Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 50
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Farstad, Sarah M. McGeown, Laura M. and von Ranson, Kristin M. 2016. Eating disorders and personality, 2004–2016: A systematic review and meta-analysis. Clinical Psychology Review, Vol. 46, p. 91.

    Forrest, Lauren N. Zuromski, Kelly L. Dodd, Dorian R. and Smith, April R. 2016. Suicidality in adolescents and adults with binge-eating disorder: Results from the national comorbidity survey replication and adolescent supplement. International Journal of Eating Disorders,

    Laurent, Jennifer S. and Sibold, Jeremy 2016. Addictive-Like Eating, Body Mass Index, and Psychological Correlates in a Community Sample of Preadolescents. Journal of Pediatric Health Care, Vol. 30, Issue. 3, p. 216.

    Postorino, Valentina and Mazzone, Luigi 2016. Psychiatric Symptoms and Comorbidities in Autism Spectrum Disorder.

    Kothari, Radha Barona, Manuela Treasure, Janet and Micali, Nadia 2015. Social cognition in children at familial high-risk of developing an eating disorder. Frontiers in Behavioral Neuroscience, Vol. 9,

    Krug, Isabel Fuller-Tyszkiewicz, Matthew Anderluh, Marija Bellodi, Laura Bagnoli, Silvia Collier, David Fernandez-Aranda, Fernando Karwautz, Andreas Mitchell, Sarah Nacmias, Benedetta Ricca, Valdo Sorbi, Sandro Tchanuria, Kate Wagner, Gudrun Treasure, Janet and Micali, Nadia 2015. A new social-family model for eating disorders: A European multicentre project using a case–control design. Appetite, Vol. 95, p. 544.

    Mandy, Will and Tchanturia, Kate 2015. Do women with eating disorders who have social and flexibility difficulties really have autism? A case series. Molecular Autism, Vol. 6, Issue. 1, p. 6.

    Oldershaw, Anna Lavender, Tony Sallis, Hannah Stahl, Daniel and Schmidt, Ulrike 2015. Emotion generation and regulation in anorexia nervosa: A systematic review and meta-analysis of self-report data. Clinical Psychology Review, Vol. 39, p. 83.

    Treasure, Janet Stein, Daniel and Maguire, Sarah 2015. Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Intervention in Psychiatry, Vol. 9, Issue. 3, p. 173.

    Van Autreve, Sara and Vervaet, Myriam 2015. Are There Differences in Central Coherence and Set Shifting Across the Subtypes of Anorexia Nervosa?. The Journal of Nervous and Mental Disease, Vol. 203, Issue. 10, p. 774.

    Degortes, Daniela Zanetti, Tatiana Tenconi, Elena Santonastaso, Paolo and Favaro, Angela 2014. Childhood Obsessive-compulsive Traits in Anorexia Nervosa Patients, Their Unaffected Sisters and Healthy Controls: A Retrospective Study. European Eating Disorders Review, Vol. 22, Issue. 4, p. 237.

    Godier, Lauren R. and Park, Rebecca J. 2014. Compulsivity in anorexia nervosa: a transdiagnostic concept. Frontiers in Psychology, Vol. 5,

    Kanakam, Natalie and Treasure, Janet 2013. A review of cognitive neuropsychiatry in the taxonomy of eating disorders: State, trait, or genetic?. Cognitive Neuropsychiatry, Vol. 18, Issue. 1-2, p. 83.

    Kanakam, Natalie Raoult, Charlotte Collier, David and Treasure, Janet 2013. Set shifting and central coherence as neurocognitive endophenotypes in eating disorders: A preliminary investigation in twins. The World Journal of Biological Psychiatry, Vol. 14, Issue. 6, p. 464.

    Kanakam, Natalie Krug, Isabel Raoult, Charlotte Collier, David and Treasure, Janet 2013. Social and Emotional Processing as a Behavioural Endophenotype in Eating Disorders: A Pilot Investigation in Twins. European Eating Disorders Review, Vol. 21, Issue. 4, p. 294.

    Marcus, Jacqueline B. 2013. Culinary Nutrition.

    Milos, Gabriella F Baur, Volker Muehlebach, Sabina and Spindler, Anja 2013. Axis-I comorbidity is linked to prospective instability of diagnoses within eating disorders. BMC Psychiatry, Vol. 13, Issue. 1,

    Pjetri, Eneda Dempster, Emma Collier, David A. Treasure, Janet Kas, Martien J. Mill, Jonathan Campbell, Iain C. and Schmidt, Ulrike 2013. Quantitative promoter DNA methylation analysis of four candidate genes in anorexia nervosa: A pilot study. Journal of Psychiatric Research, Vol. 47, Issue. 2, p. 280.

    Stulz, Niklaus Hepp, Urs Gächter, Céline Martin-Soelch, Chantal Spindler, Anja and Milos, Gabriella 2013. The severity of ADHD and eating disorder symptoms: a correlational study. BMC Psychiatry, Vol. 13, Issue. 1,

    Taborelli, E. Krug, I. Karwautz, A. Wagner, G. Haidvogl, M. Fernandez-Aranda, F. Castro, R. Jiménez-Murcia, S. Anderluh, M. Collier, D. Treasure, J. L. and Micali, N. 2013. Maternal Anxiety, Overprotection and Anxious Personality as Risk Factors for Eating Disorder: A Sister Pair Study. Cognitive Therapy and Research, Vol. 37, Issue. 4, p. 820.


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

  • M. Anderluh (a1) (a2), K. Tchanturia (a1), S. Rabe-Hesketh (a1), D. Collier (a1) and J. Treasure (a1)
  • DOI:
  • Published online: 01 April 2008

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.

Corresponding author
*Address for correspondence: M. Anderluh, M.D., Child Psychiatry Unit, University Children's Hospital, University Medical Centre, Vrazov trg 1, 1525Ljubljana, Slovenia. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

MB Anderluh , K Tchanturia , S Rabe-Hesketh , J Treasure (2003). Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype. American Journal of Psychiatry 160, 242247.

AW Bergen , MB van den Bree , M Yeager , R Welch , JK Ganjei , K Haque , S Bacanu , WH Berrettini , DE Grice , D Goldman , CM Bulik , K Klump , M Fichter , K Halmi , A Kaplan , M Strober , J Treasure , B Woodside , WH Kaye (2003). Candidate genes for anorexia nervosa in the 1p33-36 linkage region: serotonin 1D and delta opioid receptor loci exhibit significant association to anorexia nervosa. Molecular Psychiatry 8, 397406.

CM Bulik , PF Sullivan , J Fear , A Pickering (1997). Predictors of the development of bulimia nervosa in women with anorexia nervosa. Journal of Nervous and Mental Diseases 185, 704707.

DA Collier , JL Treasure (2004). The aetiology of eating disorders. British Journal of Psychiatry 185, 363365.

S Collings , M King (1994). Ten-year follow-up of 50 patients with bulimia nervosa. British Journal of Psychiatry 164, 8087.

Z Cooper , PJ Cooper , CG Fairburn (1989). The validity of the eating disorder examination and its subscales. British Journal of Psychiatry 154, 807812.

Z Cooper , PJ Cooper , CG Fairburn (2003). Refining the definition of binge eating disorder and nonpurging bulimia nervosa. International Journal of Eating Disorders 34, S89S95.

AM Crane , ME Roberts , J Treasure (2007). Are obsessive-compulsive personality traits associated with a poor outcome in anorexia nervosa? A systematic review of randomized controlled trials and naturalistic outcome studies. International Journal of Eating Disorders 40, 581588.

B Devlin , SA Bacanu , KL Klump , CM Bulik , MM Fichter , KA Halmi , AS Kaplan , M Strober , J Treasure , DB Woodside , WH Berrettini , WH Kaye (2002). Linkage analysis of anorexia nervosa incorporating behavioral covariates. Human Molecular Genetics 11, 689696.

KT Eddy , PK Keel , DJ Dorer , SS Delinsky , DL Franko , DB Herzog (2002). Longitudinal comparison of anorexia nervosa subtypes. International Journal of Eating Disorders 31, 191201.

TC Eley , D Bolton , TG O'Connor , S Perrin , P Smith , R Plomin (2003). A twin study of anxiety-related behaviours in pre-school children. Journal of Child Psychology and Psychiatry 44, 945960.

CG Fairburn , Z Cooper , HA Doll , SL Welch (1999). Risk factors for anorexia nervosa: three integrated case-control comparisons. Archives of General Psychiatry 56, 468476.

CG Fairburn , PJ Harrison (2003). Eating disorders. Lancet 361, 407416.

CG Fairburn , PA Norman , SL Welch , ME O'Connor , HA Doll , RC Peveler (1995). A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments. Archives of General Psychiatry 52, 304312.

M Fichter , N Quadflieg (2001). The structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10 (SIAB-EX): reliability and validity. European Psychiatry 16, 3848.

II Gottesman , TD Gould (2003). The endophenotype concept in psychiatry: etymology and strategic intentions. American Journal of Psychiatry 160, 636645.

DE Grice , KA Halmi , MM Fichter , M Strober , DB Woodside , JT Treasure , AS Kaplan , PJ Magistretti , D Goldman , CM Bulik , WH Kaye , WH Berrettini (2002). Evidence for a susceptibility gene for anorexia nervosa on chromosome 1. American Journal of Human Genetics 70, 787792.

DB Herzog , DJ Dorer , PK Keel , SE Selwyn , ER Ekeblad , AT Flores , DN Greenwood , RA Burwell , MB Keller (1999). Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry 38, 829837.

K Holtkamp , B Herpertz-Dahlmann , T Vloet , U Hagenah (2005). Depression, anxiety, and obsessionality in long-term recovered patients with adolescent-onset anorexia nervosa. European Child and Adolescent Psychiatry 14, 106110.

PK Keel , JE Mitchell , KB Miller , TL Davis , SJ Crow (2000). Predictive validity of bulimia nervosa as a diagnostic category. American Journal of Psychiatry 157, 136138.

MB Keller , PW Lavori , B Friedman , E Nielsen , J Endicott , P McDonald-Scott , NC Andreasen (1987). The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540548.

KS Kendler , JM Myers , FA O'Neill , R Martin , B Murphy , CJ MacLean , D Walsh , RE Straub (2000). Clinical features of schizophrenia and linkage to chromosomes 5q, 6p, 8p, and 10p in the Irish Study of High-Density Schizophrenia Families. American Journal of Psychiatry 157, 402408.

H Kordy (2005). Counting the COST: a European collaboration on the efficiency of psychotherapeutic treatment of patients with eating disorders. European Eating Disorders Review 13, 153158.

LR Lilenfeld , WH Kaye , CG Greeno , KR Merikangas , K Plotnicov , C Pollice , R Rao , M Strober , CM Bulik , L Nagy (1998). A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity. Archives of General Psychiatry 55, 603610.

C Lopez , K Tchanturia , D Stahl , R Booth , J Holliday , J Treasure (2008). An examination of the concept of central coherence in women with anorexia nervosa. International Journal of Eating Disorders 41, 143152.

G Milos , A Spindler , U Schnyder , CG Fairburn (2005). Instability of eating disorder diagnoses: prospective study. British Journal of Psychiatry 187, 573578.

MJ Rietveld , JJ Hudziak , M Bartels , CE van Beijsterveldt , DI Boomsma (2004). Heritability of attention problems in children: longitudinal results from a study of twins, age 3 to 12. Journal of Child Psychology and Psychiatry 45, 577588.

M Strober , R Freeman , W Morrell (1997). The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. International Journal of Eating Disorders 22, 339360.

K Tchanturia , RG Morris , MB Anderluh , DA Collier , V Nikolaou , J Treasure (2004). Set shifting in anorexia nervosa: an examination before and after weight gain, in full recovery and relationship to childhood and adult OCPD traits. Journal of Psychiatric Research 38, 545552.

F Tozzi , SH Aggen , BM Neale , CB Anderson , SE Mazzeo , MC Neale , CM Bulik (2004). The structure of perfectionism: a twin study. Behavior Genetics 34, 483494.

JL Treasure , DA Collier (2001). The spectrum of eating disorders in humans. In Animal Models – Disorders of Eating Behaviour and Body Composition (ed. J. B. Owen , J. L. Treasure and D. A. Collier ), pp. 1949. Kluwer Academic: Dordrecht, The Netherlands.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *