genes, environment, and eating disorders: what the
TRANSCRIPT
UNC Chapel HillCenter of Excellence for Eating Disorders
Cynthia Bulik, PhD, FAED
Karolinska InstitutetCentre for Eating Disorders Innovation
Genes, Environment, and Eating Disorders:What the Clinician Needs to Know
@cbulik
Disclosures
Β§ Shire Pharmaceuticals (grant recipient; advisory board)
Β§ Idorsia (consultant)Β§ Pearson (author)
Gratitude
Talk Map
Β§ Why study genetics of eating disorders?
Β§ Understanding current results
Β§ Guidelines for clinicians
Β§ EDGI
Topography of Feeding and Eating Disorders (DSM-5)
β’ Anorexia Nervosa β Low Weightβ Intense fear of weight gainβ Inability to recognize seriousness
of low weight
β’ Bulimia Nervosa β Binge eatingβ Regular compensatory behaviorsβ Normal, overweight, obese
β’ Binge-Eating Disorderβ Binge eatingβ No regular compensatory behaviorsβ Distressβ Often overweight/obese
β’ Avoidant and Restrictive Food Intake Disorder (ARFID)(M>F?)β Feeding disturbance, refusal, fearβ Nutritional deficienciesβ Weight loss or failure to gain
Slide courtesy of Jet Termorshuizen
6
Eating Disorders
American Psychiatric Association: DSM-5, 2013Keski-Rahkonen & Mustelin, 2016
Fichter et al., 2016Yilmaz, Hardaway, Bulik. 2015
Watson et al., 2019
Anorexia nervosa(AN)
Bulimia nervosa(BN)
Binge-eatingdisorder (BED)
<1-4%~5.4
<1-2%~1.5
1-4%~1.5
Eating disorders
(EDs)
Epidemiology- Lifetime prevalence
- Mortality (SMR)
Heritability (twin-based)
~60% ~60% ~45%
GWAS 8 independent loci x x
Diagnostic Fluctuation AN
BED
EDNOS
BN
AN
BED
BN
EDNOS
REMISSION REMISSION
EDNOS
BN
BED
AN
Schaumberg et alPMID: 29911514
Why Study the Genetics of Eating Disorders?
Β§ Bodies revert to a negative settling point
Anorexia Nervosa is Perplexing!
β’ Starvation is reinforcing
Β§ Fats are aversive Β§ Activity is more reinforcing than food
Β§ Perplexing hypermetabolicperiod during renourishment
Paradoxical Response to Negative Energy Balance
Energy consumed
ExercisePhysical activityRestFidgetingPurging
Energy expended
Broad Applicability
Knowledge about eating disorders informs our understanding of many related phenotypes.
Obesity
Physical activity
Major depressive
disorderAnxiety
disorders
Metabolism
Nutrition
GWAS Basics
Variant #1 (C/T)Less common: C
Cases
Controls
Variant #2 (A/G)Less common: G
Cases
Controls
Variant #3 Variant #4...
CasesCurrent or past AN
ControlsNo history of eating disorders
ATTGGGCGAGTGTTCTAACCCGATTGGGTGAGTGTTCTGGCCCG
How to Read a Manhattan Plot
Chromosome
Significance level
5 x 10 -8
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Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED)
Leipzig, 2017Glasgow, 2018
Anaheim, 2019
Preben Bo Mortensen
Nick MartinMikael LandΓ©n
Martin Kennedy
Bulik, Sullivan, Thornton
Tracey Wade
Flinders Jenny Jordan
Composition of Freeze 2
74%
20%
<6%
33 datasets with 16,992 cases and 55,525 controls
from 17 countries
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ββ βββββ β βββ β ββ ββββ βββββββ β ββββ βββββββ βββ ββββ β ββββββββ ββββββββ βββββ ββββ β ββββ ββ β ββ βββ ββ βββ βββ ββ βββ β βββββ ββ β β ββββ ββ β ββββ β β βββ ββ βββ ββββββ ββ ββ ββββ βββββ β ββββββββ β ββ ββ ββ ββ βββββ β ββ βββ β β βββββ ββ βββββ βββ ββββ ββ β βββββββ ββ βββ βββ βββββ βββββ ββββ βββ βββ β βββ βββββ ββ ββββ ββββββββββββ βββ βββ β βββ ββββββ ββ βββ ββ β β βββββββββ ββ ββββββββ ββββ β βββ ββ βββ β ββ β βββ ββββ β ββ ββ β βββ βββ βββ ββ βββ ββββ ββ βββββ ββ β ββββββ β β ββββ βββββββββββ ββ ββββ βββ ββββ ββ ββ ββ ββββ ββββ β β βββ ββ ββββ βββββ β ββ βββ β βββββ β ββ ββ ββ βββ βββββ βββ βββ βββββ ββ βββββ β β ββββββ ββββββββββ ββ βββ ββββββ ββββββ ββββ ββββ βββββ ββ ββ β ββββ β ββββ βββ βββββββ β βββ βββ βββ ββ ββ βββ ββββββ ββββββββ βββ β ββ βββ β βββββ βββββ β βββ ββ βββ ββ βββ β ββββββββββ βββββββ βββββ ββ ββββ ββ β βββββ βββ βββ βββ βββββββ βββ β βββ β βββββ ββ βββββ ββββββ ββ ββ βββ ββββ β βββββ ββ β ββββ ββ ββ ββ ββββ ββββ β ββ ββ ββββββββββ ββββ ββ ββββ β βββββ β βββ ββββ ββββ β ββ ββ β β ββββ ββββ β ββββ βββ ββ βββββ ββββ βββ βββββ ββββ ββ β ββ ββ β βββββ β β βββ βββ βββ βββ βββ βββββ β βββ β ββββββ βββ ββ β ββ ββββββ βββ β βββ β ββ ββ βββ ββββ βββ βββ β ββββ βββ β βββββββ β βββββββ βββββ ββ ββ ββββ ββ βββββ ββ ββ ββ ββββββ ββββββ ββββ ββ βββ ββ β ββββββ β ββββ ββββ β βββββββ βββ β ββ βββββ βββ ββ β βββββββ ββ ββ ββ ββββββ ββ ββ ββ ββββ β β β βββ β ββββ ββββ βββ βββββ βββββββ βββββββ βββββ ββββ β ββ βββ βββ βββ ββ ββ β ββ βββ ββ βββ βββ ββ β β βββ βββ β ββ βββ ββββββββ β β β ββββ ββββ ββββββ ββ ββββ ββββ β ββββββ ββββββββ ββ βββ ββ β βββ βββ β βββ βββββ β βββββββ ββ ββββ βββ ββ ββββββ ββ ββββ β βββ ββ β ββ βββββββ ββ ββ ββ ββ β βββ ββ ββββ βββββββββ βββ βββ β ββ ββββ β ββββ ββ ββ ββ ββ β ββ ββ ββββ β ββ ββββββββββ β βββββββββ ββ β β ββ ββββββ ββββ ββββ β βββ ββ β ββββ βββββ ββββ ββ β β β ββ ββββββ β β ββ ββββ βββββββ βββββ β β βββ βββ ββ βββββ βββββββ ββββββββ β βββββ ββ βββ β βββββ ββββββββββ ββββ βββββββ ββββ βββββββ βββ ββββββββ βββ β ββ βββ βββββ β βββ ββ β β ββ βββ ββββββ ββ β ββββ β βββ βββββ βββ ββββββ ββββ ββ βββββ βββ ββββ βββββ ββ βββ ββ ββββββ βββ ββββ βββββ ββ βββ βββ ββββ ββ ββββ βββ ββ βββ ββ βββ ββ βββββββ βββ ββββββ βββββ βββ ββββ ββ ββββ ββββ ββββ ββββ βββ β βββ β ββ βββ
βββββββ
βββ
βββββββββββββββββββββββββββββββββββββββββββββββββββββββββββββββββββββββββββββ
ββββββββ
ββββββ
β ββββββββ βββ βββ βββ β
β βββ ββββ ββββββββββ ββββββ β
β ββββ
ββ ββββ βββ ββββ βββ ββ ββ ββ ββ βββ ββ βββ β ββ β ββββ ββ ββ ββ ββ ββ ββ ββ β βββ β ββ βββ ββ ββ βββ ββ β βββ β ββ βββ β βββ β βββ β β βββ ββ β ββββ ββ ββ β βββ β ββ β ββ ββ β ββ ββ βββ βββ ββ ββ βββ β βββ ββββ βββ ββ βββ ββ β ββ β ββ β β β ββββ β ββ β ββββ ββ ββββ β βββ ββ βββ βββ ββ ββ βββ β ββ βββ βββ βββ ββ ββ ββ ββ ββ ββ βββ βββ βββ β ββ ββ ββ ββ β β ββ ββ ββ β βββ ββ β β ββ ββ ββ ββ βββ ββ ββ ββββ βββ ββ ββ ββββ β ββ βββ ββ ββ ββ β βββ ββ β ββ β β ββ ββ βββ ββ ββ ββ β ββ β βββ βββ β βββ β ββ β β ββ β ββ β β ββ ββ βββ βββ β β βββ βββ ββ ββ ββ βββ ββ β ββ β βββ β βββ ββ ββ βββ ββ β β ββ β ββ ββ βββ βββ ββ ββ βββ ββ β βββ β βββ β β β ββ ββ ββ β ββ β ββ ββ βββ β β β ββ ββ β β βββ ββ ββ β ββ ββ β ββββββ β ββ ββ ββ βββ βββ β ββββ βββ βββ ββ β ββ β ββββ ββ β β ββ ββ ββββ ββ β β β β βββ ββββ ββ ββ ββ βββ β ββββ βββ βββ β βββ β ββ ββ β ββ ββ ββ βββ β βββββ β ββ ββ βββ ββ βββ β β β ββββ ββ ββ ββ β βββββ β βββ βββ ββββ ββ βββ ββ βββ βββ βββ ββ ββ ββ β β ββ ββββ β ββββ ββ β ββ β βββ β βββ ββ β β β ββ β ββ β β βββ ββ ββ βββ ββ β ββ ββ β ββ ββ ββ ββββ β βββ ββββ ββ β β βββ βββ βββ ββ β βββ βββ ββ ββ ββ ββ ββ βββ ββ ββββ ββ ββ βββ β ββ ββ β βββ ββ ββββ β
βββββββ
βββ
ββββββββ
βββ
β
βββ
ββββββββββββββββββββββββββββββββββββββββββββββββββββββββββββββ
βββββ
βββ
ββ
βββ
β
ββ
βββββββ βββ βββ
βββ β
β βββ ββββ ββββββ
ββββ ββββββ β
β ββββ
ββ βββ
β ββ
β ββββ βββ ββ ββ ββ ββ βββ ββ βββ β ββ β ββββ ββ ββ ββ ββ ββ ββ ββ β βββ β ββ βββ ββ ββ βββ ββ β βββ β ββ βββ β βββ β βββ β β βββ ββ β ββββ
ββ ββ β βββ β ββ β ββ ββ β ββ ββ βββ βββ ββ ββ βββ β βββ ββββ βββ ββ βββ ββ β ββ β ββ β β β ββββ β ββ β ββββ ββ ββββ β βββ ββ βββ βββ ββ ββ βββ β ββ βββ βββ βββ ββ ββ ββ ββ ββ ββ βββ βββ βββ β ββ ββ ββ ββ β β ββ βββ ββ β βββ ββ β β ββ ββ ββ ββ βββ ββ ββ ββββ βββ ββ ββ ββββ β ββ βββ ββ ββ ββ β βββ ββ β ββ β β ββ ββ βββ ββ ββ ββ β ββ β βββ βββ β βββ β ββ β β ββ β ββ β β ββ ββ βββ βββ β β βββ βββ ββ ββ ββ βββ ββ β ββ β βββ β βββ ββ ββ βββ ββ β β ββ β ββ ββ βββ βββ ββ ββ βββ ββ β βββ β βββ β β β ββ ββ ββ β ββ β ββ ββ βββ β β β ββ ββ β β βββ ββ ββ β ββ ββ β ββββββ β ββ ββ ββ βββ βββ β ββββ βββ βββ ββ β ββ β ββββ ββ β β ββ ββ ββββ ββ β β β β βββ ββββ ββ ββ ββ βββ β ββββ βββ βββ β βββ β ββ ββ β ββ ββ ββ βββ β βββββ β ββ ββ βββ ββ βββ β β β ββββ ββ ββ ββ β βββββ β βββ βββ ββββ ββ βββ ββ βββ βββ βββ ββ ββ ββ β β ββ ββββ β ββββ ββ β ββ β βββ β βββ ββ β β β ββ β ββ β β βββ ββ ββ βββ ββ β ββ ββ β ββ ββ ββ ββββ β βββ ββββ ββ β β βββ βββ βββ ββ β βββ βββ ββ ββ ββ ββ ββ βββ ββ ββββ ββ ββ βββ β ββ ββ β βββ ββ ββββ β
Chromosome
3
4
5
6
7
8
9
10
11
12
13
14
15
16
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
βββ
temozolomideresponse
SjΓΆgrenβsSyndrome
IBD, ulcerative colitis, Crohnβs, macrophage functions, blood protein levels, obesity-related traits, HDL, Parkinsonβs
Age at menarche, obesity, body fatEsophageal adenocarcinoma, Barrett's esophagus, intellectual disabilityBMI
Autoimmune
Metabolic
Neuropsychiatric
Sex hormones
GWAS Results
Hunna Watson, PhDNature GeneticsPMID: 31308545
SNP-h2 11β17% (se = 1%)
Thereβs Valuable Information Below the Red Line!
Genetic Correlations
Β§ Estimates genetic correlations from published summary statistics
Β§ Do not need to measure all of the traits on the same people
Β§ Between diseases, βgenetic analogue of comorbidityβ
Β§ Not phenotypic correlations!
PMID: 25642630
Brendan Bulik-Sullivan
ObsessiveοΏ½compulsive disorder (PGC)Major depressive disorder (PGC)
Schizophrenia (PGC)Anxiety (UKB)
Depressive symptomsNeuroticism (UKB)Years of educationCollege completion
Attainment of a college or a university degreePhysical activity (objectively-measured)
HOMA-IR: Insulin resistance (age- & sex-adjusted)Fasting insulin (age- & sex-adjusted)
Leptin (not BMI-adjusted)Fasting insulin (BMI-adjusted)
Type 2 diabetesHDL cholesterol
Body fat percentage (UKB)Fat mass (UKB)
Body mass index (UKB)Waist circumference
Overweight (BMI 25-30)Obesity class 1 (BMI 30-35)
Waist-to-hip ratioHip circumference
Extreme body mass indexObesity class 2 (BMI 35-40)
Waist circumference (BMI-adjusted)FatοΏ½free mass
-0.25 0.25 0.500.00Genetic correlation rg
CategoryPsychiatric disorder/trait
Personality trait
Educational attainment
Physical activity
Metabolic trait
Anthropometric trait
Negative (-)
Positive (+)
GeneticCorrelationswithAnorexia
ObsessiveοΏ½compulsive disorder (PGC)Major depressive disorder (PGC)
Schizophrenia (PGC)Anxiety (UKB)
Depressive symptomsNeuroticism (UKB)Years of educationCollege completion
Attainment of a college or a university degreePhysical activity (objectively-measured)
HOMA-IR: Insulin resistance (age- & sex-adjusted)Fasting insulin (age- & sex-adjusted)
Leptin (not BMI-adjusted)Fasting insulin (BMI-adjusted)
Type 2 diabetesHDL cholesterol
Body fat percentage (UKB)Fat mass (UKB)
Body mass index (UKB)Waist circumference
Overweight (BMI 25-30)Obesity class 1 (BMI 30-35)
Waist-to-hip ratioHip circumference
Extreme body mass indexObesity class 2 (BMI 35-40)
Waist circumference (BMI-adjusted)FatοΏ½free mass
-0.25 0.25 0.500.00Genetic correlation rg
CategoryPsychiatric disorder/trait
Personality trait
Educational attainment
Physical activity
Metabolic trait
Anthropometric trait
Negative (-) Positive (+)
Genetic Correlations Between Anorexia and Psychiatric, Educational, and Physical Activity
ObsessiveοΏ½compulsive disorder (PGC)Major depressive disorder (PGC)
Schizophrenia (PGC)Anxiety (UKB)
Depressive symptomsNeuroticism (UKB)Years of educationCollege completion
Attainment of a college or a university degreePhysical activity (objectively-measured)
HOMA-IR: Insulin resistance (age- & sex-adjusted)Fasting insulin (age- & sex-adjusted)
Leptin (not BMI-adjusted)Fasting insulin (BMI-adjusted)
Type 2 diabetesHDL cholesterol
Body fat percentage (UKB)Fat mass (UKB)
Body mass index (UKB)Waist circumference
Overweight (BMI 25-30)Obesity class 1 (BMI 30-35)
Waist-to-hip ratioHip circumference
Extreme body mass indexObesity class 2 (BMI 35-40)
Waist circumference (BMI-adjusted)FatοΏ½free mass
-0.25 0.25 0.500.00Genetic correlation rg
CategoryPsychiatric disorder/trait
Personality trait
Educational attainment
Physical activity
Metabolic trait
Anthropometric trait
Negative (-) Positive (+)
Genetic Correlations Between Anorexia and Metabolic Factors
ObsessiveοΏ½compulsive disorder (PGC)Major depressive disorder (PGC)
Schizophrenia (PGC)Anxiety (UKB)
Depressive symptomsNeuroticism (UKB)Years of educationCollege completion
Attainment of a college or a university degreePhysical activity (objectively-measured)
HOMA-IR: Insulin resistance (age- & sex-adjusted)Fasting insulin (age- & sex-adjusted)
Leptin (not BMI-adjusted)Fasting insulin (BMI-adjusted)
Type 2 diabetesHDL cholesterol
Body fat percentage (UKB)Fat mass (UKB)
Body mass index (UKB)Waist circumference
Overweight (BMI 25-30)Obesity class 1 (BMI 30-35)
Waist-to-hip ratioHip circumference
Extreme body mass indexObesity class 2 (BMI 35-40)
Waist circumference (BMI-adjusted)FatοΏ½free mass
-0.25 0.25 0.500.00Genetic correlation rg
CategoryPsychiatric disorder/trait
Personality trait
Educational attainment
Physical activity
Metabolic trait
Anthropometric trait
Negative (-) Positive (+)
Genetic Correlations Between Anorexia and Anthropometric / Body Measurement Factors
ObsessiveοΏ½compulsive disorder (PGC)Major depressive disorder (PGC)
Schizophrenia (PGC)Anxiety (UKB)
Depressive symptomsNeuroticism (UKB)Years of educationCollege completion
Attainment of a college or a university degreePhysical activity (objectively-measured)
HOMA-IR: Insulin resistance (age- & sex-adjusted)Fasting insulin (age- & sex-adjusted)
Leptin (not BMI-adjusted)Fasting insulin (BMI-adjusted)
Type 2 diabetesHDL cholesterol
Body fat percentage (UKB)Fat mass (UKB)
Body mass index (UKB)Waist circumference
Overweight (BMI 25-30)Obesity class 1 (BMI 30-35)
Waist-to-hip ratioHip circumference
Extreme body mass indexObesity class 2 (BMI 35-40)
Waist circumference (BMI-adjusted)FatοΏ½free mass
-0.25 0.25 0.500.00Genetic correlation rg
CategoryPsychiatric disorder/trait
Personality trait
Educational attainment
Physical activity
Metabolic trait
Anthropometric trait
Negative (-)
Positive (+)
Reconceptualizing Anorexia Nervosa as Metabo-Psychiatric
Β§ Perplexing ability to reach and maintain low BMI
Β§ Frequent return to a βnegative settling pointβ
Β§ Negative genetic correlations with BMI and other βunfavorableβ metabolic parameters
Β§ Positive genetic correlations with HDL
Β§ Paradoxical reaction to negative energy balance
Implications and Next Steps
Β§ Greater attention to metabolic factors may improve outcome
Β§ Explanation for why adequate refeeding is essential to preventing relapse?
Β§ Need to understand metabolic mechanisms!
Does the DSM Feeding & Eating Disorders Section Actually Carve Nature at Its Joints?
Micali Loos Herle Abdulkadir HΓΌbel Breen
What is a polygenic risk score (PRS); genetic risk score (GRS); polygenic score (PGS)?
Christopher HΓΌbel
Single score per person, weighted sum of risk alleles
Utility of PRSβ¦
Β§ Can we improve risk assessment by combining PRS with other measures of risk?
Β§ Can we use PRS to screen for mental health disorders in the population?
Β§ Can PRS help in making a diagnosis or clinical decisions?
Β§ Are psychiatric PRS associated with treatment response?
Β§ Are PRS associated with adverse physical health outcomes in mental illness? (e.g., weight gain with antipsychotic medication)
READ THIS PAPER: PMID: 33052393
N 17,050
Age [years] 55.6 Β± 7.7
Height [cm] 164.7 Β± 7.1
Weight [kg] 71.0 Β± 14.3
BMI [kg/m2] 26.2 Β± 4.9
Waist circumference [cm]
83.1 Β± 12.5
Hip circumference [cm] 102.1 Β± 9.8
Waist-to-hip ratio 0.8 Β± 0.1
Body fat [%] 34.2 Β± 7.5
Fat mass [kg] 24.9 Β± 9.7
Fat-free mass [kg] 46.1 Β± 7.3
SES [Townsend] -1.8 Β± 2.8
We donβt have GWAS of bulimia and BED yet, soβ¦
Eating Disorder Cases
Mental health questionnaire (n = 156,465) & ICD-10 diagnoses
Anorexia nervosa Bulimia nervosa Binge-eating disorder
768 423 561
Controls 15,500
https://doi.org/10.1002/eat.23481
Genomic Topography of Eating Disorders
Polygenic Scores Associated with Eating Disorders in the UKBiobank βAll Traits
Polygenic Scores Associated with Eating Disorders in the UKBiobank β Psychiatric Traits
0.75 1.00 1.25 1.50
Odds Ratio (OR) per standard deviation (SD) increase of polygenic scores
Polygenic Scores Associated with Eating Disorders in the UKBiobank β Metabolic Traits
0.75 1.00 1.25 1.50
Odds Ratio (OR) per standard deviation (SD) increase of polygenic scores
Polygenic Scores Associated with Eating Disorders in the UKBiobank β Anthropometric Traits
To what end?
Β§ Identify subtypes of illness based on PRS
Β§ Predict likely course of illness and tailor treatment accordingly
Β§ Move toward personalized medicine approach to treatment instead of βone-size-fits-allβ
Β§ Drug repositioning or development based on genetic results
Β§ Eliminate mortality
Translating Information for Clinicians, Families, and Patients
Science communication
Β§ Anti-intellectualism and anti-science are rampant in some parts of the world
Β§ Scientistsβ responsibility to interpret and contextualize
Β§ Cliniciansβ responsibility to have general understanding and assist patients & families
Β§ Important role for genetic counseling!
Messaging Doβs and Donβtβs
Β§ Genetics is just one piece of the risk puzzle
Β§ All or nothing thinking (genes OR environment; nature OR nurture)
Β§ Challenges understanding probabilities
Β§ Genetic destiny
Β§ Genetic guilt
Β§ Eating disorders are genetic not psychological
Β§ Genetic simplification (I have THE gene[s] for eating disorders)
Β§ Genetic testingβ¦NO!
A Relatable Model
Genetic Risk Genetic Protective Environmental ProtectiveEnvironmental Risk
Role of Genetic Counseling
Genetic counseling for mental illnesses has been shown to help:β’ Alleviate stigma and shameβ’ Correct misconceptions about the conditionβ’ Prepare family members to interveneβ’ Promote help-seeking behaviorsβ’ Only one study on eating disordersβ¦β’ 107 individuals with personal history of an ED
Julianne Michael, UNC-GPMID: 32666600
Without Guidance, Individuals Overestimate Risk to Children
100% of respondents overestimated risk to daughters!
Take Home Messages
Β§ It is our responsibility not just to do the science, but to package the information for patients and families
Β§ Clinicians should make an effort to integrate genetics into their own case conceptualizations and develop comfort with answering their patientsβ questions
Β§ Know your limits! If you live in a country with genetic counseling, make use of your colleagues. If not, find resources for your patients.
Β§ Donβt perpetuate misinformation
EDGI!
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder
ARFID (pending)
Whatβs New About EDGI?Β§ Global goal 100K
Β§ NIMH (US, New Zealand, Australia, and Denmark)
Β§ Plus, the United Kingdom and Sweden
Β§ Coming soon: Mexico, the Netherlands, Puerto Rico, Taiwan, Italy, & more!
Β§ Same questionnaires around the world
Β§ Diversifying samples!
Β§ Digital consent and questionnaires
Β§ Simple at-home saliva collection (COVID-safe!)
Β§ Engaging advocacy community
Β§ Engaging clinicians!
www.edgi.org
EDGI Domains: Genes and Environment
Depression
Anxiety
Tobacco Use
Life events
Trauma
Physical Activity
OCD
Alcohol & Drug Use
EDGI Phenotyping
Measure DomainED100K Lifetime ED diagnosesEating Disorder Examination-Q Current ED symptomsGLAD Depression and Anxiety MDD/GADED-Quality of Life ED-specific health related QOLShort Form Health Survey-12 General mental and physical healthPHQ-9 DepressionGAD-7 AnxietyHeaviness of Smoking/Vaping Nicotine useAUDIT Lifetime alcohol useDUDIT Lifetime drug useCompulsive Exercise Test Driven exerciseObsessive-Compulsive Inventory-R Obsessive-compulsive symptomsMultidimensional Perfectionism PerfectionismLife Events Trauma historyED treatment history Lifetime ED-related utilization
edgi.nz edgi.org.au
EDGI Social Media
@EDGI_NZ @EDGI_AUS
@EDGI.NZ @EDGI.AUS
EDGI Talks: YouTube Channel EDGI Study
EATING DISORDERS WORKING GROUP OF THE PSYCHIATRIC GENOMICS CONSORTIUMHunna J Watson PhD, MPsychClin, MBiostats, Zeynep Yilmaz PhD, Laura M Thornton PhD, Christopher HΓΌbel MD, MSc, Jonathan RI Coleman PhD,a, Julien BryoisPhD, Anke Hinney PhD, HΓ©lΓ©na A. Gaspar PhD, Virpi LeppΓ€ PhD, Manuel Mattheisen MD, Sarah Medland PhD,b, Stephan Ripke MD, PhD, Shuyang Yao PhD, Paola Giusti-RodrΓ¬guez, Anorexia Nervosa Genetics Initiative, Ken B. Hanscombe PhD, Kristin L Purves MSc, Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED), Roger AH Adan PhD, Lars Alfredsson PhD, Tetsuya Ando MD, PhD, Ole A Andreassen MD, PhD, Jessica H Baker PhD, Wade H Berrettini MD, PhD, Ilka Boehm PhD, Claudette Boni PhD, Vesna Boraska Perica PhD, Katharina Buehren MD, PhD, Roland Burghardt MD, Matteo Cassina MD, Sven Cichon PhD, Maurizio Clementi MD, Roger D Cone PhD, Philippe Courtet MD, Scott Crow MD, James Crowley PhD, Unna N Danner PhD, Oliver S P Davis MSc, PhD, Martina de Zwaan MD, George Dedoussis PhD, Daniela Degortes PhD, Janiece E DeSocio PhD, RN, PMHNP-BC, Danielle M Dick PhD, Dimitris Dikeos MD, Christian Dina PhD, Monika Dmitrzak-Weglarz PhD, Elisa Docampo Martinez MD, PhD, Laramie E Duncan PhD, Karin Egberts MD, Stefan Ehrlich MD, GeΓ²rgia EscaramΓs PhD, TΓ΅nu Esko PhD, Xavier Estivill MD PhD, Anne Farmer MD, Angela Favaro MD, PhD, Fernando FernΓ‘ndez-Aranda PhD, Manfred M Fichter MD, Dipl-Psych, Krista Fischer PhD, Manuel FΓΆcker MD, Lenka Foretova MD, PhD, Andreas J Forstner MD, Monica Forzan PhD, Christopher S Franklin PhD, Steven Gallinger MD, Ina Giegling PhD, Johanna Giuranna MSc, Fragiskos Gonidakis MD, Philip Gorwood MD, PhD, Monica Gratacos Mayora MD, PhD, SΓ©bastien Guillaume MD, PhD, Yiran Guo PhD, HakonHakonarson MD, PhD, Konstantinos Hatzikotoulas MD, PhD, Joanna Hauser MD, PhD, Johannes Hebebrand MD, Sietske G Helder PhD, Stefan Herms MSc, BeateHerpertz-Dahlmann MD, Wolfgang Herzog MD, Laura M Huckins PhD, James I Hudson MD, ScD, Hartmut Imgart MD, Hidetoshi Inoko PhD, Vladimir Janout PhD, Susana JimΓ©nez-Murcia PhD, Antonio JuliΓ PhD, Gursharan Kalsi PhD, Deborah KaminskΓ‘ PhD, Jaakko Kaprio MD, PhD, Leila Karhunen PhD, Andreas KarwautzMD, Martien J H Kas PhD, James L Kennedy MD, FRCP(C), Anna Keski-Rahkonen MD, PhD, MPH, Kirsty Kiezebrink PhD, FHEA, RNutr, Youl-Ri Kim MD, PhD, Lars Klareskog MD, Kelly L Klump PhD, Gun Peggy S Knudsen PhD, Maria C La Via MD, Stephanie Le Hellard PhD, Robert D Levitan MD, Dong Li PhD, Lisa Lilenfeld PhD, Bochao Danae Lin PhD, Jolanta Lissowska PhD, Jurjen Luykx MD, PhD, Pierre Magistretti PhD, Mario Maj MD, PhD, Katrin Mannik PhD, Sara Marsal MD, PhD, Christian Marshall PhD, Morten Mattingsdal PhD, Sara McDevitt MB, MD, MRCPsych, MMedED, Peter McGuffin MD, Andres Metspalu PhD, MD, Ingrid MeulenbeltPhD, Nadia Micali MD, PhD, Karen Mitchell PhD, Alessio Maria Monteleone MD, Palmiero Monteleone MD, Melissa A Munn-Chernoff PhD, Benedetta Nacmias PhD, Marie Navratilova MUDr., PhD, Ioanna Ntalla PhD, Julie K O'Toole MD, Roel A Ophoff PhD, Leonid Padyukov MD, PhD, Aarno Palotie MD, PhD, Jacques Pantel PhD, Hana Papezova MD, PhD, Dalila Pinto PhD, Raquel Rabionet PhD, Anu Raevuori MD, PhD, Nicolas Ramoz PhD, Ted Reichborn-Kjennerud MD, PhD, Valdo Ricca MD, Samuli Ripatti PhD, Franziska Ritschel MSc, Marion Roberts PhD, Alessandro Rotondo MD, Dan Rujescu MD, Filip Rybakowski MD, PhD, Paolo Santonastaso MD, AndrΓ© Scherag PhD, Stephen W Scherer PhD, FRSC, Ulrike Schmidt MD, PhD, Nicholas J Schork PhD, Alexandra Schosser PhD, Jochen Seitz MD, Lenka SlachtovaPhD, P. Eline Slagboom PhD, Margarita C T Slof-Op 't Landt PhD, Agnieszka Slopien MD, PhD, Sandro Sorbi MD, Beata ΕwiΔ tkowska PhD, Jin P Szatkiewicz PhD, Ioanna Tachmazidou PhD, Elena Tenconi MD, Alfonso Tortorella MD, Federica Tozzi MD, Janet Treasure PhD, FRCP, FRCPsych, Artemis Tsitsika MD, PhD, Marta Tyszkiewicz-Nwafor MD, PhD, Konstantinos Tziouvas MD, MSc, Annemarie A van Elburg MD, PhD, Eric F van Furth PhD, Gudrun Wagner Dr, MSc, DPO, Esther Walton Dr. rer. nat., PhD, Elisabeth Widen MD, PhD, Eleftheria Zeggini PhD, Stephanie Zerwas PhD, Stephan Zipfel MD, Andrew W Bergen PhD, Joseph M Boden PhD, Harry Brandt MD, Steven Crawford MD, Katherine A Halmi MD, L. John Horwood MSc, Craig Johnson PhD, Allan S Kaplan MSc, MD, FRCP(C), Walter Kaye MD, James Mitchell MD, Catherine M Olsen PhD, MPH, John F Pearson PhD, Nancy L Pedersen PhD, Michael Strober PhD, Thomas Werge PhD, David C Whiteman MBBS(Hons), PhD, FAFPHM, D. Blake Woodside MD, Garret Stuber, Scott Gordon PhD, Jakob Grove PhD, Anjali K Henders BSc(Hons), Anders JurΓ©us PhD, Katherine M Kirk PhD, Janne T Larsen MSc, Richard Parker BA(Hons), Liselotte Petersen PhD, Jennifer Jordan PhD, Martin Kennedy PhD, Grant W Montgomery PhD, Tracey D Wade PhD, Andreas BirgegΓ₯rd PhD, Paul Lichtenstein PhD, Claes Norring PhD, Mikael LandΓ©n MD, PhD, Nicholas Martin PhD, Preben Mortensen MD, Patrick Sullivan MD, FRANZCP, Gerome Breen PhD & Cynthia Bulik PhD
Laura Thornton Casey MacDermod
Lauren Harper Jerry Guintivano
Jessica Baker
NaEshia Ancalade Patrick Sullivan
Hunna Watson
edgi.org
edgi.org.au edgi.nz
edgi.se
EDGI Mexico
EDGI Netherlands
EDGI Italy
EDGI Taiwan
Nick MartinRichard ParkerNatalie Garden
Allison Miller Jenny Jordan Martin Kennedy
Lana ClelandHannah Kennedy
Bengt FundΓn
Emma ForsΓ©n
Liselotte Petersen Zeynep Yilmaz Janne Larsen
Coming Soon!
edgiuk.org
Gerome Breen
@cbulik
Help EDGI Reach 100K!
@PGCgenetics Thank you!
EDGI-Aus acknowledges clinician and/or academic colleagues (Sarah Maguire, Andrea Phillipou, Tracey Wade, June Alexander, Sue Byrne, Sarah Wells, Bronwyn Raykos, Rachel Favilla, Olivia Soha), endED, Eating Disorders QLD, Inside Out Institute, Butterfly Foundation and the Australia & New Zealand Academy for Eating Disorders (ANZEAD) and the project team Natalie Garden, Mary Ferguson, and Lucy Winkler.
EDGI-NZ acknowledges clinician and/or academic colleagues (Rachel Lawson, Lois Surgenor, Andrea LaMarre, Roger Mysliwiec), Nicki Wilson (EDANZ), and Genevieve Mora (Voices of Hope), the Eating Disorders Association of New Zealand (EDANZ).
All EDGI sites thank, in particular, the essential contribution of those with lived experience who came forward to be EDGI ambassadors and to participate in EDGI.
edgi.nz
edgi.org.au