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Application of a Latent Class Analysis to Empirically Define Eating Disorder Phenotypes
Pamela K. Keel, PhD;
Manfred Fichter, MD;
Norbert Quadflieg, Dipl-Psych;
Cynthia M. Bulik, PhD;
Mark G. Baxter, PhD;
Laura Thornton, PhD;
Katherine A. Halmi, MD;
Allan S. Kaplan, MD;
Michael Strober, PhD;
D. Blake Woodside, MD;
Scott J. Crow, MD;
James E. Mitchell, MD;
Alessandro Rotondo, MD;
Mauro Mauri, MD;
Giovanni Cassano, MD;
Janet Treasure, MD;
David Goldman, MD;
Wade H. Berrettini, MD, PhD;
Walter H. Kaye, MD
Arch Gen Psychiatry. 2004;61:192-200.
Context Diagnostic criteria for eating disorders influence how we recognize, research, and treat eating disorders, and empirically valid phenotypes are required for revealing their genetic bases.
Objective To empirically define eating disorder phenotypes.
Design Data regarding eating disorder symptoms and features from 1179 individuals with clinically significant eating disorders were submitted to a latent class analysis. The resulting latent classes were compared on non–eating disorder variables in a series of validation analyses.
Setting Multinational, collaborative study with cases ascertained through diverse clinical settings (inpatient, outpatient, and community).
Participants Members of affected relative pairs recruited for participation in genetic studies of eating disorders in which probands met DSM-IV-TR criteria for anorexia nervosa (AN) or bulimia nervosa and had at least 1 biological relative with a clinically significant eating disorder.
Main Outcome Measure Number and clinical characterization of latent classes.
Results A 4-class solution provided the best fit. Latent class 1 (LC1) resembled restricting AN; LC2, AN and bulimia nervosa with the use of multiple methods of purging; LC3, restricting AN without obsessive-compulsive features; and LC4, bulimia nervosa with self-induced vomiting as the sole form of purging. Biological relatives were significantly likely to belong to the same latent class. Across validation analyses, LC2 demonstrated the highest levels of psychological disturbance, and LC3 demonstrated the lowest.
Conclusions The presence of obsessive-compulsive features differentiates among individuals with restricting AN. Similarly, the combination of low weight and multiple methods of purging distinguishes among individuals with binge eating and purging behaviors. These results support some of the distinctions drawn within the DSM-IV-TR among eating disorder subtypes, while introducing new features to define phenotypes.
From the Department of Psychology, Harvard University, Cambridge, Mass (Drs Keel and Baxter); Roseneck Hospital for Behavioural Medicine, University of Munich, Prien, Germany (Drs Fichter and Quadflieg); Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond (Dr Bulik); Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pa (Drs Thornton and Kaye); Department of Psychiatry, New York Presbyterian Hospital, Weill Medical College, Cornell University, White Plains, NY (Dr Halmi); Program for Eating Disorders (Drs Kaplan and Woodside) and Department of Psychiatry, University Health Network (Dr Kaplan), The Toronto Hospital, Toronto, Ontario; Department of Psychiatry and Behavioral Science, University of California–Los Angeles (Dr Strober); Department of Psychiatry, University of Minnesota, Minneapolis (Dr Crow); the Neuropsychiatric Research Institute, Fargo, ND (Dr Mitchell); Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnologies (Drs Rotondo, Mauri, and Cassano), University of Pisa, Pisa, Italy; Institute of Psychiatry, Maudsley Hospital, London, England (Dr Treasure); National Institutes of Health, Bethesda, Md (Dr Goldman); and Center of Neurobiology and Behavior, University of Pennsylvania, Philadelphia (Dr Berrettini). Dr Keel is now with the Department of Psychology, University of Iowa, Iowa City.
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