Can Eating Disorders Be Predicted?

Megan Brooks

December 10, 2020

Several factors present in early adolescence may help predict eating disorders, which would create opportunities for earlier intervention and prevention, new research suggests.

Investigators have identified several factors present in early adolescence that may help predict disordered eating behaviors (DEBs).

Higher body mass index (BMI), neuroticism, impulse control, and addiction-related behaviors at 14 years of age were differentially associated with future DEBs and symptoms of depression and generalized anxiety, they report.

In addition, genetic analyses showed strong etiologic overlap between BMI, neuroticism, attention-deficit/hyperactivity disorder (ADHD), and disordered eating.

The study was published online December 2 in JAMA Network Open.

Sylvane Desrivieres, PhD, King's College London, United Kingdom, and colleagues analyzed data from the IMAGEN population study, which included longitudinal measures of eating disorder symptoms and numerous other psychiatric and psychological constructs in addition to genomics.

The findings are based on longitudinal assessments of 1623 adolescents recruited at a mean age of 14.5 years and followed up at ages 16 and 19 years.

At any of the time points, 278 adolescents (17.1%) reported binge eating, 334 adolescents (20.6%) reported purging, and 356 adolescents (21.9%) reported dieting.

Among the precursors of DEBs, higher BMI in early adolescence was associated with future dieting (odds ratio [OR], 3.44; 95% CI, 2.09 – 5.65).

High levels of neuroticism (OR, 1.04; 95% CI, 1.01 – 1.06), conduct problems (OR, 1.41; 95% CI, 1.17 – 1.69), and deliberate self-harm (OR, 2.18; 95% CI, 1.37 – 3.45) were associated with later binge eating.

Low levels of agreeableness (OR, 0.95; 95% CI, 0.92 – 0.97), deliberate self-harm (OR, 2.59; 95% CI, 1.69 – 3.95), conduct problems (OR, 1.42; 95% CI, 1.20 – 1.68), alcohol misuse (OR, 1.31; 95% CI, 1.10 – 1.54), and drug abuse (OR, 2.91; 95% CI, 1.78 – 4.74) were associated with future purging.

On a genetic level, these observations mirrored the phenotypic findings.

Higher polygenic risk score (PRS) for BMI was associated with dieting, whereas the PRS for neuroticism and ADHD were associated with higher risk for binge eating and purging, respectively.

Eating disorders predated other mental health problems, the researchers found.

Dieting at 14 years was associated with later symptoms of depression (OR, 2.53; 95% CI, 1.56 – 4.10) and generalized anxiety (OR, 2.27; 95% CI, 1.14 – 4.51), as well as self-harm (OR, 2.10; 95% CI, 1.51 – 4.24), emotional problems (OR, 1.24; 95% CI, 1.08 – 1.43), and smoking (OR, 2.16; 95% CI, 1.36 – 3.48).

Purging at 14 years was associated with the development of symptoms of depression (OR, 2.87; 95% CI, 1.69 – 5.01) and anxiety (OR, 2.48; 95% CI, 1.49 – 4.12).

The researchers note that the study suggests that "genetic predispositions and psychopathological mechanisms related to obesity, ADHD, and personality were differentially associated with the vulnerability for eating disorders in adolescence. These results may have clinical implications for targeted ED prevention programs."

Important Clinical Implications

In an accompanying commentary, Moritz Herle, PhD, and Carol Kan, PhD, King's College London, note that the findings have important implications for clinical practice.

"Given the interwoven nature of both childhood psychiatric disorders, namely [ADHD] and adolescent affective disorders with eating disorder symptoms, greater clinical awareness and prompter recognition of psychiatric comorbidities by primary care teams are essential," they write.

"Identifying individuals who are at risk of developing eating disorders will create opportunities for earlier intervention, potentially preventing the onset of eating disorders or improving their clinical course," they add.

They note that this can only be achieved with multidisciplinary efforts by clinicians in primary care and psychiatry, who need to work closely with the patient as well as the patient's friends and family.

Failure to recognize and treat eating disorders can have "devastating consequences. Such failures contribute to the chronicity and severity of the illness as well as to the development of comorbidities, such as anxiety and depression," Herle and Kan conclude.

JAMA Netw Open. Published online December 2, 2020. Full text, Commentary

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