Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Jan 1;67(1):71-7.
doi: 10.1016/j.biopsych.2009.08.010.

Understanding the relation between anorexia nervosa and bulimia nervosa in a Swedish national twin sample

Affiliations

Understanding the relation between anorexia nervosa and bulimia nervosa in a Swedish national twin sample

Cynthia M Bulik et al. Biol Psychiatry. .

Abstract

Background: We present a bivariate twin analysis of anorexia nervosa and bulimia nervosa to determine the extent to which shared genetic and environmental factors contribute to liability to these disorders.

Method: Focusing on females from the Swedish Twin study of Adults: Genes and Environment (n = 7000), we calculated heritability estimates for narrow and broad anorexia nervosa and bulimia nervosa and estimated their genetic correlation.

Results: In the full model, the heritability estimate for narrow anorexia nervosa (AN) was (a(2) = .57; 95% confidence interval [CI]: .00-.81) and for narrow bulimia nervosa (BN) (a(2) = .62; 95% CI: .08-.70), with the remaining variance accounted for by unique environmental factors. Shared environmental factors estimates were (c(2) = .00; 95% CI: .00-.67) for AN and (c(2) = .00; 95% CI: .00-.40) for BN. Moderate additive genetic (.46) and unique environmental (.42) correlations between AN and BN were observed. Heritability estimates for broad AN were lower (a(2) = .29; 95% CI: .04-.43) than for narrow AN, but estimates for broad BN were similar to narrow BN. The genetic correlation for broad AN and BN was .79, and the unique environmental correlation was .44.

Conclusions: We highlight the contribution of additive genetic factors to both narrow and broad AN and BN and demonstrate a moderate overlap of both genetic and unique environmental factors that influence the two conditions. Common concurrent and sequential comorbidity of AN and BN can in part be accounted for by shared genetic and environmental influences on liability although independent factors also operative.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Graphical depiction of full bivariate twin model for lifetime history of anorexia nervosa and lifetime history of bulimia nervosa.
Figure 2
Figure 2
Graphical depiction of best-fitting narrowAN-BN bivariate model indicating common and specific genetic and environmental effects.
Figure 3
Figure 3
Graphical depiction of best-fitting broad AN-BN bivariate model indicating common and specific genetic and environmental effects.

References

    1. Eddy KT, Dorer DJ, Franko DL, Tahilani K, Thompson-Brenner H, Herzog DB. Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. Am J Psychiatry. 2008;165:245–250. - PMC - PubMed
    1. Tozzi F, Thornton L, Klump K, Bulik C, Fichter M, Halmi K, et al. Symptom fluctuation in eating disorders: correlates of diagnostic crossover. Am J Psychiatry. 2005;162:732–740. - PubMed
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition Text Revision. Washington, DC: American Psychiatric Press; 2000.
    1. Bulik C, PF S, Fear J, Pickering A. Predictors of the development of bulimia nervosa in women with anorexia nervosa. J Nerv Ment Disease. 1997;185:704–707. - PubMed
    1. Eckert ED, Halmi KA, Marchi P, Grove W, Crosby R. Ten-year follow-up of anorexia nervosa: clinical course and outcome. Psychol Med. 1995;25:143–156. - PubMed

Publication types