Study: More than half of risk for developing anorexia is genetic

[HuckleB]

http://www.concordmonitor.com/apps/pbcs.dll/article?AID=/20060316/REPOSITORY/603160365/1013/48HOURS

"Researchers studying anorexia in twins conclude that more than half a person's risk for developing the sometimes fatal eating disorder is determined by genes.

Most experts already believe there is a strong genetic component to the disorder, which mostly affects girls and women. The new study "hammers home the fact that these are biologically based disorders," said Cynthia Bulik, lead author of the study who is a psychiatrist at the School of Medicine at the University of North Carolina-Chapel Hill.

"We need to stop viewing them as a choice. . . . The patients feel guilty, the providers tell them things like they should just eat, parents are blamed, the insurance companies won't fund treatment because they think it's a choice. It's held us back for decades."

People with anorexia have a distorted body image and refuse to maintain a minimally acceptable body weight. Bulik said anorexics are about 10 times more likely to die in a given period of time than peers the same age.

..."


Other links on this story, including the abstract:

Abstract:
http://archpsyc.ama-assn.org/cgi/content/abstract/63/3/305

Anorexia is a real disease:
http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=363643&in_page_id=1774



Past pieces regarding genetics and anorexia...

A genetic link to anorexia:
http://www.apa.org/monitor/mar02/genetic.html

Anorexia 'has genetic basis':
http://news.bbc.co.uk/1/hi/health/1575523.stm

Researcher Says Risk Factors For Anorexia Nervosa Have Genetic Basis:
http://www.pslgroup.com/dg/51576.htm

Ongoing studies via UPitt:
http://www.wpic.pitt.edu/research/pfanbn/

Fighting Anorexia: No One To Blame:
http://www.msnbc.msn.com/id/10219756/site/newsweek/

[WiseButAngrySara]

1. Why do you keep posting about anorexia on the GD page? Are you

anorexic? It is NOT genetic. It is a social/psychological disease caused largely by the media, peer pressure, and poor parenting. What are you pushing?

[Warpy]

2. Do you really believe that?

Anorexia nervosa is a very old disease, one that afflicted saintly young women in convents hundreds of years ago. It very likely does have a genetic component, just like other "behavior" issues like alcoholism.

Read about "Holy Anorexia" at http://www.cyberpsych.org/pdg/pdghist.htm

[WiseButAngrySara]

4. Holy Anorexia is the LEAST likely to have a genetic component...and

your statement proves it. ..."in convents"...Psychological contagion, like 'hysteria.'

[Warpy]

11. Hardly. Saintly women (who proved themselves saintly by

self starvation) were SENT to convents. They didn't become saintly starvelings after they got there, they CAME THAT WAY.

This is an old, old disease.

[WiseButAngrySara]

19. I read your article, and it supported my belief. Greeks (like Plato), the

Gnostics, and many other sects of Christianity and even Hinduism, believed that the body was inherently 'evil'. If you really believe this, you starve your body. Look at the influence of Hinduism and fasting on the Buddha. Are you suggesting that he had a genetic component to an eating disorder? Fasting for religious reasons is superior in my mind (albeit equally fallacious) to fasting to look "good", but they are both cultural and psychological phenomenon.

[raccoon]

6. Maybe it's always been around, but I think there's much more of

it now due to the media's relentless pressure for everyone, especially women, to be thin, as well as peer pressure and social pressure.

Some models and TV stars look skeletal.

[HuckleB]

15. Please read the links I posted, as well as the one Warpy posted.

Also, spend some time at www.kartiniclinic.com . Thank you.

[raccoon]

25. Self delete nt

[HuckleB]

26. .

[lukasahero]

3. Perhaps because some people here probably are anorexic

and studies could prove beneficial to their healing? Why the animosity? "Are YOU anorexic? What are YOU pushing?" What's the gain here for the disavowal that it can't possibly be linked to genetics? It sure would help to minimize the stigma. Why shouldn't we be studying this disease? Women's health issues have been long overlooked by the medical community - I would think it a good thing to finally try and understand what's happening here as even more young women die.

BTW - my parents did not provide "poor parenting" and their daughter still developed an eating disorder long before the media even recognized it. So two of your "causes" are eliminated in that scenario. Care to try again?

[WiseButAngrySara]

10. You tell me how you developed anorexia. Most anorexics know that it's

motivated by a desire to be thin...from the causes that I stated...Anorexics fast for spiritual goals or for the more usual, mundane, materialistic pursuit of 'being thin.' It's a cultural psychological disease. The anorexic 'model' type thinness is relatively new, but the tuberculoid thinness used to be popular ("wasting from consumption"), and the spiritual fasting to connote superiority, also used to be popular. Cultural popularity is not genetic. If it makes you feel better to blame anorexia on genes, then so be it. It's a disease of deception, and if you're unfortunate enough to suffer from it, it requires facing the truth, not believing in an external cause like genetics, for which one can cast blame on, and absolve themselves of responsibility.

[lukasahero]

30. Funny you make that assumption

I never said it was me.

[WiseButAngrySara]

36. "your parents" and "their daughter" and your hostile defense...what would

you assume? I didn't discount the possibility that you might not have been talking about yourself.

[lukasahero]

38. It was deliberate

Talk about hostile defense. It was the hostility of your post that made me assume you would get all self-righteous and personal if you thought it was me. Like I said, interesting.

[ShortnFiery]

59. Even in families with strong genetic factors, the environment plays

an important role in the exact "expression" of the illness.

Whether we're focusing on mental or physical illness, what is referred to as "nature and nurture" are ever interacting to produce the visible result.

Some people fast once a week to cleanse their body of toxins. If you've got the self control, my hat's off to you and it' probably is an asset to your overall well being.

However, this seemingly modern, mostly affluent western society behavior of far too many young girls (and some young boys) of "disrespecting one's body" through abject starvation (an image vice an health focus) component is very disturbing to many of us parents.

Every individual's body is different in proportion. If you're 5'10" it's a cinch to *look bone thin* and still strike a healthy balance of dieting (food restriction) while attaining the proper balance of nutritional intake.

None of us has all the answers to these puzzles, but IMHO, there's always an nature-nurture interaction going on that is difficult, if not impossible for us to "tease out."

[lukasahero]

63. I agree with you entirely

I am a big supporter of not "nature vs. nurture" but "nature plus nurture". I agree that nurture plays a large role. I am also, however, interested in learning what nature has to do with it. I am curious to understand how it all plays a part so that we can help these young women (and men). And I am happy to see some medical studies being devoted to the subject.

Finally, I was curious as to why the poster I responded to would object to such a study being posted for discussion in GD as if it's not worthy of such? I would think that the more we can learn about the disease, the better off our sons and daughters who suffer from it would be.

[WiseButAngrySara]

72. The author of this post has posted numerous articles in GD on anorexia

nervosa, and I am very curious as to her motivations. I not only think that GD is not the correct forum for such a post (and you see the moderators apparently thought so too) but I think that blaming genetics for anorexia nervosa does nothing to cure the major etiology, and that is the sick culture that we currently live in.

[HuckleB]

75. Numerous?

LOL!

You mean I posted the Newsweek article in December. You ranted and raved then without substance then, and now you're doing it again.

[Name removed]

78. Deleted sub-thread

Sub-thread removed by moderator. Click here to review the message board rules.

[KurtNYC]

77. I don't think "blaming" is the right word

The OP links to several scientific studies that look into a genetic component for this. You haven't cited any backup for your theory. Science looks for causes, mechanisms and cures--not blame.

Certainly a component of anorexia is low self-esteem -- all the more reason that "blame" should be used sensitively in any discussion of how to help people with this condition.

[AngryAmish]

5. Mental illnesses can have a genetic component

And some may be caused by infectious disease (no cites but I am repeating what I have heard in the press).

[wisteria]

7. I disagree with you, I had the disease and now my daughter has it

also. I also think my grandmother fought this disease her whole life. She never weighed more than 93Lbs her entire life and always watched what she ate.
Oh, and by the way, I do not consider myself a poor parent.I love and encourage all my children to be the best they can be and support them in their efforts. I would give my life to see my daughter become her beautiful self again. We almost lost her once, now she maintains, but it is a constant struggle with poor body image and self doubt. Some of this is certainly social, more psychological,but I firmly believe there is a genetic link. I had no help or understanding when I went through this. I came around and started to maintain my weight after I made the decision that I wanted to live and not die as I crawled up the stairs of my home because I was to weak to walk upright. Anorexia and bulimia are serious health issues and the sadness and destruction they cause in people's lives should not be dismissed so nonchalantly.

[Bridget Burke]

21. One hears about ladies who "went into a decline"....

In the old days.

Anerexia & bulimia may well have genetic links. The current environment also encourages thinness to an unrealistic degree.

(Infotainment heard on TV as I was waking up: "Before XXXX, I was a size 6. Now I'm a size 0!")

[LostinVA]

33. That's true! I never thought of that...

Often because of a rejection... maybe a certain type of depression, etc. in some people makes it kick in???

[Bridget Burke]

39. And in the old days, those ladies were often turned over to doctors....

Whose favorite treatments included bleeding & application of leeches.

They didn't have a chance.

[LostinVA]

40. Ick. I know... excessive bleeding killed Lord Byron, and probably

George II....

[freeplessinseattle]

9. wow. feeling a little angry but insensitive today? eom

[WiseButAngrySara]

12. Wisdom speaks for truth. If there is a genetic component in eating

disorders, it is bound to be a minor one. Just look at how television, movies and magazines portray "average women" and then actually look at the women around you! I think that women are overweight AND underweight because of the faulty image that the media gives those who pay attention to it. To blame it on genetics is IRRESPONSIBLE.

[HuckleB]

16. Funny, the evidence available clearly disagrees.

There is no wisdom in the inability to challenge one's views with new information.

[SmokingJacket]

18. Why can't it be both?

Some people are more susceptible to "society's message," -- that's obvious. Some people become overweight, some under, and some are not affected. Couldn't genetics at least partially determine how we respond to the unreasonable expectations of society?

(I realize I'm arguing both sides in this thread... but that's what kind of day it is! :crazy: )

[WiseButAngrySara]

22. I never argued otherwise, but like alcoholism, it has to be a very minor

component. And like alcoholics, this will be used as an excuse to face up to the real major issues behind the disease; it's so much easier to blame it all on genes.

[LostinVA]

29. It's not a minor component in alcoholism

I come from an extended of alcohoics... I know of which I speak.

[WiseButAngrySara]

54. I would argue that in the context of most alcoholics blaming it on their

genes, it is most likely environment!

[LostinVA]

58. Not if they are an alcoholic. Alcoholism is a disease

You can be a "drunk" and not be an alcoholic. Just like you can be an alcoholic and never drink a drop in your entire life.

[XemaSab]

73. That's not medically supported

Why do you think alcoholism is so rampant among Native Americans?

Everyone responds to and metabolizes alcohol differently, and that's determined by genetics.

My family are hard drinkers, but as far as I'm aware, there's no alcoholism, because we don't have the genetics for dependancy.

It's possibly similar with anorexia, where there are cultural factors in play, for sure, but food and how we respond to food... that's biological. I feel the cultural pressure to be thin, but if I don't eat regularly I go nuts, and that's a biological limit on dieting.

[Bridget Burke]

28. "Blaming" conditions on genetics so you can ignore them....

Might be irresponsible.

But realizing a possible genetic factor exists might remove some of the guilt caused by sanctimonious onlookers. So the mind can concentrate on Getting Better, rather than self-flagellation.

[HuckleB]

34. Exactly.

And many, if not most, anorexics are already quite good at "self-flagellation," which makes an unsustainable belief that "it's all in the mind" all the more dangerous.

[HuckleB]

13. It is the general discussion page.

For general discussion topics. The evidence says it is clearly genetic. You can ignore the evidence, of course. That's your choice. But ignoring evidence it doesn't make your stand viable.

I haven't posted much at DU in general in months. So thanks for offering up a very misleading response on all accounts. I hope you don't run into people who actually must live with an eating disorder. Your attitude and chosen avoidance of information is likely to lead to a very triggering conversation.

[WiseButAngrySara]

47. One of my dearest friends is the director of an eating disorders clinic in

a large medical center in a metropoliitan city. Interestingly, she had anorexia, AND she had a twin sister, who had no problems at all with eating, nor did her mother. She believes that the trigger for the onset of her disease was when her twin sister was diagnosed with osteosarcoma, requiring amputation. She has interviewed thousands of young women suffering with anorexia and/or bullimia, and believes like I do, that it is largely psychosocial. She believes firmly in the parental role and the role of the media, although does not discount the possiblilty of genetics playing a minor role, nor do I. She told me a few years ago that a history of sexual abuse was very frequently observed in many of these women, and I didn't believe her until I had researched it independently. I met her socially without knowledge of our shared interest in eating disorders; that was just an added bonus to our friendship.

I had anorexia years ago, before it was discussed in the media. I know exactly what triggered my disease. It was my mother's fear of me getting fat. I was 5'6" and weighed 125 pounds (the most I've ever weighed in my life). I was nominated as runner up to 'Most Beautiful' by my high school peers, and was popular enough, so it was never peer pressure. It was my mother's fear of fat and my father's tacit approval
that triggered my anorexia, which lasted for several years. I starved myself to "be ye perfect", and the fasting got easier and easier; one just lost interest in food, and the starvation decreases the hunger pangs. I weighed 90 pounds at my low point, and still thought I was fat. I was so insane, that terror gripped me before I would step on the bathroom scale! I haven't owned a scale in years, and my weight has been steady at 118 pounds for as many years.

Ironically, the fasting increased my spiritual interest. It was my father's concern for me that made me realize that I was not the only one in the universe that believed that they couldn't eat. And that started the healing, reading everything I could on the subject, and at that time Hilda Bruch was the primary author. I have thankfully, been healed for years. My mother has always been thin, as has my sister (whom I've suspected of having an eating disorder herself), and they both restrict their calories, but always hide it by saying that they can eat whatever they want, having lucky metabolism. My sister is repeating the lies of my mother. Thank God I'm out of that sick mind-set. Do I think that this is genetic because my mother and sister seem to have eating disorders of some sort? Not in the slightest. It is vanity, and wanting to live up to sick social norms.

BTW, I have a masters degree in biochemistry and an MD, and am trained in pathology. So, if you think for one minute that I'm in any way ignorant about genetics, you are so wrong.

Be grateful that I disagreed with your post that 50% of eating disorders are genetic. You certainly got more responses that way. Genetic studies are often done to support a preconceived notion about what scientists want to believe.

[HuckleB]

50. Oh brother.

That has to be the funniest post I've read in some time. Sorry, but your posts make it very clear that very little of what you just claimed is true. You've offered nothing that indicates the knowledge you claim to possess. You seem to believe that everyone with anorexia must follow in your path. That's simply unreasonable. I've faced serious depression, and I know its triggers, but I make no general assumptions based on that.

What eating disorders clinic does your friend direct?

[Name removed]

52. Deleted message

Message removed by moderator. Click here to review the message board rules.

[HuckleB]

55. Sorry, I've been around too long to buy into such game playing...

Thanks for noting that there is no connection to an eating disorders clinic. It's not about identifying the doctor, but about not wanting to identify a clinic that either doesn't exist or is treating patients based on old information. If you know such an "expert," surely you could have and would have offered us some of his/her published studies. Either way, the rants you continue to offer are still just rants, with no connection to evidence, practice or study. So many repeated claims, with no science-based evidence whatsoever to back them up.

Show your knowledge, if you actually possess it.

[WiseButAngrySara]

66. It most certanly does exist, and you would recognize the medical center.

What is your interest in this topic? Are you afflicted with this disease, or are you doing research yourself? What is your authority? How dare you accuse me of lying. The connection to the evidence is personal experience. All science is based upon experience.

Show your interest and your motivations for making this post.

[HuckleB]

69. LOL!

More of the same. How dare you offer off-the-cuff rants based in minimal and dangerous "knowledge," and then claim that they're viable because you are such and such. Umm. It doesn't work that way. Show your knowledge. Name the clinic. Then we'll talk further.

[WiseButAngrySara]

70. Lady, I just did a search on all of your posts, and the only posts on

anorexia nervosa (and diet!) were posted by you...Many of them. I find that so amusing and quite telling. And you see, your thread was moved to where it should have been posted in the first place.

I also gather that you're a nurse. They frequently suffer from anorexia; again, not genetic.

[Name removed]

74. Deleted message

Message removed by moderator. Click here to review the message board rules.

[HuckleB]

83. Lady?

Thanks for showing us your stripes -- again. All of them were in the health forum.

I suppose this line of distraction is meant to divert us from the unwarranted and unsupported claims you've made. Nice try.

[seleff]

24. Anorexic daughter, family history of depression/anxiety

First, studies such as these and ones to follow will pinpoint the genetic predisposition factors to a variety of mental/behavioral disorders. Through our family experience and reading there appears to be a high comorbidity between anxiety/depression and OCD with anorexia. There is a growing (and now becoming irrefutable) that more common behavioral disorders such as anxiety/depression and OCD have a number of genetic loci that determine increased risk for developing these behavioral disorders. The studies cited in this thread are ones that suppport the idea that at least some sufferers of anorexia nervosa are predisposed to the disorder due to their inheritance of certain alleles at yet to be identified loci. At the same time, discovery of the exact loci and allelic variations that are predisposing will remain ellusive as we are learning that genetics is not as simple as Mendel first described. Besides dominant and recessive alleles, there are phenomena such as incomplete dominance, genomic imprinting, alternative RNA splicing, polygenetic interactions, and many others that will leave us with a dim understanding of how predisposition translates into disease for quite some time. For instance, recent research points to the genetics of left-right handedness as being controlled by a genetic locus that acts in an unconventional matter. There is a dominant allele which if inherited will determine one to be right handed. Failure to possess that allele from either parent doesn't determine one to be left-handed. Rather, being homozygous for the non right-handed allele makes one's handedness to be random (50-50 chance of being left or right).

Now, what are the psychosocial factors that contribute to developing an eating disorder. I believe that these are no less complex. What in our family's parenting has contributed to our daughter's anorexia? Is it because I'm a PhD that failed at being a University Professor because I became highly involved in my children's education/activities and upbringing at the expense of my career. I know that during my daughter's worst times she lost respect for me because instead of being a Prof like my PhD wife, that I'm (in her eyes) a lowly HS Science teacher (who is also 20-30 lbs "overweight"). Or was it because she also witnessed me going through episodes of depressions when I failed to get grant funding as a Professor, or lost a job when the biotech company I worked for ran out of money and was acquired by a company that decided not to pursue the area I was working in? Or was it that she overtrained as a distance runner due to a compulsion not to be a "fat american" and a belief that she could getr faster and faster if she just kept getting a bit more lean? When she dropped below 88% of "ideal" body weight, her ED voice just kept getting stronger and stronger to where she could only be treated in an inpatient setting. After 18 months of hard work with therapists, nutritionists, sports medicine docs, psychiatrists, family therapy, group therapy (4 months total was in a treatment center), her body is mostly healed, but her mind is still disordered (at 5'3" and 102 lbs she thinks she is horribly fat). During recovery she has faced failures/disappointments in school, athletics, friendships, artistic pursuits, music achievement that she rarely had to experience before, yet she is maintaining (though still somewhat depressed and obsessed).

My question to you...on what authority do you speak (including your posts below)?

[WiseButAngrySara]

49. See post #47. I not only have a personal distant history of anorexia,

but I have a master's degree in biochemistry and an MD degree, having specialized in Pathology. My authority? Personal authority. It speaks louder than any so-called expert.

[seleff]

91. Thanks for your post and I'm glad to hear that you healed

I agree that the genetics literature is stuffed with these type of (weak) linkage studies, and this particular one isn't really showing linkage, just supporting some kind of pre-disposing factor comparing twins to sibs. I don't expect to look at a chromosomal map in 30 years and see an Anx-1 locus or anything (unless we're talking about a locus contributing to anxiety/depression...even then it will be a pre-disposing site, not a determinant site). As a biochemist and MD I expect that you are struck by the physiologically intense and powerful grip that your anorexia developed as you became low weight, where you could restrict even while starving. I haven't done enough reading to see if I agree that there is a good link between endorphin action and desensitizing to the hunger response, but it was cited in therapy with my daughter along the way. I read a paper by a clinician at the U Minn (don't remember the name) that proposed that anorexia responses may have evolved in human (women) descended from migrating populations (indo-europeans, but less so in africans) as a means of maintaining energy levels to tend to children while the tribe was trying to escape famine. The article posed some compelling arguments, but I don't remember them all.

While I agree that psychosocial factors dominate this disease, the biological pattern and commonality of signs and symptoms in restricting anorexics compel me to believe that there are/will be genetic factors identified that pre-dispose some women to developing this disorder. 18 months of on and off family therapy (and talking to my daughter's therapists the first 8 months of her disorder) have failed to really pinpoint any "blame" for my daughter's condition. I've shared some of the possible factors in one of my other posts. Several authors I've read point out that the family may or may not be "to blame". In my daughter's case i think several factors came together. 1) she had had two previous experiences with a precipitous depression that came and went suddenly in the course of 2-4 weeks; 2) she has had a crisis in her teenage life where she deeply wants to "be somebody" or achieve something great, without knowing what. Early success in distance running as a ninth grader made her think she could train to excellence so she really trained the summer before her So. yr and dropped weight from 103 to 80 lbs running cross-country in the fall. We didn't see the signs of anorexia until she had dropped below 88 lbs, partly because everyone was excited with her drops in time and becoming a State -ranked runner along the way. Her therapy has had to deal with this yearning for identity. Maybe spirituality (we do not practice organized religion in our family although we celebrate jewish holidays, and Latvian cultural holidys-Xmas "winterfestival" and easter (egg hunts)) might be helpful to her. Any advice would be helpful along these lines.; 3) her older sistr went off to college and my mother in law died of cancer the year before. My (anorexic) daughter feels very close to both (especially "ol'mom") and both could have offered much support (older sister did) recognizing what was going on and in recovery. Instead, my daughter grasped onto an older girl on the cross country team who was a normal weight anorexic and who was very strong about "watching what you eat". I believe that my daughter always worried about "what would Anna say" when she approached food, and used Anna almost as a spiritual guru in her development of restrictive eating patterns.

Even though my daughter has recovered her normal weight (103 lbs), the disease has scarred her body and mind. For awhile, it really wrecked our fathr-daughtr relationship, which has gotten bettr.I keep hoping that the scars will fade.

Gotta run to take my 11 yr old son to get sushi (his favorite) for lunch!

[WiseButAngrySara]

92. Seleff, I'm working on a response to both of your posts, and I will PM

(Private Message)you as soon as I've finished, probably later today or tomorrow. I hope the best for you, your daughter and your family. I'll share further some of my insights, and I'll give you the name of my friend and her institution, should you desire to contact her.

Hope you and your son enjoyed the sushi! My older brother's favorite also...I tried many times to like sushi, but liked to look at it rather than eat it!

[spooky3]

95. No competent scientist would value "personal authority" over controlled

studies published in top refereed journals, when it comes to determining cause and effect.

[LostinVA]

27. Very legit studies have shown it bridges generations

so it's at least partly genetic/hereditary.

Although society, the media, etc. sure as hell don't help a woman's (or man's) self image... that's for sure!

[mzteris]

43. Hasn't it been linked to

OCD?

[HuckleB]

44. The comorbidity percentage is quite significant.

[SmokingJacket]

8. So why would it be increasing?

http://abcnews.go.com/GMA/HealthyWoman/story?id=808891&page=1

It's showing up more in older people AND younger children:

http://www.abc.net.au/am/content/2003/s921348.htm

I agree there's probably something biochemical going on -- and the "risk factors" appear to have a genetic base -- but there are cultural factors, too. It is more common among certain social classes, for instance.

I struggled for a while with this as a younger woman. I'm certain that if thinness weren't so valued in my family and school and country, my anxieties and neuroses would have manifested themselves differently.

[HuckleB]

14. No one is denying environmental factors play a part.

Read the newsweek link on my original post. That's where the info. in the articles you noted came from.

Further, the study that just came out notes the correlation with anxiety and mood disorders. The rise may have much to do with a connection there, as those who work with anorexics have wondered for some time.

[SmokingJacket]

17. Sorry, misread your OP!

:hi:

Seems to me we have *so much* to learn about how the human mind works... and how it's connected to the human body...

[KurtNYC]

23. I think the incidence of anorexia is going down

I have looked for statistics, including in that both ABC articles (neither includes any statistics in spite of what the headline says), but they seem hard to come by. But I note this:

the majority of people with anorexia are white girls from middle/upper income families, aged 12 to 18 years. Typically, they are intelligent, sensitive, well-behaved individuals but with a low self esteem.

http://www.annecollins.com/eating-disorders/anorexia.htm

And the number of people in that demographic is dropping. Real average incomes are down and the birth rate is down. A correlation with income cuts against the case for genetics.

The other thing I am curious about here is the difference between an eating disorder and true anorexia. They key difference between the 2 being that while many people take weight consciousness to an extreme, anorexia is characterized by a distorted body image.

There are other studies which seem to show that anorexia is about control (or starts that way). Full blown anorexia can stop menstruation. So if we look at the majority of cases (12 - 18yo mid/upper class girls), is this actually the result of not wanting to grow up? is it a kind of passive aggressive control used against highly successful, perhaps demanding parents?

Still more studies have looked at dopamine and endorphins as being the mechanism that perpetuates the condition. It is well known that fasting induces a kind of high. Is it possible that what starts as severe dieting becomes an addiction to one's own internal heroin?

[HuckleB]

31. It's actually difficult to note...

since, like many mental health issues, actual diagnosis and focused treatment have increased, it's difficult to know if the actual incidence has increased or decreased.

Can you link me to some studies (or a review) regarding the control and anorexia issue?

Gracias. Salud.

[KurtNYC]

67. Googling for studies and using the word "control"

gets me way too many results because in most studies there is a "control" group (different sense of the word). The link I used in my prior post mentioned control but that is more of an observation and not something which they cite as backed up by a specific study(ies).

The best I can do right now is the clinical definition of anorexia. Subjects must meet four criteria. The first is:

Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).

http://en.wikipedia.org/wiki/Anorexia_nervosa

And there I focus on the word "refusal" which implies a passive aggressive kind of control (albeit over one's own body). Perhaps I can find analysis of aggregated case histories which back up the idea. Of the Google links I did look at, many include phrases like "my weight was the only thing in my life that I could control."

[seleff]

37. Your citations jive with our experience

My daughter's experience fits well with much that you cite. My wife and I are PhD scientists, our first daughter turned out smarter than either of us, and the second daughter discounts her own gifts and has suffered from an unrealistically low self-esteem. Her expectations of herself have generally exceeded ours, maybe therein lies the problem...maybe she wants us to expect as much from her as from her sister. She also may feel pressure to achieve based on extended family examples. My wife's family were WWII refugees from eastern europe. My Father-in-law is a successful electical engineer, Mother-in-law was a psychiatrist (not many women got MDs in the 50s), father in law's brother is a well known Calif artist and his wife is a PhD biochemist (again women getting PhDs in the late 50s/early 60s was rare). So the message to her by example is that women must be highly accomplished. As she has had anxiety about her own achievements, she figured that she could control her weight and be the skinniest girl at school, if not the most accomplished (although she was recognized that year in so many ways: 2nd chair cellist in youth orchestra, 6th in State cross country race, selected for Governors Honors Program in visual arts, won some art competitions, all A student, played on a soccer team that was ranked about 14th in the State).

As with other mood disorders, nature-nurture must be interacting. But the most striking thing to me was how powerful her Eating Disorder "voice" became when she fell below 85% normal body weight.

[SmokingJacket]

45. Well, I have my own theories...

In the case of anorexia, the studies are conflicting and difficult to interpret. I think it's safe to say no one is really certain what the hell is going on. People *are* fucked up about food, but perhaps it has been ever thus -- I don't claim to be an expert.

I know it hit me right before I went away to college. It was about a lot of things -- yes, about not wanting to grow up and be sexual, but also about my perfectionism and my anger at my mother. It was as if all of a sudden, my anxieties and my confusion about my identity morphed into a desire to be as thin as possible. Really. I remember actually *deciding* that losing however many pounds would solve all my problems.

And all these years later, I can still remember the wonderful feeling of walking down the street, knowing 1)knowing I hadn't eaten all day, and 2)my body was shrinking at that very moment -- I could feel it happening. It *was* a high -- it was ecstatic. Like a former junky, I miss that feeling sometimes.

I think with some people, once the dieting ball gets rolling, it snowballs, to mix metaphors. But the dieting in the first place -- the hatred of one's body -- comes from the culture.

[WiseButAngrySara]

56. I can so relate to this...the perfectionism, the strange ecstatic 'high'

and, the likely etiology--culture. (Not primarily genetics)

[Bridget Burke]

80. I'm glad you're modifying your opinion.

From "It's NOT genetic." to "Not primarily genetics."

[HuckleB]

61. A very thoughtful post.

With some good insight, re: "the dieting ball gets rolling," though I'm not sure how the connection to culture slips in. Again, yes environment plays a part. Still, there is much more to the picture, IMO. What is looked at as dieting, for example, could be the mild, early stages of anorexia, just as what's looked at as "wanting time to oneself" can be the mild, early stages of anhedonia and depression, for one example.

Other research:

Specific regions of brain implicated in anorexia nervosa, Univ. of Pittsburgh study:
http://www.medicalnewstoday.com/medicalnews.php?newsid=27094

Alterations in brain serotonin activity may be associated with anorexia nervosa:
http://www.medicalnewstoday.com/medicalnews.php?newsid=30238

[SmokingJacket]

79. Like I said, it's just my own personal theorizing...

but I do think humans are social creatures, and so much of our identity comes from our place in the social order. I wanted to be the thinnest person in the room -- because that would mean I would have achieved something that was important and undeniable. It sounds silly now, but it wasn't as if this thing descended on me out of nowhere. Chemicals didn't make me want to diet, though certainly they were what made me do it with such near-lethal ferocity...

And I admit that while I'm no longer anorexic, I would to this day win no mental health award...

[HuckleB]

87. It's not silly.

For many, it's part of the deal, and you experienced it first hand.

I appreciate your posts. Take care.

Salud!

[SmokingJacket]

88. Thank you...

Interesting and telling sig line, btw!

[diamidue]

65. I think the incidence

The other thing I am curious about here is the difference between an eating disorder and true anorexia. They key difference between the 2 being that while many people take weight consciousness to an extreme, anorexia is characterized by a distorted body image.
--------------------

Thank you for posting this. It is an important point. There is a difference between the model and the ballet dancer who have to keep their weight down for their jobs. They KNOW they are thin. Whereas the anorexic would be thin and still see themselves as fat. I've also been curious about the other points you make: passive/agressive control against demanding parents or not wanting to grow up. Thinking this is solely about "vanity" is simplistic nonsense.

[HuckleB]

68. Re: differences and definitions/criteria

http://www.medicalnewstoday.com/medicalnews.php?newsid=13278

http://www.kartiniclinic.com/

[wisteria]

76. Exactly, I had a distorted body image and a need to feel in control of

something in my life. To this day, I still think I am fat. I have weighted as little as 82Lbs and as much as 140lbs (when I was pregnant).
At my lightest weight, I was exercising three times a day and actually had sores due to the pressure points from exercise where my bones protruded through my skin. Perhaps, there are differences in what trigger this as well as the trigger as well as similarities.

[etherealtruth]

20. Thanks for the post and links ....

This certainly is a topic worthy of discussion.

It's very gloomy here and has affected my attitude today; I am sadly contemplating whether we are capable of ever overcoming the "quirks" in our genetic material.


edit: affect/effect; I don't know

[HuckleB]

86. I think you got it right.

Re: affect/effect!

:)

Salud.

[progressivebydesign]

32. Then why was anorexia not rampant in the 30's or 40s or 50s??

I understand that there can be a genetic issue to that type of personality or drive, BUT.. the idea of wanting to starve yourself to look thin is was NOT prevalent before the media and corporations pushed thinness to the extreme. Does that make sense?? Yes.. there is a genetic link for some that makes them have an obsessive perosnality... but what they do with it, that has to do with images. "no one to blame"... ah.. I see the purveyors of heroin-chic, the advertisers get off scott-free here. Have any of you looked at a mag for teen girls?? The models in all the ads and editorials are around 90 pounds, with pumped up breasts and hollow eyes.. and rarely smiling.

[HuckleB]

35. Please read the actual articles...

and not the goofy headlines. Second, why assume that the incidence is actually higher now?

[LostinVA]

41. How do you know it wasn't?

[mzteris]

48. you ever really looked

at pics of women in the 30's, 40's, 50's?

Most of them were REALLY THIN!


1930's






1940's





40/50's




50's













My opinion is that

A) the diet was better - less processed foods, less soda/chips/etc, less high fructose corn syrup; &

B) people "worked" harder. Walked more. Fewer "conveniences". Vacuuming took more physical effort, as did cooking, washing, cleaning, etc.

[diamidue]

42. Thin does not mean anorexic

In order to be considered "anorexic", don't you have to originally have started out at a normal weight and then for some reason begin to starve yourself? Some people want to classify ALL thin people as anorexic. Many, many people are just naturally thin, and others just eat too little to be fashionable. But that is not the same as anorexia. It seems to me that something is tweaked in the brain of an otherwise intelligent woman to suddenly come to the conclusion that weighing 70 pounds is fat.

[porphyrian]

46. So, it's like a genetic OCD basically?

I wonder if OCD medication has any affect on anerexics. Any psychiatrists in the house?

[HuckleB]

53. FYI...

A start, re: medication treatment and eating disorders...

http://www.psychiatrictimes.com/showArticle.jhtml?articleID=175802390

OCD also likely has a strong genetic component.

[VelmaD]

51. Of course they want to find a "genetic basis"...

for eating disorders...hell what they really want is to find out it's all chemical so they can drug more people into a stupor rather than dealing with the misogyny in our culture that encourages women to commit self-harm just to look acceptable. :eyes:

Anything to avoid having to own up to the pervasive sexism of our society.

[HuckleB]

57. Wrong.

Drug companies are not doing studies to get FDA approval for medications to treat anorexia or bulimia, as the money ain't there for them. Please be open to information that questions your worldview, as that information may help women and men find their way to health.

[WiseButAngrySara]

60. Thanks! I agree. More money for the pharmaceutical industry. n/t

[HuckleB]

62. Please show us how the pharm industry is trying to make money...

treating eating disorders, specifically. Your friend, the director of the eating disorders clinic, has surely spoken to you about the frustration of professionals regarding the lack of studies re: medication treatment for eating disorders. And, why is that? Because the money ain't there for the pharms. Well, it's there. I assure you of that. But it's not big enough for them.

[seleff]

90. Maybe side effect profiles in depression studies will promote successful o

As my daughter was in a facility, it seems most of the women/girls were taking psychotropic meds such as SSRIs probably for co-morbid depression or an atypical antipsychotic (like respirdal) for obsessive thoughts (about food, adaptive for someone who is starving). One would think that that clinicians from some of the larger clinics could collaborate to run trials to compare SSRIs or other commonly used meds to see which might be more effective appetite stimulants for restrictive-type anorexics. On the other hand, as I've learned, while underweight my daughter may have said she had no appetite, but in reality she knew she was hungry and starving. Regardless, some of the limited studies I have seen and expect will continue will be with existing already approved meds. Since I don't think anorexia is a problem in traditional societies, I don't expect that studying Shamans or traditional Chinese herbal medicine will identify any helpful agents.

[HuckleB]

94. Small studies are being done, and have been done.

The cost of control groups makes it fairly prohibitive, unfortunately. Preliminary research shows Zyprexa and Seroquel to have some benefit, as per your comment about Risperdal. SSRI's have been seen to possibly help with Binge-Purge behaviors, and they may help maintain remission of anorexia. Again, though, the studies have been fairly small to this point.

[lukasahero]

64. Yeah, because it's not like big pharma is making any money

treating mental/psychological diseases or anything, right? :rofl:

[Odin2005]

71. Bullshit!

I'm fucking sick of the blank-slate brigade. As a person with a psycological disorder (ADHD), that whole post is insulting.

[WiseButAngrySara]

81. Some books on the psychosocial origin; Genetics has to explain why no men.

Any explanation concerning the role of genetics as an etiological mechanism for eating disorders has to explain the vast preponderance of women in the affected group. Perhaps the few men patients should be the ones studied genetically, as they seem least likely to be affected by psychosocial or cultural pressures, with the exceptions of 'high risk' groups like hockeys and others that need to control their weight. Three excellent books on the psychosocial role in the development of eating disorders are:

Anorexia and Bulimia; Anatomy of a Social Epidemic
by Richard Gordon, 1990,

The Obsession; Reflections on the Tyranny of Slenderness
by Kim Chernin, 1981, and

The Hungry Self; Women, Eating, and Identity
by Kim Chernin, 1985.

These are all a wonderful source for references.

[HuckleB]

84. All published before most of the actual research on anorexia occurred.

I guess we should do the same for all health care matters.

[SmokingJacket]

89. I knew an anorexic guy.

A very sweet, sensitive, and spiritual man, who also had depressive issues. He was one of the thinnest people I'd ever met, but it *never* occured to me that he might be deliberately starving himself, until years later when he told me. Poor guy!

One thing about anorexics.... they're obsessed with anorexia....

[Nikia]

82. The leader of my eating disorder support group says:

"Gentics loads the gun and environment pulls the trigger."
I think that in addition to obvious triggers like abuse and the media obsession with thiness, another big trigger is obsession with success. Of course for some, thiness=success.
I think another trigger for the gentically predisposed is engaging in the behavior. I think it is like alcohol in this respect. Some people who get drunk every weekend in college can give up the behavior easily while others become alcohols. I think the same is true of fasting and low calorie diets. I do know that whenever I fasted or took in few calories, for even a short time for any reason, that I didn't want to go back to normal eating, that normal no longer felt naturual anymore. Also, the thinner I have been, the more obsessed with my weight I became.

[HuckleB]

85. Good post.

Now that's what I call wisdom.

[varkam]

93. Very true...

It's like with schizophrenia - there's approximately a 50% concordance rate for schizophrenia in monozygotic (identical) twins; if one gets it, there's a 50% chance the other will as well. But they have identical genetic makeup, so there has to be other factors as well besides genetic determinism.

I think it's probably the same issue here with anorexia. While there may be a genetic predisposition towards being anorexic, environmental factors also probably play a role (e.g. susceptibility to social pressure).

I like that quote though, it sums it up rather nicely.