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A nation-wide study of the family aggregation and risk factors in anorexia nervosa over three generations

Authors

  • Hans-Christoph Steinhausen MD, PhD, DMSc,

    Corresponding author
    1. Research Unit for Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
    2. Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Switzerland
    3. Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland
    • Correspondence to: Hans-Christoph Steinhausen, Research Unit of Child and Adolescent Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark. E-mail: hces@rn.dk

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  • Helle Jakobsen MS,

    1. Research Unit for Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
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  • Dorte Helenius MS,

    1. Institute of Biological Psychiatry, Psychiatric Centre St. Hans, Roskilde, Denmark
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  • Povl Munk-Jørgensen DMSc,

    1. Department M, Aarhus University Hospital, Risskov, Denmark
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  • Michael Strober PhD

    1. Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, California
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  • Supported by Resnick Family Endowed Chair in Eating Disorders (to M.S.).

ABSTRACT

Objective

This nation-wide register-based study investigated how often anorexia nervosa (AN) and co-morbid disorders occur in affected families compared with control families. Furthermore, the study addressed the impact of sex, year of birth, and degree of urbanization in terms of risk factors.

Method

A total of N = 2,370 child and adolescent psychiatric subjects born between 1951 and 1996 and registered in the Danish Psychiatric Central Research Register (DPCRR) had any mental disorder before the age of 18 and developed AN at some point during their life-time. In addition, N = 7,035 controls without any psychiatric diagnosis before age 18 and matched for age, sex, and residential region were included. Psychiatric diagnoses were also obtained on the first-degree relatives as a part of the Danish Three Generation Study (3GS). A family load component was obtained by using various mixed regression models.

Results

AN occurred significantly more often in case than in control families. AN Risk factors included having a sibling with AN, affective disorders in family members, and co-morbid affective, anxiety, obsessive-compulsive, personality, or substance use disorders. Furthermore, female sex, and ascending year of birth were significantly associated with having AN. Urbanization was not related to the family load of AN and case-relatives did not develop AN earlier than control relatives.

Discussion

These findings based on a very large and representative dataset provide evidence for the family aggregation and further risk factors in AN. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:1–8)

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