Crisp, Arthur, Gowers, Simon, Joughin, Neil, McClelland, Lisa, Rooney, Barbara, Nielsen, Soren, Bowyer, Carol, Halek, Chris, and Hartman, David (2006) Anorexia nervosa and season of birth. European Eating Disorders Review, 14 (3). pp. 144-146.

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Abstract

Nielsen (1992) has reported an excess of births in the period February–May of patients who later developed anorexia nervosa in Denmark, but only those born during and after 1964. Rezaul, Persaud, Takei, and Treasure (1996), studying nearly 2000 undifferentiated eating disorder patients, reported a significant peak season of birth occurring in May. When they also divided their population according to whether birth occurred before or during/after 1964, they found the peak season to be March for those in the later born category. These authors reviewed the literature thoroughly and explored possible explanations of their findings, ranging from physical and biological to social. The social and psychological considerations included social class, religion, presence of eating disorders in the parents influencing fertility on a seasonal basis, and parental neurotic disorders influencing and governing their relationship including frequency and timing of their sexual relationship. METHOD The present report concerns a study of the first 980 patients with anorexia nervosa on the St George’s database, examined both as a total population and also in relation to the same historical watershed of birth in 1964. As with the study reported by Rezaul et al. (1996) the data were compared with those on season of births in the general population obtained from the UK Office for National Statistics (ONS). Comparisons between these data sets were conducted using SPSS statistical software and the Edwards test for seasonality (Edwards, 1961). In addition, season of birth in the present population was examined in relation to 16 parental background variables also derived from the database. Thesewere (1) Paternal and maternal neurosis defined as nonpsychotic psychiatric disorders for which medical help had been sought. (2) Family relationships categorised as impoverished/not impoverished, overprotective/not overprotective, enmeshed/not enmeshed, conflict avoidant/not conflict avoidant, sexually conflictual/not sexually conflictual. (3) Presence/ absence of anorexia nervosa, obesity, alcoholism, ‘abnormal-normal weight control’ in the father and mother. (4) Weight consciousness/absence of weight consciousness in the mother.Within the database all these variables were scored on a four point scale. These ratings were subsequently categorised either as 1 compared with 2, 3 and 4, or 1 and 2 compared with 3 and 4 depending on distributions of data. The term ‘abnormal-normal weight control’ was coined by the first author in the 1970s (e.g. Crisp, 1981). It has survivedinthe database, and relates very closely to what, these days, is called ‘bulimia nervosa’. It refers to extreme patterns of defensive behaviour concerned with maintaining body weight within normal boundswhen itwould otherwise have escalated due to excessive food intake, causing great distress. Such patterns included excessive exercise or vomiting/purging, either immediately or shortly after eating, especially binge eating.

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