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Am J Psychiatry 1991; 148:1627-1637
Copyright © 1991 by American Psychiatric Association
The genetic epidemiology of bulimia nervosa
KS Kendler, C MacLean, M Neale, R Kessler, A Heath and L Eaves
Department of Psychiatry, Medical College of Virginia, Richmond.
OBJECTIVE: The authors seek to clarify, from both an epidemiologic and
genetic perspective, the major risk factors for bulimia nervosa and to
understand the relationship between narrowly defined bulimia and
bulimia-like syndromes. METHOD: Personal structured psychiatric interviews
were conducted with 2,163 female twins from a population- based register.
Psychiatric disorders were assessed using DSM-III-R criteria. RESULTS:
Lifetime prevalence and risk for narrowly defined bulimia were 2.8% and
4.2%, respectively. Including bulimia-like syndromes increased these
estimates to 5.7% and 8.0%, respectively. Risk factors for bulimia included
1) birth after 1960, 2) low paternal care, 3) a history of wide weight
fluctuation, dieting, or frequent exercise, 4) a slim ideal body image, 5)
low self-esteem, 6) an external locus of control, and 7) high levels of
neuroticism. Significant comorbidity was found between bulimia and anorexia
nervosa, alcoholism, panic disorder, generalized anxiety disorder, phobia,
and major depression. Proband-wise concordance for narrowly defined bulimia
was 22.9% in monozygotic and 8.7% in dizygotic twins. The best-fitting
model indicated that familial aggregation was due solely to genetic factors
with a heritability of liability of 55%. A multiple threshold model
indicated that narrowly defined bulimia nervosa and bulimia-like syndromes
represented different levels of severity on the same continuum of
liability. CONCLUSIONS: The liability to fully syndromal bulimia nervosa,
which affects around one in 25 women at some point in their lives, is
substantially influenced by both epidemiologic and genetic risk factors.
The same factors that influence the risk for narrowly defined bulimia also
influence the risk for less severe bulimia-like syndromes.
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