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Phenotypes, endophenotypes, and genotypes in bulimia spectrum eating disorders
Howard Steiger1, Kenneth R Bruce
1Psychiatry Department, McGill University, Montreal, Quebec. stehow@douglas.mcgill.ca
Summary
Bulimia spectrum disorders vary, with some linked to mood/impulse control issues and others to dieting. Understanding these differences requires considering genetics, environment, and personality traits.
Area of Science:
- Psychiatry
- Genetics
- Neurobiology
Background:
- Bulimia spectrum syndromes encompass diverse presentations, including bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD).
- Existing diagnostic categories may not fully capture the heterogeneity within these eating disorders.
Purpose of the Study:
- To review phenomenological variants of bulimia spectrum syndromes.
- To identify etiological factors contributing to these syndromes.
- To propose a multidimensional model accounting for observed heterogeneities.
Main Methods:
- Broadly defined bulimic syndromes, including threshold and subthreshold BN, BED, and PD.
- Reviewed evidence on diagnostic validity and the roles of sociocultural, family-developmental, neurobiological, and genetic factors.
- Examined gene-environment interactions and their relation to phenotypic variations.
Main Results:
- Phenotypic and subphenotypic variations in bulimia spectrum disorders are validated, often characterized by impulsivity or affective instability.
- Subphenotypic variations correlate with endophenotypes (e.g., reduced serotonin transporter activity) and candidate genotypes.
- Gene-environment interactions are linked to variations in traits like novelty seeking.
Conclusions:
- Bulimic syndromes can stem from primary disruptions in mood, impulse, and appetite control or from dieting-induced appetite control erosion.
- Dimensional perspectives, incorporating comorbid personality traits and symptoms, are crucial.
- A comprehensive etiologic model must integrate familial-developmental, neurobiological, and genetic variables and their interactions.
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