Skip to main content

Cynthia Bulik, PhD, founding director of the UNC Center of Excellence for Eating Disorders, is senior author of the article published in JAMA Psychiatry.

Cynthia Bulik, PhD, FAED

ARFID is a serious eating disorder that leads to malnutrition and nutritional deficiencies. Researchers estimate that between one to five percent of the population is affected by the eating disorder.

Unlike anorexia, ARFID is not about the patient’s experience of their own body and fear of gaining weight. Instead, the disease is characterized by the avoidance of certain types of food due to a sensory discomfort because of the characteristics or appearance of food, or for example, the fear of choking, a food poisoning phobia or lack of appetite.

17,000 pairs of twins involved in the study

Researchers at Karolinska Institutet and the University of North Carolina School of Medicine have now investigated the importance of genetic factors for developing ARFID. A cohort of almost 17,000 pairs of twins in Sweden born between 1992 and 2010 participated in the study. A total of 682 children with ARFID between the ages of six and twelve years could be identified.

The researchers used the twin method to determine the influence of genes and the environment on the onset of the disease.

“We know that identical twins share all genes and that fraternal twins share about half of the genes that make people different. When we then see that a certain character trait is more common in monozygotic twin pairs than in dizygotic twin pairs, it is an indication that there is a genetic influence. We can then estimate the degree to which a character trait is influenced by the genes,” says Lisa Dinkler, PhD, lead author of the study and a postdoctoral researcher at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet.

The study was published online Feb. 1 in JAMA Psychiatry. Cynthia Bulik, PhD, founding director of the Center of Excellence for Eating Disorders at UNC-Chapel Hill, is senior author of the article. Dr. Bulik leads research teams at UNC-Chapel Hill and the Karolinska Institutet Centre for Eating Disorders Innovation.

The researchers discovered that the genetic component for developing ARFID was high, 79 per cent. This means that 79 per cent of the risk of developing ARFID are explained by genetic factors.

“This study suggests that ARFID is highly heritable. The genetic component is higher than that of other eating disorders and on par with that of neuropsychiatric disorders such as autism and ADHD,” says Dr. Dinkler.

ARFID is a relatively new diagnosis. In 2013, the disorder was included in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, and this year it was included in the World Health Organization’s diagnostic manual ICD. The latest edition, ICD-11, will be introduced to the Swedish healthcare system in a couple of years, consequently, the diagnosis is not an official part of Swedish health and medical care yet.

Desire to investigate connections with other conditions

The next step in Dr. Dinkler’s research is to study the extent to which ARFID is associated with other psychiatric diagnoses, such as anxiety and depression, neurodevelopmental disorders, and gastrointestinal problems.

“We will use twin studies to test the extent to which ARFID shares underlying genetic and environmental factors with these conditions,” says Dr. Dinkler.

The study was mainly funded by the Swedish Research Council, the Swedish Mental Health Fund, Fredrik and Ingrid Thuring Foundation, Lundbeckfonden, NIMH and Brain and Behavior Research Foundation.

Many of the researchers have received fees from private companies for work done outside this study, see the scientific article for more information.

Publication: ”Etiology of the broad avoidant restrictive food intake disorder phenotype in Swedish twins aged 6 to 12 years”, Lisa Dinkler, Marie-Louis Wronski, Paul Lichtenstein, Sebastian Lundström, Henrik Larsson, Nadia Micali, Mark J. Taylor, Cynthia M. Bulik, JAMA Psychiatry, online 1 February 2023, doi: 10.1001/jamapsychiatry.2022.4612