Internalizing and Externalizing Behaviour Problems in Childhood Contribute to the Development of Anorexia and Bulimia Nervosa—A Study Comparing Sister Pairs

Authors


Prof. Andreas Karwautz, MD, FAED, Department of Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Tel: +43-1-40400-3012; Fax: +43-1-9147317.

Email: andreas.karwautz@meduniwien.ac.at

Abstract

Objective

We wanted to clarify whether there is any clinically relevant behavioural psychopathology in patients before onset of an eating disorder (ED) compared with their healthy sisters and if there are differences in behavioural problems between the ED subtypes anorexia nervosa—restricting type (AN-R) and EDs with bulimic behaviour.

Method

Behavioural psychopathology was examined by parental report using the Child Behaviour Checklist retrospectively in 83 sister pairs discordant for an ED (37 with AN-R and 46 with bulimic EDs) by means of conditional logistic regression.

Results

Participants who later developed an ED had significantly higher internalizing and externalizing behavioural abnormality scores before onset of the ED than their unaffected sisters. Conditional logistic regression revealed significantly higher internalizing behaviour scores in AN-R and significantly higher internalizing and externalizing scores in the bulimic disorders.

Discussion

Internalizing problems (anxiety, depression and somatization) preceded the development of AN, whereas both internalizing and externalizing behaviour problems (aggressive and delinquent behaviour) preceded bulimic disorders. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

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