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By Laura Collins | February 28th 2008 06:13 PM | 6 comments | Track Comments

Dr. Cynthia Bulik, William R. and Jeanne H. Jordan Distinguished Professor of Eating Disorders at the University of North Carolina, spoke forcefully at yesterday's US Congressional Briefing organized by the Eating Disorders Coalition.

Bulik gave a 20-minute talk that could, if widely available, change the way society - and patients - look at eating disorders.

The research she cites is well-established, but still controversial among clinicians treating the illness.

In the past, Bulik told Congressional staff, eating disorders were wrongly blamed on families, on the individual, or on society. These causes seemed plausible. But "plausibility is just too convenient."

 "These are not disorders of choice."

Genetic relatives of eating disorder patients have a 7-12 times greater risk of also having an eating disorder.

"The major contributor is genetics. Not family environment, not choice."

Why does this matter? Bulik thinks it matters a great deal:

  • Because it destigmatizes the illness
  • Because it means we can, and should, mention eating disorders whenever we talk about other mental illness
  • Because it empowers parents and sufferers
  • Because this knowledge improves treatment and insurance coverage Because it underscores the seriousness of the illness
  • Because genetics research needs research dollars.

Bulik has in recent months identified enough genetic samples "already in the freezer" for genome-wide eating disorder studies that she believes could revolutionize the way eating disorders are understood and treated.

"We are in the middle of a landmark year in genetics," Bulik said. "Funding is the only obstacle."


Comments

adaptivecomplexity's picture
There is hardly a trait we possess that is not affected in some way by genetics, from personality to susceptibility to infections to the makeup of our gut microbe populations, so I'm not surprised that a propensity to eating disorders is heritable.

People and families should definitely not be stigmatized for it.

Hank's picture
Mike, it could also be that if your favorite tool is a hammer, you see a lot of nails. You breathe genetics.

We found Laura because she wanted to discuss Sociological Spin: Stating There Is A Genetic Cause Gets Anorexics Less Blame so I asked her to educate us here on occasion - but there's a lot left unanswered.

Namely, how can research be "well-established, but still controversial"? Plus, 'eating disorders' covers a lot of ground. Is obesity an eating disorder? When it was a physician-treated issue, it was uncommon. When it got into the DSM and it began to be treated psychologically, it skyrocketed. Now we are saying it is genetic?

And anorexia is an eating disorder but are we going to look for a genetic component that primarily affects white teenage girls and only in the last 20 years?

Whenever I see "Funding is the only obstacle" I reach for my wallet. :)

Good article, Laura. You got me and Mike to disagree on something. That doesn't happen often.

Georg von Hippel's picture
are we going to look for a genetic component that primarily affects white teenage girls and only in the last 20 years?

Not knowing the data or the state of the debate among the experts, I have no opinion either way, but: If it is genetic, than the fact that it primarily affects a certain ethnic group is no surprise at all. There are genetic disorders (such as Tay-Sachs) that primarily affect Ashkenazi Jews. And genetic disorders specific to an age or sex exist as well. As for only existing in the last 20 years, anorexia was first understood as a disease in the 19th century, when it was already not that uncommon; cf. the references on wikipedia.

adaptivecomplexity's picture
I do breathe genetics! Researchers are finding more and more evidence that obesity (and not just the obvious really, really overweight kind) has a significant genetic component. Propensity to obesity, together with diabetes and heart disease is being lumped together in the term 'metabolic syndrome.' I can't comment on the clinical usefulness of that term, but it does capture a common set of disease mechanisms that appear to have a strong genetic component.

I think when the public hears something about the genetic basis for a disease, they tend to think of simple Mendelian diseases - where there is a gene for this, and a gene for that, like cystic fibrosis.

But most diseases and disorders are much, much more complex - many potential genes are involved, and environmental interactions play a big role. This is where large-scale genome studies come in, like genome-wide association studies - we finally have the ability (in a fairly economical way) to test hundreds of thousands of different genetic variants for association with a disease. We can tackle the problem of complex diseases in a way that has eluded us before.

And the results so far tell what any geneticist would have argued a prioi - there is almost nothing that is not affected in some way by our genes. Again, that's not to say environment doesn't play a huge role - gene by environment interactions make up the real story - it's explains why smoking causes cancer, but George Burns lived to 100 anyway - it's not just chance, it was his genes.

So in the case of anorexia, I would argue it's worth funding for the following reasons:
- there is very likely a genetic component

- these new studies aren't going to break the bank - it doesn't require a major new investment in funding to do this; researchers could try to get it funded under existing NIH programs

- we may come up with new drug targets to treat the problem

- and finally, my favorite reason, we could learn something about the biology of mental illness, and probably not just anorexia specifically. A guy in our lab studies complex traits like in yeast - not because we care about yeast so much, but because it can teach us how these complex traits work. A well-designed study for anorexia could do the same thing - pick a disease, any disease, no matter what the demographics of the target population, create a well-designed study, and we could learn something important about the biology of complex traits.

Laura Collins's picture
Sorry, I just now read your comments - thank you for your thoughtful remarks.

You ask "how can research be "well-established, but still controversial"?"

It is a wierd field, with a serious paradigm shift under way and some ugly turf warfare. If you ask the serious researchers, or Dr. Insel the head of NIMH, they're clear on this: genetically-transmitted illness. But the knowledge is still controversial among clinicians treating patients. There is a strong resistance going on among clinicians AND patients. Patients don't necessarily want to see this illness as biologically-driven. Part of this is because AN is ego-syntonic and anosognosic in nature. But even in BN and BED you are talking about illnesses where society has a strong investment in making into a story, a narrative, a choice.

On the question of genetics and only 20 years and only young white girls: you may need to let that idea go. Eating disorders have been around a long time (Joan of Arc, Saint Catherine of Siena...), and though we've only had a name for it more recently we also still have a diagnosis bias: you are unlikely to have a family to consult a psychiatrist unless you are of a certain social class.

In other words, EDs didn't begin when the DSM began to include them!

Dieting, however, is a clear environmental trigger for those with a genetic predisposition. More dieting = more eating disorder prevalence.

Laura Collins
author of "Eating With Your Anorexic"
www.eatingwithyouranorexic.com

Eating disorders is very serious since those articles with those models that don't eat anything all day long just to be very very very skinny for their "job". There should be done more programs for those with this problem.

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