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David Baxter PhD

Late Founder
Study reveals childhood vulnerabilities that may lead to eating disorders
January 27, 2005

Do childhood traits set the stage for eating disorders? New research suggests they might.

In a study reported in the December 2004 American Journal of Psychiatry, psychiatrist Walter H. Kaye, MD, of the University of Pittsburgh School of Medicine, and an international team of researchers found that people with current or past eating disorders often report having had anxiety disorders in childhood, and that anxious symptoms tend to persist even after recovery from the eating disorder.

"We found that people with eating disorders often had anxiety problems as children, years before they developed anorexia or bulimia nervosa," noted Kaye, who also is conducting a 10-site, U.S. National Institute of Mental Health (NIMH)-funded study of anorexia genetics with some of the same researchers.

In a study supported by the Price Foundation, the team compared rates of current and past anxiety disorders in two groups. One group consisted of 672 people, nearly all women, who, either presently or in the past, had anorexia nervosa and bulimia nervosa or some combination of them. The second group included 694 healthy women without eating disorders. Anxiety disorders included such symptoms as excessive worry, avoidance of social situations, and obsessive thoughts. These symptoms had to interfere with their ability to perform normally at home, work, or school, or to cause much emotional distress.

About two thirds of the eating disorder group had one or more anxiety disorders over the course of their lifetimes, the team found, more than twice that of the general population. The most common disorder was obsessive-compulsive disorder (OCD), present in almost half of the group, followed by anxiety in social situations and excessive shyness, present in almost a quarter of the group. The rates were significantly higher than in the women without eating disorders.

These patterns began early in childhood, according to the participants. About 42% said they met the criteria for one or more anxiety disorders as children. As with reported lifetime rates of OCD, rates of childhood OCD were particularly high, with 23% of women with eating-disorders reporting diagnosable symptoms in childhood, compared to 3% in the general population.

Even those who never had a diagnosable anxiety disorder and who had recovered from an eating disorder for at least a year reported more anxiety, harm-avoidance, and perfectionism than the comparison group, the team found.

"These findings suggest that anxiety symptoms are present in most people with eating disorders," commented Kaye. "Many people diet in our society, but relatively few develop an eating disorder. It may be that having a lot of anxiety increases the risk that someone may develop an eating disorder, as extreme eating behaviors may be a way to cope with those anxious feelings."

The research adds another link to the growing notion that eating disorders have a genetic basis, Kaye added. "Our collaborative group has been testing candidate genes for related behavioral and personality traits like anxiety and obsessiveness, and already has found regions on several chromosomes that may contain such genes."

The genetic and childhood findings argue that people with eating disorders may need treatment that focuses on the anxiety features underlying eating disorders," Kaye noted.

"Indeed, these anxieties can be as incapacitating as the eating disorder itself," he said.

Lynn Grefe, of the National Eating Disorders Association (NEDA), commended the study as "one more significant research step toward helping us understand these illnesses and their biological components. Identifying 'at risk' children may improve our prevention strategies. The more we know about eating disorders, the earlier we can help families steer their loved ones toward appropriate treatments."

For more information about the current Genetics study on Anorexia Nervosa, go to, email , or call toll-free in the U.S. 1-888-895-3886.
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