Psychological Medicine

Original Articles

Lifetime course of eating disorders: design and validity testing of a new strategy to define the eating disorders phenotype

M. Anderluha1a2 c1, K. Tchanturiaa1, S. Rabe-Hesketha1, D. Colliera1 and J. Treasurea1

a1 Eating Disorders Unit, Institute of Psychiatry, King's College London, London, UK

a2 University Children's Hospital, University Medical Centre, Ljubljana, Slovenia


Background Aetiological studies of eating disorders would benefit from a solution to the problem of instability of eating disorder symptoms. We present an approach to defining an eating disorders phenotype based on the retrospective assessment of lifetime eating disorders symptoms to define a lifetime pattern of illness. We further validate this approach by testing the most common lifetime categories for differences in the prevalence of specific childhood personality traits.

Method Ninety-seven females participated in this study, 35 with a current diagnosis of restricting anorexia nervosa, 32 with binge/purging subtype of anorexia nervosa and 30 with bulimia nervosa. Subjects were interviewed by a newly developed EATATE Lifetime Diagnostic Interview for a retrospective assessment of the lifetime course of eating disorders symptoms and childhood traits reflecting obsessive–compulsive personality.

Results The data illustrate the extensive instability of the eating disorders diagnosis. Four most common lifetime diagnostic categories were identified that significantly differ in the prevalence of childhood traits. Perfectionism and rigidity were more common in groups with a longer duration of underweight status, longer episodes of severe food restriction, excessive exercising, and shorter duration of binge eating.

Conclusions The assessment of lifetime symptoms may produce a more accurate definition of the eating disorders phenotype. Obsessive–compulsive traits in childhood may moderate the course producing longer periods of underweight status. These findings may have important implications for nosology, treatment and future aetiological studies of eating disorders.

(Received March 08 2007)

(Revised February 04 2008)

(Accepted February 29 2008)

(Online publication April 01 2008)


c1 Address for correspondence: M. Anderluh, M.D., Child Psychiatry Unit, University Children's Hospital, University Medical Centre, Vrazov trg 1, 1525 Ljubljana, Slovenia. (Email: