I am a clinical psychologist and have been conducting research and providing treatment for individuals with eating disorders since 1984. Although I have approached eating disorders from a variety of perspectives from animal models to clinical trials, my greatest contribution to eating disorders research has been via research using genetic epidemiologic methods—including family, twin, and molecular genetic designs. I am the founding director of the University of North Carolina Center of Excellence for Eating Disorders and I direct the Center for Eating Disorders Innovation at Karolinska Institutet focused on advancing research on the genetic epidemiology of eating disorders.
Together with my research team, I hope to crack the genetic code of eating disorders to enhance our understanding of the underlying neurobiology of the illnesses in service of improving prevention and treatment.
My commitment to training developing researchers has been unwavering and individuals who I have trained have ascended to prominent positions in the field around the globe.
Current positions and commissions of trust
- Professor, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Distinguished Professor of Eating Disorders, Department of Psychiatry, University of North Carolina at Chapel Hill, USA
- Founding Director, Center of Excellence for Eating Disorders, University of North Carolina at Chapel Hill, USA
- Professor, Department of Nutrition, Gillings School of Global Public Health, UNC Chapel Hill
- Adjunct Professor, Norwegian Institute of Public Health, Oslo, Norway
- Co-Director UNC Center for Psychiatric Genomics, University of North Carolina at Chapel Hill
- Univ. of Notre Dame, Notre Dame, IN: B.A. – Psychology
- Univ. of California at Berkeley, CA: M.A. - Psychology (Clin)
- Univ. of California at Berkeley, CA: Ph.D. - Psychology (Clin)
- Univ. of Pittsburgh, Dept. of Psychiatry, NIMH: (Post-doc) - Psychiatry Research
- Univ. of Pittsburgh, Dept. of Psychiatry, MacArthur: (Post-doc) - Psychiatry Research
Revolutionized the understanding of risk factors for eating disorders by demonstrating the role of genetic factors in influencing risk for anorexia nervosa, bulimia nervosa, and binge eating disorder and escorting the science from family studies to twin studies, through linkage and candidate gene studies, into the genome-wide association study era.
At the beginning of my career, eating disorders were widely considered to be purely sociocultural in origin and related to family dysfunction. Unconvinced, my dissertation focused on family psychiatric history and family environment in women with bulimia nervosa and identified significantly elevated relative risk for alcohol abuse and dependence. My work went on to identify the familiality of eating disorders, the heritability of eating disorders as determined by twin studies, significant linkage peaks for both anorexia nervosa and bulimia nervosa, and the largest GWAS study ever conducted of anorexia nervosa. As the founder of the Genetic Consortium for Anorexia Nervosa (GCAN) and co-recipient of a Wellcome Trust Case Control Consortium 3 GWAS grant, I seeded an even larger movement in the field to amass >25,000 anorexia nervosa samples. I founded and co-lead the Anorexia Nervosa Working Group of the Psychiatric Genomics Consortium and am Principal Investigator of the Anorexia Nervosa Genetics Initiative.
Thoroughly explicated the impact of pregnancy on birth outcomes and maternal outcomes in women with eating disorders.
Prior to the 2000s, empirical literature on eating disorders in pregnancy was sparse and consisted mostly of studies in small clinical samples. In collaboration with the Norwegian Institute for Public Health, we published a body of 20 studies using longitudinal data from the Norwegian Mother and Child Cohort Study (MoBa). We addressed diverse questions including the prevalence, course, and risk correlates of eating disorders during pregnancy and the postpartum. We also reported associations between eating disorder exposure and pregnancy, birth and obstetric outcomes, and maternal and offspring health and wellbeing. The findings indicate that eating disorders in pregnancy are relatively common and confer health risks to mother and child related to sleep, birth outcomes, maternal nutrition, and child feeding and eating. Studies are ongoing and will include biomarkers as the children are now entering adolescence—the highest risk period for the onset of eating disorders.
Developed and disseminated interventions that have improved the standard of care for anorexia nervosa, bulimia nervosa, and binge eating disorder.
I have designed and participated multiple clinical trials for anorexia nervosa, bulimia nervosa, and binge eating disorder. Innovations have included employing exposure with response prevention in the treatment of bulimia nervosa; development of Specialist Supportive Clinical Management for anorexia nervosa, which although initially designed to be a control intervention has been disseminated widely across three continents as a evidence-based intervention for anorexia; development of couple-based interventions for all three eating disorders which leverage the power of the family in an age-appropriate manner for the treatment of adults with eating disorders; incorporation of cultural factors into treatment, parenting interventions for mothers with eating disorders; and incorporation of technology into treatment to broaden the reach of evidence-based interventions. I have also conducted comprehensive Agency for Healthcare Quality and Research supported reviews of the state of the evidence for the treatment of eating disorders that have guided research direction and service planning.
Broadened the understanding of comorbidity in eating disorders by exploring the nature and mechanisms of association with anxiety disorders, major depressive disorder, autism spectrum disorder, and substance use disorders.
Via clinical, epidemiologic, genetic epidemiologic and now molecular genetic methodologies, I explored patterns of comorbidity as well as mechanisms of comorbidity. Historically, eating disorders were often considered to be “variants” of other disorders. By applying a variety of methods, this work made the understanding of comorbidity more sophisticated by explicating patterns of onset and the extent to which both genetic and environmental risk factors are shared across classes of disorders. This work has also informed the well-known phenomenon of diagnostic crossover within eating disorders by revealing both shared and independent genetic factors influencing anorexia and bulimia nervosa. A natural extension of this work is calculating genetic correlations across psychiatric and somatic disorders for which GWAS data are available.
Current research projects
ANGI - The Anorexia Nervosa Genetics Initiative (ANGI) is the largest and most rigorous genetic investigation of eating disorders ever conducted. Researchers in the United States, Sweden, Australia, and Denmark will collect clinical information and blood samples from over 13,000 individuals with anorexia nervosa and individuals without an eating disorder. ANGI represents a global effort to detect genetic variation that contributes to this potentially life-threatening illness. The goal of the research study is to transform our knowledge about the causes of eating disorders to work toward greater understanding and ultimately a cure. The project also has a Swedish website.
CREAT - A Study of discordant monozygotic twins with anorexia nervosa
Binge Eating Disorder: Epidemiology, Course, Utilization, and Outcome – A joint KI/University of North Carolina project supported by a grant from Shire Pharmaceuticals Inc., we are exploring the epidemiology, clinical course, healthcare utilization patterns, and outcome of binge eating disorder (BED) using information in the Swedish quality registers for eating disorders Riksät and Stepwise and the Swedish population registers.
Five selected publications
- Prevalence, heritability, and prospective risk factors for anorexia nervosa.
Arch. Gen. Psychiatry 2006 Mar;63(3):305-12
- Understanding the relation between anorexia nervosa and bulimia nervosa in a Swedish national twin sample.
Biol. Psychiatry 2010 Jan;67(1):71-7
- A genome-wide association study of anorexia nervosa.
Mol. Psychiatry 2014 Oct;19(10):1085-94
- Watson, H.J., Torgersen, L., Zerwas, S., Reichborn-Kjennerud, T., Knopf, C., Siega-Riz, A., Bulik, C.M. (2014). Eating disorders, pregnancy, and the post-partum period: A review of findings from the Norwegian Mother and Child Cohort Study (MoBa). Norsk Epidemiologi, 24, 51-62. (Review)
- The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality.
J Psychiatr Res 2015 Jun;65():16-22
Working group at Karolinska Institutet
- Elisabeth Welch, PhD, post doc
- Anna Hedman, Ph.D., post doc
- Ida Nilsson, Ph.D., post doc
- Shuyang Yao (co-supervisor), PhD student
- Camilla Wiklund, PhD student
- Andreas Jangmo, PhD student
- Jessica Pege, Research Coordinator for CREAT
- Johan Källberg, system developer
- Ann-Sofie Lundin, research administrator
Academic honors, awards and prizes
1996 Founding Fellow, Academy for Eating Disorders
2003-2004 President, Academy for Eating Disorders
2004 Eating Disorders Coalition Research Award
2006 Carolina Women’s Advocacy Award
2006-8 Vice-President, Eating Disorders Coalition
2006 Academy for Eating Disorders Leadership in Research Award
2008 The Price Family National Eating Disorders Association Award for Excellence in Research
2009 Women’s Leadership Council Faculty-to-Faculty Mentorship Award
2011 František Faltus Award Czech Psychiatric Society of the J.E. Purkyně Czech Medical Society
2011 Academy for Eating Disorders Meehan Hartley Advocacy Award