Biomedical subjects

C M Bulik

Publications and source records attributed to C M Bulik.

At least 19 recordsLinked to original sources

PubMed2005

Is Swedish snus associated with smoking initiation or smoking cessation?

Nicotine replacement therapies (NRT) are an effective treatment for tobacco dependence, yet most smokers do not quit or remain abstinent. We investigated whether Swedish snus (snuff) use was associated with smoking cessation among males participating in a large population based twin study in Sweden. Snus use was associated with smoking cessation but not initiation. Given that snus delivers comparable nicotine concentrations but carries lesser cancer risk than cigarettes, snus may be a widely used, non-medical form of NRT. Evaluation of the efficacy of snus for smoking cessation should be evaluated in randomised clinical trials.

Adult↗

PubMed2003

Gender differences in binge-eating: a population-based twin study.

OBJECTIVE: To assess whether genetic and environmental effects on liability to binge-eating (BE) are of equal importance for males and females and whether the same genetic risk factors predispose to BE in the two sexes. METHOD: Questionnaire data on 8045 same sex and opposite sex twins, aged 19-31 years, from a population-based Norwegian registry, was used to estimate the relative contribution of genetic and environmental factors to liability for BE utilizing structural equation modeling. RESULTS: In the best-fitting model, the magnitude of genetic and environmental effects on BE was the same for males and females. Heritability was 51%. The correlation between genetic risk factors in men and women was estimated to be +0.57. CONCLUSION: Binge-eating appears to be equally heritable in males and females. Although the majority of the genetic risk factors are shared between the sexes, there may exist gender-specific genetic effects on liability.

Adult↗

PubMed2003

Thyroid indices and treatment outcome in bulimia nervosa.

OBJECTIVE: This study examined the thyroxine (T4) and free T4 (FT4) status of women with bulimia nervosa and its value as a predictor of outcome. METHOD: A total of 135 women with bulimia nervosa underwent 12-weeks cognitive behavioral therapy treatment. Prior to and at 3-year follow-up patients completed psychiatric assessments and serumT4 and FT4 were measured. RESULTS: At 3-year follow-up, 71% had no eating disorder and 29% met criteria for any eating disorder diagnosis. Mean T4 and FT4 concentrations were within normal ranges. Pre-treatment T4 and FT4 concentrations were inversely associated with food restriction and purging frequency, respectively. Compared with women with no eating disorder, those with any eating disorder at follow-up had lower pretreatment T4 concentrations. When pre-treatment food restriction, oral contraceptive use and binge frequency where controlled for, low T4 concentration was the only predictor of eating disorder diagnosis at follow-up. CONCLUSION: Low T4 concentrations at pretreatment may be a predictor of poor outcome in bulimia nervosa.

Adolescent↗

PubMed2003

Candidate genes for anorexia nervosa in the 1p33-36 linkage region: serotonin 1D and delta opioid receptor loci exhibit significant association to anorexia nervosa.

Serotonergic and opioidergic neurotransmitter system alterations have been observed in people with eating disorders; the genes for the serotonin 1D receptor (HTR1D) and the opioid delta receptor (OPRD1) are found on chr1p36.3-34.3, a region identified by our group in a linkage analysis of anorexia nervosa (AN). These candidate genes were evaluated for sequence variation and for linkage and association of this sequence variation to AN in family and case : control data sets. Resequencing of the HTR1D locus and a portion of the OPRD1 locus identified novel SNPs and confirmed existing SNPs. Genotype assay development and genotyping of nine SNPs (four at HTR1D and five at OPRD1) was performed on 191 unrelated individuals fulfilling DSM-IV criteria (w/o amenorrhea criterion) for AN, 442 relatives of AN probands and 98 psychiatrically screened controls. Linkage analysis of these candidate gene SNPs with 33 microsatellite markers in families including relative pairs concordantly affected with restricting AN (N=37) substantially increased the evidence for linkage of this region to restricting AN to an NPL score of 3.91. Statistically significant genotypic, allelic, and haplotypic association to AN in the case : control design was observed at HTR1D and OPRD1 with effect sizes for individual SNPs of 2.63 (95% CI=1.21-5.75) for HTR1D and 1.61 (95% CI=1.11-2.44) for OPRD1. Using genotype data on parents and AN probands, three SNPs at HTR1D were found to exhibit significant transmission disequilibrium (P&<0.05). The combined statistical genetic evidence suggests that HTR1D and OPRD1 or linked genes may be involved in the etiology of AN.

Anorexia Nervosa↗

PubMed2002

Evidence for a susceptibility gene for anorexia nervosa on chromosome 1.

Eating disorders, such as anorexia nervosa (AN), have a significant genetic component. In the current study, a genomewide linkage analysis of 192 families with at least one affected relative pair with AN and related eating disorders, including bulimia nervosa, was performed, resulting in only modest evidence for linkage, with the highest nonparametric linkage (NPL) score, 1.80, at marker D4S2367 on chromosome 4. Since the reduction of sample heterogeneity would increase power to detect linkage, we performed linkage analysis in a subset (n=37) of families in which at least two affected relatives had diagnoses of restricting AN, a clinically defined subtype of AN characterized by severe limitation of food intake without the presence of binge-eating or purging behavior. When we limited the linkage analysis to this clinically more homogeneous subgroup, the highest multipoint NPL score observed was 3.03, at marker D1S3721 on chromosome 1p. The genotyping of additional markers in this region led to a peak multipoint NPL score of 3.45, thereby providing suggestive evidence for the presence of an AN-susceptibility locus on chromosome 1p.

Adult↗

PubMed2001

Characteristics of monozygotic twins discordant for bulimia nervosa.

OBJECTIVE: We studied monozygotic (MZ) twins who were discordant for bulimia nervosa in order to identify environmental factors that could have contributed to the expression of bulimia nervosa in only one member of these genetically identical twin pairs. METHOD: Female twin pairs from the Virginia Twin Registry were identified. One twin met DSM-III-R criteria for bulimia nervosa (excluding the frequency and duration criterion) and the co-twin either reported some symptoms of bulimia nervosa but never met full diagnostic criteria (n = 20 pairs) or reported no symptoms of bulimia nervosa (n = 10). We compared the twins on demographic, developmental, personality, and psychiatric dimensions using self- and maternal report. RESULTS: Affected twins were more likely to report lifetime generalized anxiety disorder and were described by their mothers as more anxious and fearful as children. They also had significantly lower mastery, optimism, and self-esteem, and significantly greater obsessive and compulsive symptoms than their unaffected co-twins. Affected twins recalled greater discord in their families but viewed their parents as more warm toward them than toward their unaffected co-twin. DISCUSSION: Given that MZ twins are genetically identical and share a common family background, differences between them must be attributable to unique environmental factors. Although it is difficult to disentangle predisposing risk factors from sequelae of psychiatric illness in a retrospective co-twin control design, the affected twins were perceived to have been more anxious as children by their mothers-possibly reflecting a predisposing trait. More extensive interviews are required to determine the nature of environmental events that contribute to the expression of the observed personality, behavioral, anxious, and eating-related traits in the affected twins.

Adult↗

PubMed2001

Changes in cue reactivity following treatment for bulimia nervosa.

OBJECTIVE: To examine changes in cue reactivity following cognitive-behavior therapy (CBT) for bulimia nervosa and to evaluate whether changes are associated with treatment modality or treatment outcome. METHOD: Subjects were 135 women (17-45 years old) with a current, primary diagnosis of bulimia nervosa. They were participants in a randomized clinical trial examining the additive efficacy of exposure and nonexposure-based behavior therapy to a core of CBT. Physiological, self-report, and behavioral measures of cue reactivity to individualized high-risk binge foods were obtained at pretreatment and posttreatment. Primary, secondary, and tertiary outcome measures are reported for posttreatment. RESULTS: Bulimic patients experienced significant changes in cue reactivity following treatment. With the exception of salivary reactivity, patients experienced less reactivity at posttreatment. Changes in cue reactivity were not related to treatment modality, but were related to positive treatment outcome for self-report measures of cue reactivity. DISCUSSION: Favorable treatment outcome among bulimic women is associated with low cue reactivity on self-report measures at posttreatment.

Adolescent↗

PubMed2001

Investigation of quality of the parental relationship as a risk factor for subclinical bulimia nervosa.

OBJECTIVE: Previous literature suggests a link between the quality of the parental relationship and disordered eating in offspring. We investigated the relationship between offspring pyschopathology and the parental relationship using a population-based twin registry that contained 766 complete twin pairs. METHOD: We used reports of twin lifetime psychopathology from the twins and quality of parental relationship and parental lifetime psychopathology from both parents. RESULTS: Poorer quality of the marital relationship predicted the presence of subclinical bulimia nervosa (SBN) using both mother's (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.71-0.97) and father's (OR = 0.78, 95% CI: 0.62-0.97) reports. It also predicted the presence of generalized anxiety disorder (GAD) and alcohol dependence. SBN was still strongly predicted by the marital relationship when parental psychopathology was included as a covariate. DISCUSSION: These results are supportive of the notion that a conflictual and distant marital relationship can, at least partially, act as an environmental risk factor for SBN.

Adolescent↗

PubMed2001

Abstention during cue reactivity assessment is associated with better outcome among women with bulimia nervosa.

OBJECTIVE: To compare women with bulimia nervosa who abstained from eating during pretreatment cue reactivity assessment with those who ate. METHOD: 135 participants in a randomized clinical trial completed an assessment of cue reactivity to individualized high-risk binge foods prior to treatment. A broad range of physiological, self-report, and behavioral measures of cue reactivity was assessed. Primary, secondary, and tertiary outcome measures of eating disorder symptomatology were evaluated at pretreatment, midtreatment, posttreatment, and 6-month follow-up. RESULTS: As expected, women who abstained from eating during pretreatment cue reactivity assessment exhibited less cue reactivity than women who ate. This was especially evident for self-report measures of cue reactivity. Surprisingly, women who abstained from eating during pretreatment cue reactivity assessment also had significantly less eating disorder symptomatology at 6-month follow-up. DISCUSSION: Possible psychological mechanisms contributing to the superior outcome of women who abstained from eating during the cue reactivity assessment and implications for the assessment of cue reactivity are discussed.

Clinical Trial↗

PubMed2001

Relating body mass index to figural stimuli: population-based normative data for Caucasians.

OBJECTIVE: To establish body mass index (BMI) norms for standard figural stimuli using a large Caucasian population-based sample. In addition, we sought to determine the effectiveness of the figural stimuli to identify individuals as obese or thin. DESIGN: All Caucasian twins born in Virginia between 1915 and 1971 were identified by public birth record. In addition, 3347 individual twins responded to a letter published in the newsletter of the American Association of Retired Persons (AARP). All adult twins (aged 18 and over) from both of these sources and their family members were mailed a 16 page 'Health and Lifestyle' questionnaire. SUBJECTS: BMI and silhouette data were available on 16 728 females and 11 366 males ranging in age from 18-100. MEASUREMENTS: Self-report information on height-weight, current body size, desired body size and a discrepancy score using standard figural stimuli. RESULTS: Gender- and age-specific norms are presented linking BMI to each of the figural stimuli. Additional norms for desired body size and discrepancy scores are also presented. Receiver operating curves (ROC) indicate that the figural stimuli are effective in classifying individuals as obese or thin. CONCLUSIONS: With the establishment of these norms, the silhouettes used in standard body image assessment can now be linked to BMI. Differences were observed between women and men in terms of desired body size and discrepancy scores, with women preferring smaller sizes. The figural stimuli are a robust technique for classifying individuals as obese or thin.

Adolescent↗

PubMed2001

The genetic epidemiology of thinness.

Most genetic research in the area of human obesity asks the question 'Why are certain people obese?' Considerably less attention has been paid to the question of why certain people are not obese, particularly given the obesogenic environment that permeates the western culture. We present data from human and animal studies and evolutionary arguments supporting the notion that genetic studies of thinness or obesity resistance may yield important and complementary findings to genetic studies of obesity. We offer strategies for further refining the definition of thinness, weigh the advantages and disadvantages of potential sampling strategies and suggest candidate genes for thinness or obesity resistance.

Animals↗

PubMed2001

Features of childhood sexual abuse and the development of psychiatric and substance use disorders.

BACKGROUND: Childhood sexual abuse (CSA) is associated with an increased risk of subsequent psychiatric disorders. AIMS: To explore the risk associated with features of CSA and examine whether specific associations exist between particular profiles of CSA and the development of specific syndromes. METHOD: In a population-based sample of adult female twins, we used logistic regression to explore the association between features of CSA (reported by the twin and her co-twin) and lifetime major depression, generalised anxiety disorder, bulimia nervosa, panic disorder and alcohol and drug dependence. RESULTS: In univariate and stepwise multiple regressions, patterns of predictors differed, although not significantly, across diagnoses. Greater risk was associated with attempted or completed intercourse, the use of force or threats, abuse by a relative, and a negative response by someone who was told about the abuse. Similar patterns were observed with co-twin reports. CONCLUSIONS: Specific features of CSA differentially increase risk of later psychopathology; however, there do not appear to be unique predictive relationships between features of CSA and the emergence of specific psychiatric disorders.

Adolescent↗

PubMed2001

The influence of genetic and environmental factors in estimations of current body size, desired body size, and body dissatisfaction.

The objective was to investigate the genetic epidemiology of figural stimuli. Standard figural stimuli were available from 5,325 complete twin pairs: 1,751 (32.9%) were monozygotic females, 1,068 (20.1%) were dizygotic females, 752 (14.1%) were monozygotic males, 495 (9.3%) were dizygotic males, and 1,259 (23.6%) were dizygotic male-female pairs. Univariate twin analyses were used to examine the influences on the individual variation in current body size and ideal body size. These data were analysed separately for men and women in each of five age groups. A factorial analysis of variance, with polychoric correlations between twin pairs as the dependent variable, and age, sex, zygosity, and the three interaction terms (age x sex, age x zygosity, sex x zygosity) as independent variables, was used to examine trends across the whole data set. Results showed genetic influences had the largest impact on the individual variation in current body size measures, whereas non-shared environmental influences were associated with the majority of individual variation in ideal body size. There was a significant main effect of zygosity (heritability) in predicting polychoric correlations for current body size and body dissatisfaction. There was a significant main effect of gender and zygosity in predicting ideal body size, with a gender x zygosity interaction. In common with BMI, heritability is important in influencing the estimation of current body size. Selection of desired body size for both men and women is more strongly influenced by environmental factors.

Adolescent↗

PubMed2000

A search for susceptibility loci for anorexia nervosa: methods and sample description.

BACKGROUND: Eating disorders have not traditionally been viewed as heritable illnesses; however, recent family and twin studies lend credence to the potential role of genetic transmission. The Price Foundation funded an international, multisite study to identify genetic factors contributing to the pathogenesis of anorexia nervosa (AN) by recruiting affective relative pairs. This article is an overview of study methods and the clinical characteristics of the sample. METHODS: All probands met modified DSM-IV criteria for AN; all affected first, second, and third degree relatives met DSM-IV criteria for AN, bulimia nervosa (BN), or eating disorder not otherwise specified (NOS). Probands and affected relatives were assessed diagnostically with the Structured Interview for Anorexia and Bulimia. DNA was collected from probands, affected relatives and a subset of their biological parents. RESULTS: Assessments were obtained from 196 probands and 237 affected relatives, over 98% of whom are of Caucasian ancestry. Overall, there were 229 relative pairs who were informative for linkage analysis. Of the proband-relative pairs, 63% were AN-AN, 20% were AN-BN, and 16% were AN-NOS. For family-based association analyses, DNA has been collected from both biological parents of 159 eating-disordered subjects. Few significant differences in demographic characteristics were found between proband and relative groups. CONCLUSIONS: The present study represents the first large-scale molecular genetic investigation of AN. Our successful recruitment of over 500 subjects, consisting of affected probands, affected relatives, and their biological parents, will provide the basis to investigate genetic transmission of eating disorders via a genome scan and assessment of candidate genes.

Adult↗

PubMed2000

Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis.

BACKGROUND: Women who report childhood sexual abuse (CSA) are at increased risk for developing psychiatric disorders in adulthood. What is the diagnostic specificity and cause of this association? METHODS: In a population-based sample of 1411 female adult twins, 3 levels of CSA were assessed by self-report and cotwin report: nongenital, genital, and intercourse. Interviews with twins and parents assessed family background and diagnoses of psychiatric and substance dependence disorders. Odds ratios (ORs) were calculated by logistic regression. RESULTS: By self-report, 30.4% reported any CSA and 8.4% reported intercourse. Self-reported CSA was positively associated with all disorders, the highest ORs being seen with bulimia and alcohol and other drug dependence. The ORs were modest and often nonsignificant with nongenital CSA and increased with genital CSA and especially intercourse, where most ORs exceeded 3.0. A similar pattern of findings was seen with CSA as reported by the cotwin, although many ORs were smaller. Controlling for family background factors and parental psychopathology produced a small to modest reduction in ORs. In twin pairs discordant for CSA, the exposed twin was at consistently higher risk of illness. CONCLUSIONS: Women with CSA have a substantially increased risk for developing a wide range of psychopathology. Most of this association is due to more severe forms of CSA and cannot be explained by background familial factors. Although other biases cannot be ruled out, these results are consistent with the hypothesis that CSA is causally related to an increased risk for psychiatric and substance abuse disorders.

Adult↗

PubMed2000

Twin studies of eating disorders: a review.

OBJECTIVE: Twin methodology has been used to delineate etiological factors in many medical disorders and behavioral traits including eating disorders. Although twin studies are powerful tools, their methodology can be arcane and their implications easily misinterpreted. METHOD: The goals of this study are to (a) review the theoretical rationale for twin studies; (b) provide a framework for their interpretation and evaluation; (c) review extant twin studies on eating disorders; and (d) explore the implications for understanding etiological issues in eating disorders. DISCUSSION: On the basis of this review, it is not possible to draw firm conclusions regarding the precise contribution of genetic and environmental factors to anorexia nervosa. Twin studies confirm that bulimia nervosa is familial and reveal significant contributions of additive genetic effects and of unique environmental factors in liability to bulimia nervosa. The magnitude of the contribution of shared environment is less clear, but in the studies with the greatest statistical power, it appears to be less prominent than additive genetic factors.

Anorexia Nervosa↗

PubMed2000

Interpersonal psychotherapy for anorexia nervosa.

OBJECTIVE: This paper outlines the rationale for treating individuals with anorexia nervosa using interpersonal psychotherapy. METHOD: We review theoretical, empirical, and psychotherapy literature relating to interpersonal functioning in anorexia nervosa. RESULTS: Etiological theories emphasize interpersonal and family dysfunction in the development of anorexia nervosa. Research supports the notion that families of individuals with anorexia nervosa have dysfunctional patterns of communication. The history of treatment for anorexia nervosa emphasizes the need for resolution of interpersonal dysfunction, within the traditions of psychodynamic, family therapy, and multidimensional therapies. DISCUSSION: Interpersonal psychotherapy is a time-limited psychotherapy based on the notion that regardless of etiology, interpersonal relationships are intertwined with symptomatology. The goals of the therapy are to improve interpersonal functioning and thereby decrease symptomatology. Factors identified as important in the development of anorexia nervosa are readily conceptualized within the interpersonal psychotherapy problem areas of grief, interpersonal disputes, interpersonal deficits, and role transitions.

Anorexia Nervosa↗

PubMed2000

Outcome of anorexia nervosa: eating attitudes, personality, and parental bonding.

BACKGROUND: We examined eating attitudes, personality, and parental bonding in women with a history of anorexia nervosa stratified by degree of recovery in comparison to randomly selected controls. We were interested in the distinguishing characteristics of recovery and of chronic anorexia nervosa. METHOD: All female new referrals to an eating disorders service between January 1, 1981 and December 31, 1984 with probable or definite anorexia nervosa were eligible for inclusion. 86.4% of these women ("cases") were located and agreed to participate. The control group was a random community sample. All subjects were interviewed with a structured diagnostic instrument and completed a battery of psychological inventories including the Eating Disorder Inventory (EDI), the Three-Factor Eating Questionnaire (TFEQ), the Temperament and Character Inventory (TCI), and the Parental Bonding Instrument (PBI). RESULTS: We divided the anorexia follow-up sample into full recovery (n = 21), partial recovery (n = 34), and chronically ill (n = 15) and compared them to community controls (n = 98). The chronically ill group was distinguished by a lower desired body mass index (BMI), higher cognitive restraint on the TFEQ, higher Drive for Thinness and Bulimia on the EDI, lower maternal and paternal care on the PBI, and high harm avoidance and low self-directedness on the TCI. The full recovery group scored high on self-directedness and cooperativeness on the TCI. CONCLUSIONS: The domains of personality, character, and parental bonding differ among categories of recovery in anorexia nervosa. Whether these differences contribute to recovery or emerge during recovery or lack thereof remains an unanswered question.

Adult↗