This study is the result of two Portuguese case–control studies that examined the replication of retrospective correlates and preceding life events in anorexia nervosa (AN) and bulimia nervosa (BN) development. This study aims to identify retrospective correlates that distinguish AN and BN
A case–control design was used to compare a group of women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for AN (N = 98) and BN (N = 79) with healthy controls (N = 86) and with other psychiatric disorders (N = 68). Each control group was matched with AN patients regarding age and parental social categories. Risk factors were assessed by interviewing each person with the Oxford Risk Factor Interview.
Compared to AN, women with BN reported significantly higher rates of paternal high expectations, excessive family importance placed on fitness/keeping in shape, and negative consequences due to adolescent overweight and adolescent objective overweight.
Overweight during adolescence emerged as the most relevant retrospective correlate in the distinction between BN and AN participants. Family expectations and the importance placed on keeping in shape were also significant retrospective correlates in the BN group.
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Attia E, Walsh BT (2007) Anorexia nervosa. Am J Psychiatry 164:1805–1810. doi:10.1176/appi.ajp.2007.07071151
Bulik CM, Landt MC, van Furth EF, Sullivan PF (2007) The genetics of anorexia nervosa. Annu Rev Nutr 27:263–275. doi:10.1146/annurev.nutr.27.061406.093713
Smink FRE, Hoeken DV, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414. doi:10.1007/s11920-012-0282-y
Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Silova E, Raevuori A et al (2007) Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry 164:1259–1265. doi:10.1176/appi.ajp.2007.06081388
Wilson TG, Grilo CM, Vitousek KM (2007) Psychological treatments of eating disorders. Am Psychol 62:199–216. doi:10.1037/0003-066X.62.3.199
Fairburn CG (2008) Eating disorders: The transdiagnostic view and the cognitive behavioural therapy. In: Fairburn CG (ed) Cognitive behavior therapy and eating disorders. New York: The Guilford Press pp 7–22. doi: 10.1177/13591045090140031012
Fairburn CG, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther 41:509–528. doi:10.1016/S0005-7967(02)00088-8
Fairburn CG, Harrison PJ (2003) Eating disorders. Lancet 361:407–416. doi:10.1016/S0140-6736(03)12378-1
Bulik CM, Reba L, Siega-Riz AM, Reichborn-Kjennerud T (2005) Anorexia nervosa: definition, epidemiology, and cycle of risk. Int J Eat Disord 37:S2–S9. doi:10.1002/eat.20107
Garfinkel PE, Dorian BJ (2001) Improving understanding and care for the eating disorders. In: Striegel-Moore RH, Smolak L (eds) Eating disorders: innovative directions in research and practice. Washington: American Psychological Association/APA, pp 9–26. doi: 10.1037/10403-001
Hoek HW (2006) Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr Opin Psychiatry 19:289–394. doi:10.1097/01.yco.0000228759.95237.78
Striegel-Moore RH, Bulik CM (2007) Risk factors for eating disorders. Am Psychol 62:181–198. doi:10.1037/0003-066X.62.3.181
Sullivan PF (2002) Course and outcome of anorexia nervosa and bulimia nervosa (2th ed). In: Fairburn CG, Brownell KD (eds) Eating disorders and obesity: a comprehensive handbook. New York: The Guilford Press, pp 226–232. doi: 10.1080/1363849031000149756-3
Birmingham CL, Su J, Hlynsky JA, Goldner EM, Gao M (2005) The mortality rate from anorexia disorder. Int J Eat Disord 38:143–146. doi:10.1002/eat.20164
Collier DA, Treasure JL (2004) The aetiology of eating disorders. Br J Psychiatry 185:363–365. doi:10.1192/bjp.185.5.363
Treasure J, Claudino AM, Zucker N (2010) Eating disorders. Lancet 2010(375):583–593. doi:10.1016/S0140-6736(09)61748-7
Schmidt U (2002) Risk factors for eating disorders (2nd ed). In: Fairburn CG, Brownell KD (eds). Eating disorders and obesity: a comprehensive handbook. New York: The Guilford Press 2002, pp 247–250. doi: 10.1080/1363849031000149756-3
Fairburn CG, Cooper Z, Doll HA, Welch SL (1999) Risk factors for anorexia nervosa: three integrated case-control comparisons. Arch Gen Psychiatry 56:468–476. doi:10.1001/archpsyc.55.5.425
Fairburn CG, Welch SL, Doll HA, Davies BA, O’Connor ME (1997) Risk factors for bulimia nervosa: a community based case-control study. Arch Gen Psychiatry 54:509–517. doi:10.1001/archpsyc.1997.01830180015003
Jacobi C, Haywar C, de Zwaan M, Kraemer HC, Agras WS (2004) Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychol Bull 130:19–65. doi:10.1037/0033-2909.130.1.19
Karwautz A, Rabe-Heskeht S, Hu X, Zaho J, Sham P, Collier DA et al (2001) Individual-specific risk factors for anorexia nervosa: a pilot study using discordant sister-pair design. Psychol Med 31:317–329. doi:10.1017/S0033291701003129
Pike KM, Hilbert A, Wilfley DE, Fairburn CG, Dohm FA, Walsh BT et al (2008) Toward an understanding of risk factors for anorexia nervosa: a case-control study. Psychol Med 38:1443–1453. doi:10.1017/S0033291707002310
Karwautz AF, Wagner G, Waldherr K, Nader IW, Fernandez-Aranda F, Estivill X et al (2011) Gene-environment interaction in anorexia nervosa: relevance of non-shared environment and the serotonin transporter gene. Mol Psychiatry 16:590–592. doi:10.1038/mp.2010.125
Machado BC, Gonçalves S, Martins C, Hoek HW, Machado PP (2014) Risk factors and antecedent life events in the development of anorexia nervosa: a portuguese case-control study. Eur Eat Disorders Rev 22:243–251. doi:10.1002/erv.2286
Day J, Schmidt U, Collier D, Perkins S, Van den Eynde F, Treasure J et al (2011) Risk factors, correlates, and markers in early-onset bulimia nervosa and EDNOS. Int J Eat Disord 44:287–294. doi:10.1002/eat.20803
Gonçalves S, Machado BC, Martins C, Hoek HW, Machado PP. Retrospective correlates of Bulimia Nervosa: a matched case–control study (submitted)
Hilbert A, Pike KM, Goldschmidt AB, Wilfley DE, Fairburn CG, Dohm F et al (2014) Risk factors across the eating disorders. Psychiatry Res 220:500–506. doi:10.1016/j.psychres.2014.05.054
American Psychiatry Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: Author; 2004. doi: 10.1017/s0033291700035765
First MB, Sptizer RL, Williams JB, Gibbon M. Structured Clinical Interview for DSM-IV (SCID). Washington, DC: American Psychiatric Association; 1995. doi: 10.1002/9781118625392.wbecp351
Fairburn CG, Cooper Z (1993) The eating disorder examination (12th ed). In: Fairburn CG, Wilson GT (eds) Binge Eating: nature, assessment and treatment. New York: The Guilford Press, pp 317–360. doi: 10.1002/erv.2400030211
Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 4:363–370. doi:10.1002/1098-108X(199412)
Graffar M (1956) Une méthode de classification sociale d’échantillons de population. Courrier 6:445–459. doi:10.2307/2172077
Stice E, Marti CN, Durant S (2011) Risk factors for onset of eating disorders: evidence of multiple risk pathways from an 8-year prospective study. Behav Res Ther 49:622–627. doi:10.1016/j.brat.2011.06.009
Wade TD, Tiggemann M, Bulik CM, Fairburn CG, FMedSci Wray NR et al (2008) Shared temperament risk factors for anorexia nervosa: a twin study. Psychosom Med 70:239–244. doi:10.1097/PSY.0b013e31815c40f1
This research was partially supported by a Portuguese Fundação para a Ciência e a Tecnologia/Foundation for Science and Technology research grant to the last author (PTDC/PSI-PCL/099981/2008) and a doctoral grant to the first author (FCT-SFRH/BD/22038/2005). The authors acknowledge Christopher G. Fairburn, MD, of the Department of Psychiatry at Oxford University (UK) for providing initial consultation and training and Helen A. Doll, PhD, for help with the initial data analysis.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
This study was reviewed and approved by the Institutional Review Board and conformed to both Portuguese and European regulations on conducting research with human participants and on the management of personal data.
All participants gave written informed consent, and in the case of minors, child assent and parental consent for research participation were obtained.
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Machado, B.C., Gonçalves, S.F., Martins, C. et al. Anorexia nervosa versus bulimia nervosa: differences based on retrospective correlates in a case–control study. Eat Weight Disord 21, 185–197 (2016). https://doi.org/10.1007/s40519-015-0236-6