The evolving genetic foundations of eating disorders
The evolving genetic foundations of eating disorders
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DOI：
10.1016/s0193-953x(05)70218-5
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发表时间：
2001-06-01
影响因子：
1.7
通讯作者：
Strober, M
中科院分区：
文献类型：
--
作者：
Klump, KL;Kaye, WH;Strober, M
神经性厌食症（Anorexia neurovosa， AN）和神经性贪食症（bulimia neurosa， BN）是一种以进食行为和体重调节模式异常、体重和体型态度紊乱以及体型感知为特征的疾病。在美国，即使面对日益严重的恶病质，也有一种对体重增加的莫名其妙的恐惧和对肥胖的无情痴迷。BN通常在节食一段时间后出现，这可能与体重减轻有关，也可能与体重减轻无关。暴饮暴食是指以一种无法控制的方式摄入大量食物，紧接着是自我诱导的呕吐或其他一些补偿方式（例如，滥用泻药、利尿剂或灌肠剂，或过度运动或禁食）来补偿摄入的过量食物。大多数BN患者的进食方式不规律，饱腹感可能受损。虽然异常低体重是BN诊断的排除因素，但到治疗中心就诊的BN患者中有25%至30%有an病史；然而，所有患有BN的个体都与体重和形状有病理关系。AN和BN患者的共同特点是自卑、抑郁和焦虑。这些疾病的原因被认为是复杂的，受到发育、社会和生物过程的多重影响（17,59;），然而，这些相互作用过程的确切性质仍然不完全清楚。当然，对身体吸引力标准的文化态度与饮食失调的精神病理学有关，但文化对发病机制的影响不太可能非常突出。首先，在工业化国家，节食行为和追求苗条是相当普遍的，但据估计，在普通人群中，AN和BN分别只影响0.3%至0.7%和1.7%至2.5%的女性。(1)此外，关于AN的许多明确描述可以追溯到19世纪中叶（59），这一事实表明，除了我们当前的文化之外，其他因素也起着致病作用。此外，这两种综合征，特别是AN，具有相对刻板的临床表现、性别分布和发病年龄，支持一些生物学脆弱性的可能性。来自家庭、双胞胎和分子遗传学研究的证据表明，这种生物脆弱性可能是遗传的。这篇文章回顾了这些行为遗传学的发现，强调了新出现的证据表明显著的遗传影响这些疾病。
Anorexia nervosa (AN) and bulimia nervosa (BN) are disorders characterized by aberrant patterns of feeding behavior and weight regulation, disturbances in attitudes toward weight and shape, and the perception of body shape. In AN, there is an inexplicable fear of weight gain and unrelenting obsession with fatness even in the face of increasing cachexia. BN usually emerges after a period of dieting, which may or may not have been associated with weight loss. Binge eating, which is the consumption of a large amount of food in an uncontrollable manner, is followed by either self-induced vomiting or by some other means of compensation (e.g., misuse of laxatives, diuretics, or enemas, or the use of excessive exercise or fasting) for the excess of food ingested. Most people with BN have irregular feeding patterns, and satiety may be impaired. Although abnormally low body weight is an exclusion for the diagnosis of BN, 25% to 30% of patients with BN who present to treatment centers have a history of AN; however, all individuals with BN have pathologic concern with weight and shape. Common to individuals with AN and BN are low self-esteem, depression, and anxiety.The cause of these disorders is presumed to be complex and multiply influenced by developmental, social, and biological processes(17, 59;) however, the exact nature of these interactive processes remains incompletely understood. Certainly, cultural attitudes toward standards of physical attractiveness have relevance to the psychopathology of eating disorders, but it is unlikely that cultural influences in pathogenesis are very prominent. For one, dieting behavior and the drive toward thinness is quite commonplace in industrialized countries, but AN and BN affect only an estimated 0.3% to 0.7%, and 1.7% to 2.5%, respectively of females in the general population.(1) Moreover, the fact that numerous clear descriptions of AN date from the middle of the nineteenth century(59) suggests that factors other than our current culture have an etiologic role. In addition, both syndromes, AN in particular, have a relatively stereotypic clinical presentation, sex distribution, and age-of-onset, supporting the possibility of some biological vulnerability.Evidence from family, twin, and molecular genetic studies suggest that this biological vulnerability might be genetic. This article reviews these behavioral genetic findings, highlighting the emerging evidence suggesting significant genetic influences on these disorders.