PITTSBURGH, Dec. 1, 2004 – The prevalence of childhood anxiety in individuals who later developed anorexia nervosa or bulimia nervosa shows it may be a vulnerability factor for these eating disorders, according to a study in the December issue of the American Journal of Psychiatry.
Eating disorders most often strike young women in their teens and 20s, but the discovery of anxiety disorders as a childhood prelude may give doctors the ability to get an early start on prevention and treatment, according to the authors.
“We identified a strong link between anxiety disorders and eating disorders that shows they not only share many of the same personality traits, but also likely share a genetic pathway,” said Walter H. Kaye, M.D., professor of psychiatry at the University of Pittsburgh School of Medicine and primary author. “This study shows that to help young women recover from these devastating illnesses, doctors need to develop strategies to treat both the eating disorder and the underlying anxiety. It also is possible that treating the anxiety disorder early on may provide some preventative effect against eating disorders.”
The study of 672 individuals is the largest ever seeking to clarify the relationship between eating and anxiety disorders. The researchers found that two-thirds of people with eating disorders experienced some sort of clinical anxiety, such as obsessive compulsive disorder or social phobia, at some point in their lives. A significant number of them – 42 percent – developed their anxiety disorder when they were children, years before their eating disorder.
The researchers also found that anxiety remains pervasive even after women had recovered from an eating disorder. The normal rate of anxiety in otherwise healthy women is between 13 and 31 percent.
The strength of the bond between anxiety and eating disorders is bolstered by the fact that nearly all women with eating disorders report having certain anxiety traits, such as harm avoidance, generalized anxiety and perfectionism, even if they do not have a diagnosable illness.
The researchers used standard psychiatric tests to assess anxiety. They discovered that rates of anxiety were similar for each of the three subtypes of eating disorders – anorexia nervosa, bulimia nervosa and anorexia nervosa comorbid with bulimia nervosa. Two anxiety disorders appeared more often than the others – 41 percent of the participants had a history of obsessive compulsive disorder (OCD) and 20 percent had social phobia.
A striking finding was that 23 percent of the patients with childhood anxiety reported a history of obsessive compulsive disorder, compared with a rate of 2 to 3 percent in other children. Because the normal age of onset of OCD is the 20s, childhood OCD could be a significant predictor of a future eating disorder.
This collaborative group is currently conducting a new study of the genetics of anorexia nervosa, for which they need families with at least two relatives with that disorder.
Patients who would like more information on eating disorders or assistance finding a doctor or treatment program, should contact the National Eating Disorders Association at (206) 382-3587 or visit http://www.nationaleatingdisorders.org/
The research was supported by the Price Foundation. Other authors are: Cynthia M. Bulik, Ph.D., University of North Carolina at Chapel Hill; Laura Thornton, Ph.D.; Nicole Barbarich, B.S.; Kim Masters, B.S.; Katherine Plotinicov, Ph.D.; Christine Pollice, M.P.H.; and Bernie Devlin, Ph.D., all of the department of psychiatry, University of Pittsburgh School of Medicine; Manfred M. Fichter, M.D., and Norbert Quadflieg, Dipl. Psych., Klinik Roseneck, Hospital for Behavioral Medicine, affiliated with the University of Munich, Prien, Germany; Katherine A. Halmi, M.D., New York Presbyterian Hospital, Weill Medical College of Cornell University, White Plains, N.Y.; Allan S. Kaplan, M.D., Program for Eating Disorders, Department of Psychiatry, Toronto General Hospital; Michael Strober, Ph.D., department of psychiatry and behavioral science, University of California at Los Angeles; D. Blake Woodside, M.D., Program for Eating Disorders; Andrew W. Bergen, Ph.D., Core Genotyping Facility, Advanced Technology Center, National Cancer Institute, Gaithersburg, Md.; Scott Crow, M.D., department of psychiatry, University of Minnesota, Minneapolis; James Mitchell, M.D., Neuropsychiatric Research Institute, Fargo, N.D.; Alessandro Rotondo, M.D., department of psychiatry, neurobiology, pharmacology and biotechnologies, University of Pisa, Italy; Mauro Mauri, M.D., University of Pisa, Italy; Pamela Keel, Ph.D., department of psychology, Harvard University; Kelly L. Klump, Ph.D., department of psychology, Michigan State University; Lisa R. Lilenfeld, Ph.D., department of psychology, Georgia State University, Atlanta; and Wade H. Berrettini, M.D., Center of Neurobiology and Behavior, University of Pennsylvania.
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