European Child & Adolescent Psychiatry

, Volume 1, Issue 1, pp 54–65 | Cite as

Background factors in anorexia nervosa

A controlled study of 51 teenage cases including a population sample
  • Maria Råstam
  • Christopher Gillberg


Fifty-one adolescents with anorexia nervosa and 51 sex-, age- and school-matched comparison cases were psychiatrically and physically examined. Twenty-four of the anorexia cases constituted the total population of anorexia nervosa cases born in 1970. The cases were examined at a mean age of 16 years. The mothers were interviewed in detail concerning hereditary and other family factors, child's early physical and temperamental development, and the family's overall social situation. Medical records pertaining to the pre-, peri- and neonatal periods were analysed blind to diagnosis. Thirty-five of the anorexia cases (69%) had a reasonably plausible background factor which could have contributed to the development of the eating disorder. Similar background factors were encountered in 2 (4%) of the comparison cases. The findings are discussed as they pertain to anorexia nervosa etiology.


Medical Record Peri Total Population Anorexia Nervosa Eating Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Cinquante et un adolescents présentent une anorexie mentale et 51 cas témoin appariés suivant le sexe, l'âge et le niveau scolaire subirent un examen psychiatrique et somatique. Vingt quatre des cas de l'échantillon total d'anorexie sont nés en 1970. La moyenne d'âge lors de l'examen était de 16 ans. Il y eut un entretien détaillé avec les mères concernant l'hérédité et d'autres facteurs familiaux, le développement précoce du corps et du tempérament de lénfant et lénsemble de la situation sociale de la famille. Les données médicales des périodes pré, péri et néo-natales furent analysées en aveugle du diagnostic. Trente cinq des cas d'anorexie (69%) présentaient des facteurs d'antécédents ayant pu d'une façon raisonnablement plausible contribuer au développement du trouble alimentaire. Ces facteurs semblables furent retrouvés chez deux des cas témoins (4%). Ces faits sont discutés en tant que jouant un rôle dans l'étiologie de lánorexie mentale.


Es wurden 51 Jugendliche mit Anorexia nervosa und 51 Vergleichsfälle, die nach Geschlecht, Alter und Schultyp parallelisiert waren, psychiatrisch und körperlich untersucht. Vierundzwanzig der Anorexiefälle bildeten die Gesamtpopulation der 1970 geborenen Fälle von Anorexia nervosa. Die Fälle wurden mit einem durchschnittlichen Alter von 16 Jahren untersucht. Die Mütter wurden hinsichtlich Heredität und anderer Familienfaktoren, der frühen körperlichen Entwicklung und Temperamentsentwicklung des Kindes und der allgemeinen sozialen Situation der Familie befragt. Medizinische Krankengeschichten wurden hinsichtlich der prä-, peri- und neonatalen Periode ohne Kenntnis der Diagnose analysiert. Fünfunddreißig der Anorexiefälle (69%) hatten einen genügend plausiblen Hintergrundsfaktor, der zur Entwicklung der Eßstörung beigetragen haben könnte. Vergleichbare Hintergrundfaktoren wurden bei zwei (4%) der Vergleichsfälle gefunden. Die Befunde werden hinsichtlich der Beziehung zur Ätiologie der Anorexia nervosa diskutiert.


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  1. American Psychiatric Association (1980).Diagnostic and Statistical Manual of Mental Disorders-DSM-III.Third Edition. Washington D.C.: Author.Google Scholar
  2. American Psychiatric Association (1987).Diagnostic and Statistical Manual of Mental Disorders-DSM-III-R.Third Edition Revised. Washington D. C.: Author.Google Scholar
  3. Birleson, P. (1981). The validity of depressive disorder in childhood and the development of a self-rating scale: a research report.Journal of Child Psychology and Psychiatry, 22, 73–88.Google Scholar
  4. Crisp, A. H., Hsu, L. K. G., Harding, B., & Hartshorn, J. (1980). Clinical features of anorexia nervosa. A study of a consecutive series of 102 female patients.Journal of Psychosomatic Research, 24, 179–191.Google Scholar
  5. Crisp, A. H., Palmer, R. L., & Kalucy, R. S. (1976). How common is anorexia nervosa? A prevalence study.British Journal of Psychiatry, 128, 549–554.Google Scholar
  6. Dally, P. (1969).Anorexia Nervosa. London: William Heineman Medical Books.Google Scholar
  7. Eisler, I., & Szmukler, G.I. (1985). Social class as a confounding variable in the Eating Attitudes Test.Journal of Psychiatric Research, 19, 171–176.Google Scholar
  8. Eysenck, H. J., & Eysenck, S. S. G. (1964).Manual of the Eysenck Personality Inventory. London: University of London Press.Google Scholar
  9. Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G., & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research.Archives of General Psychiatry, 26, 57–93.Google Scholar
  10. Fries, H. (1977). Studies on secondary amenorrhea, anorectic behavior, and body-image perception: importance for the early recognition of anorexia nervosa. In R. A. Vigersky (Ed.),Anorexia Nervosa. New York: Raven Press.Google Scholar
  11. Garfinkel, P. E., & Garner, D. M. (1982).Anorexia Nervosa: A Multidimensional Perspective. New York, Brunner/Mazel.Google Scholar
  12. Garner, D. M., & Garfinkel, P. E. (1979). The Eating Attitudes Test.Psychological Medicine, 9, 273–279.Google Scholar
  13. Gillberg, C. (1991). Clinical and neurobiological aspects of Asperger syndrome in six family studies. In: U. Frith, (Ed.),Asperger Syndrome. Cambridge: Cambridge University Press.Google Scholar
  14. Gillberg, C., & Gillberg, I. C. (1983). Infantile autism: a total population study of reduced optimality in the pre-, peri-, and neonatal period.Journal of Autism and Developmental Disorders, 13, 153–166.Google Scholar
  15. Gillberg, I. C., & Gillberg, C. (1983). Three-year follow-up at age 10 of children with minor neurodevelopmental disorders. I. Behavioural problems.Developmental Medicine and Child Neurology, 25, 438–449.Google Scholar
  16. Gillberg, C., Persson, E., Grufman, M., & Themnér, U. (1986). Psychiatric disorders in mildly and severely mentally retarded urban children and adolescents: epidemiological aspects.British Journal of Psychiatry, 149, 68–74.Google Scholar
  17. Gillberg, I. C., & Gillberg, C. (1989a). Asperger syndrome — some epidemiological considerations.Journal of Child Psychology and Psychiatry, 30, 631–638.Google Scholar
  18. Gillberg, I. C., & Gillberg, C. (1989b). Children with preschool minor neurodevelopmental disorders. IV: Behaviour and school achievement at age 13.Developmental Medicine and Child Neurology, 31, 3–13.Google Scholar
  19. Gillberg, C., & Råstam, M. (1991). Do some cases of anorexia nervosa reflect underlying autistic-like conditions? (submitted).Google Scholar
  20. Goodyer, I. M. (1990). Recent life events and psychiatric disorder in school age children.Journal of Child Psychology and Psychiatry, 31, 839–848.Google Scholar
  21. Goodyer, I. M., Kolvin, I., & Gatzanis, S. (1987). The impact of recent life events in psychiatric disorders of childhood and adolescence.British Journal of Psychiatry, 151, 185–197.Google Scholar
  22. Hellgren, L., Gillberg, C., &Enerskog, I. (1987). Antecedents of adolescent psychoses: a population-based study of school health problems in children who develop psychosis in adolescence.Journal of the American Academy of Child and Adolescent Psychiatry, 26, 351–355.Google Scholar
  23. Holland, A. J., Hall, A., Murray, R., Russell, G. F. M., & Crisp, A. H. (1984). Anorexia nervosa: a study of 34 twin-pairs and one set of triplets.British Journal of Psychiatry, 145, 414–419.Google Scholar
  24. Holland, A. J., Sicotte, N., & Treasure, J. (1988). Anorexia nervosa: evidence for a genetic basis.Journal of Psychosomatic Research, 32, 561–571.Google Scholar
  25. Humphrey, L. L. (1989). Observed family interactions among subtypes of eating disorders using structural analysis of social behaviour.Journal of Consulting and Clinical Psychology, 57, 206–214.Google Scholar
  26. Kay, D. W. K. & Leigh, D. (1954). The natural history, treatment and prognosis of anorexia nervosa, based on a study of 38 patients.Journal of Mental Science, 100, 411–431.Google Scholar
  27. King, A. (1963). Primary and secondary anorexia nervosa syndromes.British Journal of Psychiatry, 109, 470–479.Google Scholar
  28. Maxwell, A. E. (1961).Analyzing qualitative data. London: Methuen.Google Scholar
  29. Minuchin, S., Rosman, B. L., & Baker, L. (1978).Psychosomatic families: Anorexia nervosa in context. Cambridge, Massachusetts. Harvard University Press.Google Scholar
  30. Morgan, H. G. & Russell, G. F. M. (1975). Value of family background and clinical features as predictors of long-term outcome in anorexia nervosa: four-year follow-up study of 41 patients.Psychological Medicine, 5, 355–371.Google Scholar
  31. Norris, D. L. (1979). Clinical diagnostic criteria for primary anorexia nervosa.South African Medical Journal, 56, 987–993.Google Scholar
  32. Nylander, I. (1971). The feeling of being fat and dieting in a school population: an epidemiologic interview investigation.Acta Socio-Medica Scandinavica, 1, 17–26.Google Scholar
  33. Olson, D. H. (1986). Circumplex Model VII: Validation Studies and FACES III.Family Process, 25, 337–351.Google Scholar
  34. Olson, D. H., Sprenkle, D. H., & Russell, C. S. (1979). Circumplex Model of Marital and Family Systems.Family Process, 18, 3–28.Google Scholar
  35. Russell, G. F. M. (1970). Anorexia nervosa: its identity as an illness and its treatment. In J. H. Price, (Ed.),Modern Trends in Psychological Medicine, Vol. 2 (pp. 131–164). London: Butterworth.Google Scholar
  36. Råstam, M. (1991). Anorexia nervosa in 51 Swedish children and adolescents. Premorbid problems and co-morbidity (submitted).Google Scholar
  37. Råstam, M. & Gillberg, C. (1991). The family background in anorexia nervosa: a population-based study.Journal of the American Academy of Child and Adolescent Psychiatry, 30, 283–289.Google Scholar
  38. Råstam, M., Gillberg, C., & Wahlström, J. (1991). Chromosomes in anorexia nervosa. A study of 47 cases including a population-based group.Journal of Child Psychology and Psychiatry, 32, 695–701.Google Scholar
  39. Råstam, M., Gillberg, C., Trygstad, O., & Foss, I. (1990). Anorexia nervosa and urinary excretion of peptides and protein-associated peptide complexes.Child and Youth Psychiatry: European Perspectives, 1, 54–58.Google Scholar
  40. Råstam, M., Gillberg, C., & Garton, M. (1989). Anorexia nervosa in a Swedish urban region: a population-based study.British Journal of Psychiatry, 155, 642–646.Google Scholar
  41. Selvini-Palazzoli, M. & Viaro, M. (1988). The anorectic process in the family: a six-stage model as a guide for individual therapy.Family Process, 27, 129–148.Google Scholar
  42. Sohlberg, S., Berg, I., & Holmgren, S. (1984).A cross-cultural multisample validation of the eating attitudes test. Uppsala: University Hospital Press.Google Scholar
  43. Steinhausen, H. (1985). Anorexia nervosa: transcultural comparisons.Pediatrician, 12, 157–163.Google Scholar
  44. Swedish Central Bureau of Statistics (1982). Socioeconomic classification (in Swedish).Google Scholar
  45. Szmukler, G. I., McCance, C., McCrone, L., & Hunter, D. (1986). Anorexia nervosa: a psychiatric case register study from Aberdeen.Psychological Medicine, 16, 49–58.Google Scholar
  46. Theander, S. (1970). Anorexia nervosa: a psychiatric investigation of 94 female patients.Acta Psychiatrica Scandinavica, Suppl. 214.Google Scholar
  47. Treasure, J. & Holland, A. J. (1990). Genetic vulnerability to eating disorders: evidence from twin and family studies.Child and Youth Psychiatry: European Perspectives, 1, 59–68.Google Scholar

Copyright information

© Hogrefe & Huber Publishers 1992

Authors and Affiliations

  • Maria Råstam
  • Christopher Gillberg
    • 1
  1. 1.Department of Pediatrics and Child PsychiatryChild Neuropsychiatry Centre, Annedals ClinicsGöteborgSweden

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