Cynthia Bulik

Cynthia Bulik

Professor
Telephone: +46852482419
Visiting address: Nobels väg 12a, 17165 Solna
Postal address: C8 Medicinsk epidemiologi och biostatistik, C8 MEB Bulik, 171 77 Stockholm
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About me

  • 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 Centre for Eating Disorders Innovation (CEDI) 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
    • Co-Director UNC Center for Psychiatric Genomics, University of North Carolina at Chapel Hill

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, and was the lead Principal Investigator of the Anorexia Nervosa Genetics Initiative (ANGI). I founded and co-lead the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED) and am the lead Principal Investigator of the Eating Disorders Genetics Initiative (EDGI)

    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

    EDGI - Eating Disorders Genetics Initiative is the largest global investigation of the genetics of eating disorders ever undertaken. In Sweden, funded by Vetenskaprådet, we are collecting online questionnaires and saliva samples from individuals who have had eating disorders at any time in their life. Find out more about EDGI-Sweden at edgi.se. Other countries involved include the United States, Australia, New Zealand, Denmark, and the United Kingdom, Several other countries are joining this global effort.

    CREAT - Comprehensive Risk Evaluation for Anorexia nervosa in Twins (CREAT). An in-depth study of monozygotic (identical) twins who are discordant for anorexia nervosa.

    PAST RESEARCH PROJECTS

    ANGI - The Anorexia Nervosa Genetics Initiative (ANGI) was the largest and most rigorous genetic investigation of anorexia nervosa ever conducted. Researchers in the United States, Sweden, Australia, and Denmark collected clinical information and blood samples from over 13, 000 individuals with anorexia nervosa and individuals without an eating disorder. ANGI represented a global effort to detect genetic variation that contributes to this potentially life-threatening illness. ANGI transformed our understanding of the causes of anorexia nervosa and encouraged its reconceptiualization as a metabo-psychiatric disorder. The project also has a Swedish website. Results were published in Nature Genetics.

    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.

    AFFILIATES
    Laura Thornton, Ph.D.
    Jessica Baker, Ph.D.
    Melissa Munn-Chernoff, Ph.D.
    Hunna Watson, Ph.D.
    Marianna Rania, MD, Ph.D.
    Janina Seubert, Ph.D.
    Lauren Breithaupt, Ph.D.
    Long Long Chen, MD
    Mattias Strand, MD
    Elisabeth Welch, Ph.D.
    Johanna Levallius, Ph.D.

    WORKING GROUP AT KAROLINSKA INSTITUTET
    Bengt Fundín, Ph.D., operations manager
    Linn Austin, research administrator
    Emma Forsén, Ph.D. post-doc and clinical psychologist
    Ida Nilsson, Ph.D., docent
    Shuyang Yao, Ph.D., post doc
    Annelie Billger, research coordinator for CREAT
    Afrouz Abbaspour, Ph.D., post doc
    Androula Savva​, research assistant
    Maria Seidel, Ph.D., post doc
    Elin Monell, Ph.D. student and clinical psychologist
    Andreas Birgegård, Ph.D., associate professor
    David Clinton, Ph.D., lecturer
    Ata Ghaderi, Ph.D., professor
    Ruyue Zhang, Ph.D. student

    EDUCATION
    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

    ACADEMIC HONOURS, AWARDS AND PRIZES
    Selection

    • 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
    • 2020 Honorary Professor, Department of Psychological Medicine (University of Otago, Christchurch, New Zealand)

Selected publications

  • Article: JOURNAL OF PSYCHIATRIC RESEARCH. 2015;65:16-22
    Zerwas S; Larsen JT; Petersen L; Thornton LM; Mortensen PB; Bulik CM
  • Article: MOLECULAR PSYCHIATRY. 2014;19(10):1085-1094
    Boraska V; Franklin CS; Floyd JAB; Thornton LM; Huckins LM; Southam L; Rayner NW; Tachmazidou I; Klump KL; Treasure J; Lewis CM; Schmidt U; Tozzi F; Kiezebrink K; Hebebrand J; Gorwood P; Adan RAH; Kas MJH; Favaro A; Santonastaso P; Fernandez-Aranda F; Gratacos M; Rybakowski F; Dmitrzak-Weglarz M; Kaprio J; Keski-Rahkonen A; Raevuori A; Van Furth EF; 't Landt MCTS-O; Hudson JI; Reichborn-Kjennerud T; Knudsen GPS; Monteleone P; Kaplan AS; Karwautz A; Hakonarson H; Berrettini WH; Guo Y; Li D; Schork NJ; Komaki G; Ando T; Inoko H; Esko T; Fischer K; Maennik K; Metspalu A; Baker JH; Cone RD; Dackor J; DeSocio JE; Hilliard CE; O'Toole JK; Pantel J; Szatkiewicz JP; Taico C; Zerwas S; Trace SE; Davis OSP; Helder S; Buehren K; Burghardt R; de Zwaan M; Egberts K; Ehrlich S; Herpertz-Dahlmann B; Herzog W; Imgart H; Scherag A; Scherag S; Zipfel S; Boni C; Ramoz N; Versini A; Brandys MK; Danner UN; de Kovel C; Hendriks J; Koeleman BPC; Ophoff RA; Strengman E; van Elburg AA; Bruson A; Clementi M; Degortes D; Forzan M; Tenconi E; Docampo E; Escaramis G; Jimenez-Murcia S; Lissowska J; Rajewski A; Szeszenia-Dabrowska N; Slopien A; Hauser J; Karhunen L; Meulenbelt I; Slagboom PE; Tortorella A; Maj M; Dedoussis G; Dikeos D; Gonidakis F; Tziouvas K; Tsitsika A; Papezova H; Slachtova L; Martaskova D; Kennedy JL; Levitan RD; Yilmaz Z; Huemer J; Koubek D; Merl E; Wagner G; Lichtenstein P; Breen G; Cohen-Woods S; Farmer A; McGuffin P; Cichon S; Giegling I; Herms S; Rujescu D; Schreiber S; Wichmann H-E; Dina C; Sladek R; Gambaro G; Soranzo N; Julia A; Marsal S; Rabionet R; Gaborieau V; Dick DM; Palotie A; Ripatti S; Widen E; Andreassen OA; Espeseth T; Lundervold A; Reinvang I; Steen VM; Le Hellard S; Mattingsdal M; Ntalla I; Bencko V; Foretova L; Janout V; Navratilova M; Gallinger S; Pinto D; Scherer SW; Aschauer H; Carlberg L; Schosser A; Alfredsson L; Ding B; Klareskog L; Padyukov L; Courtet P; Guillaume S; Jaussent I; Finan C; Kalsi G; Roberts M; Logan DW; Peltonen L; Ritchie GRS; Barrett JC; Estivill X; Hinney A; Sullivan PF; Collier DA; Zeggini E; Bulik CM
  • Article: NORSK EPIDEMIOLOGI. 2014;24(1-2):51-62
    Watson HJ; Torgersen L; Zerwas S; Reichborn-Kjennerud T; Knoph C; Stoltenberg C; Siega-Riz AM; Von Holle A; Hamer RM; Meltzer H; Ferguson EH; Haugen M; Magnus P; Kuhns R; Bulik CM
  • Article: BIOLOGICAL PSYCHIATRY. 2010;67(1):71-77
    Bulik CM; Thornton LM; Root TL; Pisetsky EM; Lichtenstein P; Pedersen NL
  • Article: ARCHIVES OF GENERAL PSYCHIATRY. 2006;63(3):305-312
    Bulik CM; Sullivan PF; Tozzi F; Furberg H; Lichtenstein P; Pedersen NL

Articles

All other publications

Grants

  • Swedish Research Council for Health Working Life and Welfare
    1 November 2022 - 30 September 2026
    Research problem and specific questions. Avoidant/restrictive food intake disorder is a serious, taxing, and potentially life-threatening condition that affects 1-5% of the population. First recognized in 2013, we know little about causes, course, maintenance factors, and outcome
    however, nutritional, medical, and psychosocial consequences are severe. We propose establishing a re-contactable, longitudinal cohort (ARFID InitiativE Sweden: ARIES) to study genetic and environmental contributors to ARFID through a developmental lens. ARIES will include rich phenotyping, DNA samples, and stool samples in a national data- and biorepository linkable to Swedish population health and quality registers to answer fundamental questions about this pernicious, life-impairing, and understudied condition. Data and method. We will first form a community-based Parent Advisory Committee (PAC) to guide our assessment domains and then recruit 500 children ages 4-9 with ARFID and 500 age and gender matched controls
    collect parental report via online questionnaires on development, feeding history, food preferences, behavior, mood, feeding-related adverse events, and other domains suggested by the PAC
    and create a biobank of saliva (for DNA) and stool (for intestinal microbiota and microbiome). Plan for project realisation. We will launch a national recruitment campaign using our country-wide collaborations with eating disorders clinicians and pediatricians and our social media channels to reach parents of children with ARFID. After an online eligibility screen, parents will complete questionnaires
    submit saliva samples for their children
    and provide a stool sample. Families will enroll in ARIES, agreeing to regular follow-ups. In addition to baseline research aims, ARIES will enable identification of predictors of transient versus enduring illness course, impact of puberty on ARFID symptoms, and impact of ARFID on educational achievement. Linking ARIES with population registers will allow research questions about ARFID comorbidity and healthcare utilization. Relevance. No evidence-based treatment for ARFID and no national guidelines exist. Parents desperately seek guidance on managing ARFID and fear for their child’s long-term well-being. ARIES will be the foundation for understanding ARFID, identifying factors related to onset, maintenance, and outcome, and be a national and international resource for essential research.
  • National Institute of Mental Health
    16 August 2022 - 31 July 2025
  • Swedish Research Council
    1 December 2021 - 30 November 2025
    Schizophrenia (SCZ) and anorexia nervosa (AN) are severe psychiatric disorders with insufficient treatments and an unexpectedly high genetic correlation. To further investigate this genetic relationship and the clinical impact of shared genes, we aim to:1) Use conjunctional FDR to identify shared genomic risk loci for SCZ and AN using data from the Psychiatric Genomics Consortium (94 390 total cases)2) Quantify the impact of AN and SCZ-AN genomic risk on the clinical presentation and outcome of SCZ in 10 827 cases from the Swedish Schizophrenia Study (S3
    PI: Sullivan)3) Quantify the impact of SCZ and SCZ-AN genomic risk on the clinical presentation and outcome of AN in 6187 cases from the Eating Disorder Genetics Initiative (EDGI
    PI: Bulik)4) Define relationships between SCZ-AN genomic risk and other medical outcomes by conducting a PheWAS in individuals without either disorder from S3 and EDGI (N=18 532) and the UK Biobank (N=400k)  The project involves 5 years of international and local collaboration with clinical and basic researchers specializing in SCZ (PI Bergen-KI
    Prof. Sullivan-KI/UNC) or AN (Dr. Baker-UNC
    Prof. Bulik-KI/UNC
    Dr. Birgegard-KI).Successful completion of these aims will identify genetic risk loci for SCZ-AN, the ways these loci modify clinical features of SCZ and AN, and their impact on risk for other medical problems. These results can be leveraged to improve outcomes for two difficult to treat and deadly psychiatric illnesses.
  • National Institute of Mental Health
    14 April 2021 - 28 February 2026
    Project Summary Now in its 13th year, the Psychiatric Genomics Consortium is perhaps the most innovative and productive experiment in the history of psychiatry. The PGC unified the field and attracted a cadre of outstanding scientists (802 investigators from 157 institutions in 41 countries). PGC work has led to identification of ~500 genetic loci in the 11 psychiatric disorders we study. Our work has led to 320 papers, many in high-profile journals (Nature 3, Cell 5, Science 2, Nat Genet 27, Nat Neurosci 9, Mol Psych 37, Biol Psych 25). As summary statistics are freely available, psychiatric disorders often feature prominently in papers by non-PGC investigators. To advance discovery and impact, we propose to continue the work of the PGC across 11 disorder groups. Considerable new data are coming in the next five years. We thus can rapidly and efficiently increase our knowledge of the fundamental basis of major psychiatric disorders. Aim 1: we will continue to advance genetic discovery for severe psychiatric disorders in all working groups, systematically interface with large biobank studies to ensure maximal comparability, and aggressively promote new studies of individuals with psychiatric disorders from diverse ancestries to increase discovery and improve fine-mapping. Aim 2: most studies analyze common variation (Aim 1), rare CNV (Aim 2), and rare exome/genome resequencing results (via collaboration) in isolation: we will apply an integrative framework to rigorously evaluate the contributions of all measured types of genetic variation on risk for psychiatric disorders. Aim 3: we will move beyond classical case-control definitions to a more biologically-based and nuanced understanding by enabling large trans-diagnostic studies, convene trans-disciplinary teams to use genetics to address unresolved questions about the nature of psychiatric disorders, and to promote large studies of the severest cases seen in psychiatric practice (leveraging the global reach of PGC investigators). Aim 4: we will work to maximize the impact of our work via translational efforts: close collaborations with neuroscience consortia to understand the biological implications of our findings
    work to identify modifiable causal risk factors
    and work to robustly predict clinical outcomes and identify patient subsets. Aim 5: we will increase impact of our work by extending and formalizing outreach to different communities (including pharma and biotech), via digital media (Twitter, Facebook, Wikipedia), and by developing, distributing, and updating resources/educational material for patients, families, and medical professionals. We will convene a Scientific Advisory Board to ensure we respond positively to those invested in our results Successful completion of this body of work will greatly advance knowledge of the genetic basis of psychiatric disorders with potentially major nosological and treatment implications. These goals are consistent with a core mission of the NIMH, and the central idea of the PGC: to convert the family history risk factor into biologically, clinically, and therapeutically meaningful insights.
  • National Institute of Mental Health
    23 September 2019 - 31 July 2024
  • National Institute of Mental Health
    11 September 2019 - 30 June 2025
  • Southern and Eastern Norway Regional Health Authority
    1 January 2019
    Further outputs from the MoBa-Eat project in 2024<br/><br/>NOForskningsopphold i utlandetIn 2024, MoBa-Eat researchers have continued to work on analyses to answer the core questions of the project: how and why do eating disorders develop early in life, and what are the role of familial risk transmission processes?In 2024 we have written several papers which are submitted or ready for submission. <br/><br/>In one study, we estimated the prevalence of avoidant/restrictive food intake in a general population sample, examined developmental characteristics across childhood, and investigated its genetic architecture using genome-wide association analysis. In data from 35 5751 children in MoBa, we identified children with avoidant/restrictive food intake (ARFI-Broad), separating between children with persistent (present at both ages 3 and 8), transient (only at age 3), and emergent (only at age 8) symptoms. Relevant register-based diagnostic codes were used as indicators of clinical significance to identify children with more severe problems (ARFI-Clinical). We found that prevalence of persistent avoidant/restrictive eating was 6%, while 18% had transient and 8% emergent symptoms. Children with persistent avoidant/restrictive eating exhibited more developmental difficulties across multiple domains from infancy to adolescence. We identified significant genome-wide heritability and a potential genetic variant association for avoidant/restrictive eating. Our findings point to substantial prevalence of avoidant and restrictive food intake and elevated risk for other developmental difficulties in affected children, the need for broad support interventions, and advance understanding of genetic influences on avoidant and restrictive eating.<br/><br/>In another study, we examined eating problems among adolescent boys and girls before and during the Covid-19 Pandemic. Based on a preregistered analysis plan, we used cross-sectional data collected from 22,706 14-16-year-olds over 6 years (55% during the pandemic) in the Norwegian Mother, Father, and Child Cohort. We used measurement invariance analyses to compare the level of eating restraint and body concern before and during the pandemic, and multi-group structural equation models to estimate pre-pandemic and pandemic patterns of associations. We found there was a general increase in eating problems among 14-16-year-olds over time. Adjusting for this trend, the pandemic appeared to exacerbate problems among girls. Although the mechanisms are unclear, our results point to factors susceptible to change that could have been intensified during the pandemic (e.g., screen time, mental distress). Our results highlight the importance of recognizing sex-specific differences in eating problems.<br/><br/>In a third study, we investigated associations between genetic liability to eating disorders indexed by polygenic scores (PGSs), exposure to childhood maltreatment, and lifetime risk of anorexia nervosa, bulimia nervosa, binge-eating disorder, purging disorder, and binge-eating spectrum disorder. The lifetime prevalence of eating disorders ranged from 0.52% (purging disorder) to 11.72% (binge-eating spectrum disorder). All forms of childhood maltreatment were robustly associated with elevated risk of eating disorders. Eating disorder PGSs also predicted a higher risk of eating disorders. We did not find consistent evidence of statistically significant interaction effects between childhood maltreatment and eating disorder PGSs. Our findings highlight substantial associations between both childhood maltreatment and genetic risk for eating disorders in mothers.<br/><br/>A fourth study on parental BMI and offspring childhood body size and eating behaviour is under review. <br/><br/>The MoBa-Eat team has also contributed as co-authors on several other publications.<br/>
  • National Institute of Mental Health
    23 August 2018 - 30 June 2022
  • National Institute of Mental Health
    18 September 2017 - 31 August 2021
  • Southern and Eastern Norway Regional Health Authority
    1 January 2017 - 31 December 2021
  • Swedish Research Council
    1 January 2017 - 31 July 2017
  • National Institute of Mental Health
    11 June 2012 - 28 February 2018
  • National Institute of Mental Health
    8 April 2011 - 31 January 2014
  • A Genomewide association study of anorexia nervosa.
    Wellcome Trust Ltd
    1 August 2009 - 31 July 2012
  • National Institute of Mental Health
    6 June 2008 - 28 February 2012
  • National Institute of Mental Health
    1 April 2008 - 31 March 2014
  • National Institute of Mental Health
    28 September 2007 - 31 July 2011
  • National Institute of Mental Health
    17 July 2007 - 30 June 2018
  • National Institute of Mental Health
    27 September 2005 - 29 February 2008
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development
    4 February 2005 - 31 December 2008
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Employments

  • Professor, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 2014-

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