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The coexistence of psychiatric and gastrointestinal problems in children with restrictive eating in a nationwide Swedish twin study

Journal article
Authors J. Taljemark
Maria Råstam
P. Lichtenstein
Henrik Anckarsäter
N. Kerekes
Published in Journal of Eating Disorders
Volume 5
ISSN 2050-2974
Publication year 2017
Published at Institute of Neuroscience and Physiology
Gillberg Neuropsychiatry Centre
Centre for Ethics, Law, and Mental Health
Language en
Links doi.org/10.1186/s40337-017-0154-2
Keywords Restrictive eating problem, Neurodevelopmental problem, Psychiatric problem, Gastrointestinal, AUTISM SPECTRUM DISORDERS, FOOD-INTAKE DISORDER, ANOREXIA-NERVOSA, ANXIETY DISORDERS, CHRONIC CONSTIPATION, BULIMIA-NERVOSA, ABDOMINAL-PAIN, A-TAC, ADOLESCENTS, COMORBIDITY
Subject categories Neurosciences, Child and adolescent psychiatry

Abstract

Background: Restrictive eating problems are rare in children but overrepresented in those with neurodevelopmental problems. Comorbidities decrease wellbeing in affected individuals but research in the area is relatively scarce. This study describes phenotypes, regarding psychiatric and gastrointestinal comorbidities, in children with restrictive eating problems. Methods: A parental telephone interview was conducted in 9- or 12-year old twins (n = 19,130) in the Child and Adolescent Twin Study in Sweden. Cases of restrictive eating problems and comorbid problems were established using the Autism, Tics-AD/HD and other Comorbidities inventory, parental reports of comorbidity as well as data from a national patient register. In restrictive eating problem cases, presence of psychiatric and gastrointestinal comorbidity was mapped individually in probands and their co-twin. Two-tailed Mann-Whitney U tests were used to test differences in the mean number of coexisting disorders between boys and girls. Odds ratios were used to compare prevalence figures between individuals with or without restrictive eating problems, and Fisher exact test was used to establish significance. Results: Prevalence of restrictive eating problems was 0.6% (concordant in 15% monozygotic and 3% of dizygotic twins). The presence of restrictive eating problems drastically increased odds of all psychiatric problems, especially autism spectrum disorder in both sexes (odds ratio = 11.9 in boys, odds ratio = 10.1 in girls), obsessive-compulsive disorder in boys (odds ratio = 11.6) and oppositional defiant disorder in girls (odds ratio = 9.22). Comorbid gastrointestinal problems, such as lactose intolerance (odds ratio = 4.43) and constipation (odds ratio = 2.91), were the most frequent in girls. Boy co-twins to a proband with restrictive eating problems generally had more psychiatric problems than girl co-twins and more girl co-twins had neither somatic nor any psychiatric problems at all. Conclusions: In children with restrictive eating problems odds of all coexisting psychiatric problems and gastrointestinal problems are significantly increased. The study shows the importance of considering comorbidities in clinical assessment of children with restrictive eating problems.

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