ارتباطات آینده نگر زودهنگام اختلالات محور I با ایجاد اختلالات تغذیه ای

Objective The purpose of this study is to analyze the developmental relationships of adolescent-onset Axis I mental disorders and eating disorders (EDs). Method One thousand three hundred eighteen adolescent twins born from 1983 to 1987 completed a professionally administered semistructured psychiatric interview at the age of 14 years and a questionnaire follow-up at the age of 17.5 years. Results Eating disorders at the age of 17.5 years were significantly predicted by major depressive disorder (odds ratio, 5.9; 95% confidence interval, 2.6-15.3) and generalized anxiety disorder (GAD) (odds ratio, 4.7; 95% confidence interval, 1.8-15.6) at the age of 14 years, when baseline EDs were excluded. Early-onset major depressive disorder in combination with GAD increased the likelihood of developing EDs compared with either mood or anxiety disorders alone. Similar risks and trends were evident in within-family analyses of twin pairs discordant for baseline predictors and ED outcome. Conclusions Depressive disorder and GAD that manifest at that age of 14 years predict future EDs. Analysis of discordant twins suggested that early-onset depressive disorder and GAD prospectively relate to EDs in adolescence, even after familial factors are taken into account.

1. Introduction The developmental relationships of juvenile eating disorders (EDs) and other mental disorders are poorly understood. To date, only few studies have examined the longitudinal relationships of EDs and other psychopathology in adolescence. In general, these studies are suggestive of the existence of longitudinal relationships between depression, attention-deficit/hyperactivity disorder (ADHD), substance use, and EDs, but the sequence in the development of these disorders remains unknown because of inconclusive and mixed results. In some studies, EDs have preceded other forms of psychopathology [1] and [2], whereas in others, EDs have followed the same disorders [3], [4], [5] and [6]. Once comorbidity is established, several etiologic mechanisms are possible; one disorder may affect the expression of another, a third mediating factor may exist, or comorbidity may be caused by a common underlying factor, such as common genes. Studying twins discordant for a particular disorder offers an elegant way to control familial background [7] and [8]. In fact, if the within-twin-pair analyses replicate the association found among twins as individuals, it rules out the confounding effects associated with shared family background, that is, family structure or family history of disorder. The importance of these tests is highlighted because most of the prospective associations in clinical patients and population rests in individuals. Thus, using a large prospective adolescent sample, we addressed the predictive value of Axis I disorders for the development of EDs. To control for familial factors, we studied the associations among twins discordant for predictive baseline disorders and later EDs