ANOREXIA-NERVOSA AND ANOREXIC-LIKE SYNDROMES IN A POPULATION-BASED FEMALE TWIN SAMPLE

Objective: The authors explored the epidemiologic characteristics and risk factors of anorexia nervosa and examined the relationship between narrowly defined anorexia nervosa and anorexia-like syndromes. Method : Structured interviews were administered to a population-based sample of 2,163 female twins. Anorexia nervosa was diagnosed by computer alg orithm (''computer narrow'') and by narrow and broad clinical definiti ons. Results: Lifetime prevalence estimates of 0.51%, 1.62%, and 3.70% were obtained for the computer narrow, clinical narrow, and clinical broad diagnoses, respectively. Dieting status, greater number of years of parental education, low self-esteem, high levels of neuroticism, a nd maternal overprotectiveness were significantly associated with anor exia nervosa. Both the pattern of comorbidity and the relationship to epidemiologic risk factors suggested an etiologic continuity between n arrowly and broadly defined anorexic syndromes. Co-twins of twins with anorexia nervosa were at significantly higher risk for lifetime anore xia nervosa, bulimia nervosa, major depression, and current low body m ass index. Significant comorbidity was found between anorexia nervosa and major depression, bulimia nervosa, generalized anxiety disorder, a lcoholism, phobias, and panic disorder. Conclusions: The authors' anal yses support the hypothesis of a spectrum of anorexic-like syndromes i n women. These syndromes are familial and share familial etiologic fac tors with major depression and bulimia nervosa.