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Familial co-aggregation of schizophrenia and eating disorders in Sweden and Denmark

Molecular Psychiatry volume 26, pages 5389–5397 (2021)Cite this article

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Abstract

Eating disorders and schizophrenia are both moderately to highly heritable and share significant genetic risk despite distinct diagnostic criteria. Large-scale family studies on the co-aggregation of these disorders are lacking. Thus, we aimed to estimate the co-occurrence and familial co-aggregation of these disorders within the entire Swedish and Danish population. The proband cohort consisted of individuals born in Sweden (1977–2003) and Denmark (1984–2006) and still residing in their respective country at age six (NSweden = 2,535,191, NDenmark = 1,382,367). Probands were linked to their biological parents, siblings, grandparents, uncles/aunts, and cousins. Diagnoses for anorexia nervosa (AN) and other eating disorders (OED: bulimia nervosa, binge-eating disorder, and eating disorder not otherwise specified) for probands and schizophrenia diagnoses for both probands and relatives were obtained. The likelihood of having schizophrenia in those with AN or OED and their relatives was compared with individuals without eating disorder diagnoses and their relatives. Probands with AN or OED were more likely to have schizophrenia than probands without these disorders. All relatives of probands with AN or OED (except parents and uncles/aunts of probands with AN) were at increased risk of schizophrenia. In general, the magnitude of odds ratios attenuated with decreasing genetic relatedness. These results suggest familial liability contributes to the association between eating disorders and schizophrenia. Clinicians should be mindful of this comorbid and co-aggregation pattern as it may influence case conceptualization and treatment decisions.

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Fig. 1: OR for SCZ in individuals with AN and their relatives, compared with individuals without AN and their relatives.
Fig. 2: OR for SCZ in individuals with OED and their relatives, compared with individuals without OED and their relatives.

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Acknowledgements

RZ was supported by Chinese Scholarship Council (CSC201700260258) and by the Swedish Medical Association #777621 (PI: SB). LVP was supported by the Lundbeck Foundation (grant no R276-2017-4581). CMB acknowledges funding from the Swedish Research Council (VR Dnr: 538-2013-8864).

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Authors and Affiliations

  1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Ruyue Zhang, Ralf Kuja-Halkola, Shuyang Yao, Henrik Larsson, Paul Lichtenstein, Cynthia M. Bulik & Sarah E. Bergen

  2. National Centre for Register-based Research, Aarhus University, Aarhus, Denmark

    Janne Tidselbak Larsen & Liselotte Vogdrup Petersen

  3. iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark

    Janne Tidselbak Larsen & Liselotte Vogdrup Petersen

  4. Centre for Integrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark

    Janne Tidselbak Larsen

  5. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Laura Thornton & Cynthia M. Bulik

  6. School of Medical Sciences, Örebro University, Örebro, Sweden

    Henrik Larsson

  7. Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Cynthia M. Bulik

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Correspondence to Sarah E. Bergen.

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CMB has served on scientific advisory boards for Shire, serves as a consultant for Idorsia, and received royalties from Pearson (all outside the submitted work). HL has served as a speaker for Evolan Pharma and Shire and has received research grants from Shire (all outside the submitted work).

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Zhang, R., Larsen, J.T., Kuja-Halkola, R. et al. Familial co-aggregation of schizophrenia and eating disorders in Sweden and Denmark. Mol Psychiatry 26, 5389–5397 (2021). https://doi.org/10.1038/s41380-020-0749-x

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