., binge eating, dietary restraint) are highly comorbid, but the mechanisms underlying their comorbidity remain unknown. This was the first twin study to examine whether their co-occurrence may be driven by genetic and/or environmental influences on emotion regulation (ER; ability to modulate duration/intensity of emotions). Analyses included 688 adult female twins from the Michigan State University Twin Registry. Cholesky decomposition twin models showed that comorbidity between dimensionally modeled internalizing and DE was due to overlapping genetic ( r = .55; 69.3% of shared variance) and nonshared environmental influences ( r = .26; 30.7% of shared variance). When ER was added into the model, all genetic influences shared between internalizing and DE were attributable to ER, suggesting genetic influences on ER are the primary driver of comorbidity between internalizing and DE. Shared genes may shape affective processing, interoceptive sensitivity, or other brain-based processes (e.g., cognitive control) implicated in ER.

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  • Mikhail et al. found significant genetic overlap between Internalizing Disorders and ED, with approximately 50% of the genetic variance in internalizing symptoms attributable to ER difficulties, and 17% of the genetic variance in Disordered Eating linked to these challenges.

    “The analyses revealed significant genetic overlap between Internalizing Disorders and ED, with approximately 50% of the genetic variance in internalizing symptoms attributable to ER difficulties, and 17% of the genetic variance in Disordered Eating also linked to these challenges [44].”

    From Emotional Dysregulation and Cognitive Disengagement Syndrome: Exploring Their Relationship Through the Lens of Twin Studies (2025) · cites this paper as [44]

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  • Few available twin studies suggest that while both CDS and ED have strong genetic underpinnings, they are primarily influenced by non-shared environmental factors.

    “Moreover, the few available twin studies suggest that while both CDS and ED have strong genetic underpinnings, they are primarily influenced by non-shared environmental factors [12,39,42,44,45].”

    From Emotional Dysregulation and Cognitive Disengagement Syndrome: Exploring Their Relationship Through the Lens of Twin Studies (2025) · cites this paper as [44]

    The Results (Twin Models; page not provided) report genetic and nonshared environmental influences on disordered eating, supporting that part of the claim. The paper does not address CDS, and it does not establish that both conditions are primarily influenced by nonshared environmental factors. For the overlap it studies—internalizing symptoms and disordered eating—it instead reports a larger genetic than nonshared environmental contribution (69.3% versus 30.7% of shared variance). (LLM, conf=0.85)

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  • Although genetic factors connect internalizing symptoms and Disordered Eating through ER difficulties, the pathways leading to Disordered Eating involve additional unique genetic influences.

    “These findings suggest that, although genetic factors connect internalizing symptoms and Disordered Eating through ER difficulties, the pathways leading to Disordered Eating involve additional unique genetic influences, highlighting the importance of considering distinct developmental trajectories in the understanding of eating disorders in relation to internalizing psychopathology.”
  • Disordered Eating showed a distinct genetic contribution that did not overlap with either internalizing symptoms or ER difficulties.

    “Notably, while internalizing symptoms shared substantial genetic influences with ER, Disordered Eating showed a distinct genetic contribution that did not overlap with either internalizing symptoms or ER difficulties [44].”
  • ER is a critical shared mechanism in internalizing disorders and disordered eating.

    “This study underscores ER as a critical shared mechanism in these conditions, suggesting potential targets for intervention and treatment strategies [44].”

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  1. Keys A, Brožek J, Henschel A, Mickelsen O, & Taylor HL (1950). The biology of human starvation. (2 Vols.). University of Minnesota Press.

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Authors
Mikhail, M. E., Burt, S. A., Neale, M. C., Keel, P. K., Katzman, D. K., & Klump, K. L.
Affiliations
  • Michigan State University (US)
  • Virginia Commonwealth University (US)
  • Florida State University (US)
  • University of Toronto (CA)
Corresponding author
Klump, Kelly L.
Venue
Clinical Psychological Science
Published
2024-03-12
Volume
12
Issue
6
Pages
1242-1261
ISSN
  • 2167-7026 (ISSN-L)
  • 2167-7034
OpenAlex
W4392742350
Cited by
3
References
94
Citations by year
2026: 1 · 2025: 2
FWCI
1.50
Type
journal article
Language
en
Open access
Locations
  • Clinical Psychological Science (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Science Foundation (Graduate Research Fellowship)
  • National Institute of Mental Health (MH111715)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
internalizing problems, disordered eating, comorbidities, emotion regulation, genetic factors, nonshared environment, shared environment, anxiety, depression, binge eating, dietary restraint, adult women, twin studies

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