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Anorexia Nervosa in Identical Triplets

Published online by Cambridge University Press:  07 November 2014

Mae S. Sokol ,
Anna K. Carroll ,
Denise M. Heebink ,
Kristina M. Hoffman-Rieken ,
Christine S. Goudge  and
Douglas D. Ebers
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Abstract

The cause of anorexia nervosa (AN) is unclear, but is likely multifactorial, including psychological, familial, environmental, societal, genetic, and other biological factors. This case report of identical 12-year-old female triplets simultaneously concordant for AN illustrates the importance of addressing all these components in evaluation and treatment, and the difficulty of determining the relative importance of each factor in the cause of an individual's eating disorder. An overly close relationship and competitiveness between the girls, treated at times as a triplet group rather than as individuals, as well as stressful family dynamics, were probably important antecedents to the girls' AN. The girls encouraged each other and competed to lose weight. Brief individual and family psychotherapy, parent counseling, nutritional counseling, and psychoeducation led to successful treatment. The triplets were encouraged in treatment to compete with and encourage each other to obtain treatment goals, including eating more healthily and achieving healthy weights. A literature review of AN twins studies is also presented, as these studies add to our understanding of the relative importance of shared genes and shared environment in the development of AN. These studies also add insight into treating individuals from families with multiple affected relatives.

Type
Case Report
Information
CNS Spectrums , Volume 14 , Issue 3 , March 2009 , pp. 156 - 162
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

1.Vitiello, B, Lederhendler, I. Research on eating disorders: current status and future prospects. Biol Psychiatry. 2000;47:777–786.Google Scholar
2.American Psychiatric Association. Treatment of patients with eating disorders, third edition. American Psychiatric Association. Am J Psychiatry. 2006;163(7 suppl):1–54.Google Scholar
3.Schmidt, U. Aetiology of eating disorders in the 21(st) century: new answers to old questions. Eur Child Adolesc Psychiatry. 2003:12(suppl 1):130–137.Google Scholar
4.Fairburn, CG, Cowen, PJ, Harrison, PJ. Twin studies and the etiology of eating disorders. Int J Eat Disord. 1999;26:349–358.Google Scholar
5.Grice, DE, Halmi, KA, Fichter, MM, et al.Evidence for a susceptibility gene for anorexia nervosa on chromosome 1. Am J Hum Genet. 2002;70:787–792.Google Scholar
6.Brown, KMO, Bujac, SR, Mann, ET, Campbell, DA, Stubbins, MJ, Blundell, JE. Further evidence of association of OPRD1 & HTR1D polymorphisms with susceptibility to anorexia nervosa. Biol Psychiatry. 2007;61:367–373.Google Scholar
7.Holland, AJ, Hall, A, Murray, R, Russell, GF, Crisp, AH. Anorexia nervosa: a study of 34 twin pairs and one set of triplets. Br J Psychiatry. 1984;145:414–419.CrossRefGoogle ScholarPubMed
8.Debow, SL. Identical twins concordant for anorexia nervosa. Can Psychiatr Assoc J. 1975;20:215–217.CrossRefGoogle ScholarPubMed
9.le Grange, D, Schwartz, S. Family therapy for identical twins with anorexia nervosa. Eat Weight Disord. 2003;8:84–87.CrossRefGoogle ScholarPubMed
10.Nowlin, NS. Anorexia nervosa in twins: case report and review. J Clin Psychiatry. 1983;44:101–105.Google ScholarPubMed
11.Suematsu, H, Kuboki, T, Ogata, E. Anorexia nervosa in monozygotic twins. Psychother Psychosom. 1986;45:46–50.Google Scholar
12.Werman, DS, Katz, J. Anorexia nervosa in a pair of identical twins. J Am Acad Child Psychiatry. 1975;14:633–645.Google Scholar
13.Hamill, PV, Drizd, TA, Johnson, CL, Reed, RB, Roche, AF, Moore, WM. Physical growth: National Center for Health Statistics percentiles. Am J Clin Nutr. 1979;32:607–629.CrossRefGoogle ScholarPubMed
14.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
15.Burckle, MA, Ryckman, RM. Forms of competitive attitude and achievement orientation in relation to disordered eating. Sex Roles. 1999;40:853–870.CrossRefGoogle Scholar
16.Borkenau, P, Riemann, R, Angleitner, A, Spinath, FM. Similarity of childhood experiences and personality resemblance in monozygotic and dizygotic twins: a test of the equal environments assumption. Pers Individ Dif. 2002;33:261–269.Google Scholar
17.Klump, KL, Holly, A, Iacono, WG, McGue, M, Willson, LE. Physical similarity and twin resemblance for eating attitudes and behaviors: a test of the equal environments assumption. Behav Genet. 2000;30:51–58.Google Scholar
18.Gorwood, P, Kipman, A, Foulon, C. The human genetics of anorexia nervosa. Eur J Pharmacol. 2003;480:163–170.Google Scholar
19.Bulik, CM, Sullivan, PF, Tozzi, F, Furberg, H, Lichtenstein, P, Pedersen, NL. Prevalence, heritability, and prospective risk factors for anorexia nervosa. Arch Gen Psychiatry. 2006;63:305–312.Google Scholar
20.Hettema, JM, Neale, MC, Kendler, KS. Physical similarity and the equal-environment assumption in twin studies of psychiatric disorders. Behav Genet. 1995;25:327–335.Google Scholar
21.Klump, KL, McGue, M, Iacono, WG. Age differences in genetic and environmental influences on eating attitudes and behaviors in preadolescent and adolescent female twins. J Abnorm Psychol. 2000;109:239–251.CrossRefGoogle ScholarPubMed
22.Richardson, K, Norgate, S. The equal environments assumption of classical twin studies may not hold. Br J Educ Psychol. 2005;75(pt 3):339–350.Google Scholar
23.Klump, KL, McGue, M, lacono, WG. Differential heritability of eating attitudes and behaviors in prepubertal versus pubertal twins. Int J Eat Disord. 2003;33:287–292.Google Scholar
24.Bryant-Waugh, RJ, Lask, BD, Shafran, RL, Fosson, AR. Do doctors recognize eating disorders in children? Arch Dis Child. 1992;67:103–105.CrossRefGoogle ScholarPubMed
25.Sokol, MS, Jackson, TK, Selser, CT, Nice, HA, Christiansen, ND, Carroll, AK. Review of clinical research in child and adolescent eating disorders. Primary Psychiatry. 2005;12:52–58.Google Scholar
26.Bostic, JQ, Muriel, AC, Hack, S, Weinstein, S, Herzog, D. Anorexia nervosa in a 7-year-old girl. J Dev Behav Pediatr. 1997;18:331–333.Google Scholar
27.Klump, KL, Perkins, PS, Burt, SA, McGue, M, Iacono, WG. Puberty moderates genetic influences on disordered eating. Psychol Med. 2007;37:627–634.CrossRefGoogle ScholarPubMed
28.Klump, KL, Burt, A, McGue, M, Iacono, WG. Changes in genetic and environmental influences on disordered eating across adolescence. Arch Gen Psychiatry. 2007;64:1409–1415.CrossRefGoogle ScholarPubMed