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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)...

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:
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Anderluh, MB, Tchanturia, K, Rabe-Hesketh, S, Treasure, J (2003). Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype. American Journal of Psychiatry 160, 242247.
Bergen, AW, van den Bree, MB, Yeager, M, Welch, R, Ganjei, JK, Haque, K, Bacanu, S, Berrettini, WH, Grice, DE, Goldman, D, Bulik, CM, Klump, K, Fichter, M, Halmi, K, Kaplan, A, Strober, M, Treasure, J, Woodside, B, Kaye, WH (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.
Bulik, CM, Sullivan, PF, Fear, J, Pickering, A (1997). Predictors of the development of bulimia nervosa in women with anorexia nervosa. Journal of Nervous and Mental Diseases 185, 704707.
Collier, DA, Treasure, JL (2004). The aetiology of eating disorders. British Journal of Psychiatry 185, 363365.
Collings, S, King, M (1994). Ten-year follow-up of 50 patients with bulimia nervosa. British Journal of Psychiatry 164, 8087.
Cooper, Z, Cooper, PJ, Fairburn, CG (1989). The validity of the eating disorder examination and its subscales. British Journal of Psychiatry 154, 807812.
Cooper, Z, Cooper, PJ, Fairburn, CG (2003). Refining the definition of binge eating disorder and nonpurging bulimia nervosa. International Journal of Eating Disorders 34, S89S95.
Crane, AM, Roberts, ME, Treasure, J (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.
Devlin, B, Bacanu, SA, Klump, KL, Bulik, CM, Fichter, MM, Halmi, KA, Kaplan, AS, Strober, M, Treasure, J, Woodside, DB, Berrettini, WH, Kaye, WH (2002). Linkage analysis of anorexia nervosa incorporating behavioral covariates. Human Molecular Genetics 11, 689696.
Eckert, ED, Halmi, KA, Marchi, P, Grove, W, Crosby, R (1995). Ten-year follow-up of anorexia nervosa: clinical course and outcome. Psychological Medicine 25, 143156.
Eddy, KT, Keel, PK, Dorer, DJ, Delinsky, SS, Franko, DL, Herzog, DB (2002). Longitudinal comparison of anorexia nervosa subtypes. International Journal of Eating Disorders 31, 191201.
Eley, TC, Bolton, D, O'Connor, TG, Perrin, S, Smith, P, Plomin, R (2003). A twin study of anxiety-related behaviours in pre-school children. Journal of Child Psychology and Psychiatry 44, 945960.
Fairburn, CG, Cooper, Z, Doll, HA, Welch, SL (1999). Risk factors for anorexia nervosa: three integrated case-control comparisons. Archives of General Psychiatry 56, 468476.
Fairburn, CG, Harrison, PJ (2003). Eating disorders. Lancet 361, 407416.
Fairburn, CG, Norman, PA, Welch, SL, O'Connor, ME, Doll, HA, Peveler, RC (1995). A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments. Archives of General Psychiatry 52, 304312.
Fichter, M, Quadflieg, N (2001). The structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10 (SIAB-EX): reliability and validity. European Psychiatry 16, 3848.
Gottesman, II, Gould, TD (2003). The endophenotype concept in psychiatry: etymology and strategic intentions. American Journal of Psychiatry 160, 636645.
Grice, DE, Halmi, KA, Fichter, MM, Strober, M, Woodside, DB, Treasure, JT, Kaplan, AS, Magistretti, PJ, Goldman, D, Bulik, CM, Kaye, WH, Berrettini, WH (2002). Evidence for a susceptibility gene for anorexia nervosa on chromosome 1. American Journal of Human Genetics 70, 787792.
Hay, PJ, Fairburn, CG, Doll, HA (1996). The classification of bulimic eating disorders: a community-based cluster analysis study. Psychological Medicine 26, 801812.
Herzog, DB, Dorer, DJ, Keel, PK, Selwyn, SE, Ekeblad, ER, Flores, AT, Greenwood, DN, Burwell, RA, Keller, MB (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.
Holtkamp, K, Herpertz-Dahlmann, B, Vloet, T, Hagenah, U (2005). Depression, anxiety, and obsessionality in long-term recovered patients with adolescent-onset anorexia nervosa. European Child and Adolescent Psychiatry 14, 106110.
Keel, PK, Mitchell, JE (1997). Outcome in bulimia nervosa. American Journal of Psychiatry 154, 313321.
Keel, PK, Mitchell, JE, Miller, KB, Davis, TL, Crow, SJ (2000). Predictive validity of bulimia nervosa as a diagnostic category. American Journal of Psychiatry 157, 136138.
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, McDonald-Scott, P, Andreasen, NC (1987). The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540548.
Kendler, KS, Myers, JM, O'Neill, FA, Martin, R, Murphy, B, MacLean, CJ, Walsh, D, Straub, RE (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.
Kordy, H (2005). Counting the COST: a European collaboration on the efficiency of psychotherapeutic treatment of patients with eating disorders. European Eating Disorders Review 13, 153158.
Lilenfeld, LR, Kaye, WH, Greeno, CG, Merikangas, KR, Plotnicov, K, Pollice, C, Rao, R, Strober, M, Bulik, CM, Nagy, L (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.
Lopez, C, Tchanturia, K, Stahl, D, Booth, R, Holliday, J, Treasure, J (2008). An examination of the concept of central coherence in women with anorexia nervosa. International Journal of Eating Disorders 41, 143152.
Milos, G, Spindler, A, Schnyder, U, Fairburn, CG (2005). Instability of eating disorder diagnoses: prospective study. British Journal of Psychiatry 187, 573578.
Rietveld, MJ, Hudziak, JJ, Bartels, M, van Beijsterveldt, CE, Boomsma, DI (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.
Srinivasagam, NM, Kaye, WH, Plotnicov, KH, Greeno, C, Weltzin, TE, Rao, R (1995). Persistent perfectionism, symmetry, and exactness after long-term recovery from anorexia nervosa. American Journal of Psychiatry 152, 16301634.
Strober, M, Freeman, R, Morrell, W (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.
Tchanturia, K, Morris, RG, Anderluh, MB, Collier, DA, Nikolaou, V, Treasure, J (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.
Tozzi, F, Aggen, SH, Neale, BM, Anderson, CB, Mazzeo, SE, Neale, MC, Bulik, CM (2004). The structure of perfectionism: a twin study. Behavior Genetics 34, 483494.
Treasure, JL, Collier, DA (2001). The spectrum of eating disorders in humans. In Animal Models – Disorders of Eating Behaviour and Body Composition (ed. Owen, J. B., Treasure, J. L. and Collier, D. A.), pp. 1949. Kluwer Academic: Dordrecht, The Netherlands.
WHO (1992). The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Description and Diagnostic Guidelines. World Health Organization: Geneva.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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