{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:54:28Z","timestamp":1791366868730,"version":"4.3.1"},"reference-count":72,"publisher":"Royal College of Psychiatrists","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"abstract":"<jats:sec id=\"S0007125026107636_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Eating disorder treatment is most successful when delivered at first onset, underscoring the importance of early intervention. Genetic factors may contribute to earlier onset, but molecular genetic research into symptom onset and severity remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026107636_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We investigated: (a) age at onset of behavioural symptoms and low weight, including sex and gender differences; and (b) the single-nucleotide polymorphism (SNP)-based heritability and cross-trait polygenic associations of symptoms, onset, and severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026107636_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      Participants (\n                      <jats:italic>n<\/jats:italic>\n                      = 24 973) of genetically derived European ancestry were from the National Institute for Health and Care Research BioResource, including the Genetic Links to Anxiety and Depression Study, the Eating Disorders Genetics Initiative UK\u00a0and the COVID-19 Psychiatry and Neurological Genetics study. Symptoms were assessed with the ED100K questionnaire. We described sex-stratified onset of binge eating, low weight, self-induced vomiting, laxatives, diuretics, excessive exercise, and fasting. SNP-based heritability was estimated with genome-wide complex trait analysis using genomic-relatedness-based restricted maximum-likelihood. We tested associations with 26 polygenic scores (PGS), which were calculated using SBayesRC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026107636_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Symptom median onset ranged from 16 to 20 years: vomiting (16 years), fasting and excessive exercise (17 years), binge eating (18 years), laxatives (19 years), diuretics (20 years) and low weight (20 years). Males were disproportionately likely to report adult onset. In females, behavioural symptoms and low weight showed substantial heritability (SNP-based\n                      <jats:italic>h<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.31\u20130.78), but age at onset and cognitive symptoms were less heritable. PGS analyses identified distinct pathways: in females, higher childhood obesity PGS was linked to earlier binge eating onset (approximately 7 months), and higher educational attainment PGS to earlier low weight onset (approximately 6 months).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026107636_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Eating disorder symptoms begin in adulthood as frequently as adolescence, challenging stereotypes and underscoring investment needed in adult services, particularly for males. Although behavioural symptoms and low weight were strongly heritable, age at onset and cognitive symptoms showed limited genetic contribution. Symptom-level PGS analyses highlight distinct biological and developmental pathways. Larger sample sizes and more accurate phenotyping are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjp.2026.10763","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:28:33Z","timestamp":1791365313000},"page":"1-10","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Mapping the genetic landscape of the age at onset and severity of eating disorder symptoms"],"prefix":"10.1192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9419-1009","authenticated-orcid":false,"given":"Helena L.","family":"Davies","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"R. ter Kuile","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"},{"name":"University College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain-Ul-Abideen","family":"Ahmad","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"},{"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Hyuck","family":"Lee","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"},{"id":[{"id":"https:\/\/ror.org\/015803449","id-type":"ROR","asserted-by":"publisher"}],"name":"South London and Maudsley NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rujia","family":"Wang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5513-8902","authenticated-orcid":false,"given":"Jessica","family":"Mundy","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"},{"name":"London School of Hygiene & Tropical Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6759-0944","authenticated-orcid":false,"given":"Jonathan R. I.","family":"Coleman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"},{"name":"South London and Maudsley NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Sampels","sequence":"additional","affiliation":[{"name":"Humboldt-University of Berlin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1677-1857","authenticated-orcid":false,"given":"Saakshi","family":"Kakar","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Kelly","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea Mika","family":"Malouf","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gursharan","family":"Kalsi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerome","family":"Breen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Herle","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1267-8287","authenticated-orcid":false,"given":"Christopher","family":"H\u00fcbel","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King\u2019s College London"},{"id":[{"id":"https:\/\/ror.org\/015803449","id-type":"ROR","asserted-by":"publisher"}],"name":"South London and Maudsley NHS Foundation Trust"},{"name":"Aarhus University"},{"id":[{"id":"https:\/\/ror.org\/02y3dtg29","id-type":"ROR","asserted-by":"publisher"}],"name":"German Red Cross Hospitals Berlin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"S0007125026107636_ref40","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.o537"},{"key":"S0007125026107636_ref48","doi-asserted-by":"publisher","DOI":"10.1002\/erv.1137"},{"key":"S0007125026107636_ref24","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2021.102"},{"key":"S0007125026107636_ref26","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-023-01593-7"},{"key":"S0007125026107636_ref35","doi-asserted-by":"publisher","DOI":"10.1101\/2025.09.25.25336612"},{"key":"S0007125026107636_ref25","doi-asserted-by":"crossref","first-page":"eaap8757","DOI":"10.1126\/science.aap8757","article-title":"Analysis of shared heritability in common disorders of the brain","volume":"360","author":"Anttila","year":"2018","journal-title":"Science"},{"key":"S0007125026107636_ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2023.08.063"},{"key":"S0007125026107636_ref47","unstructured":"47 NHS England and NHS Improvement and the National Collaborating Central for Mental Health. The Community Mental Health Framework for Adults and Older Adults . NHS England, 2019 (https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2019\/09\/community-mental-health-framework-for-adults-and-older-adults.pdf)."},{"key":"S0007125026107636_ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2019.103503"},{"key":"S0007125026107636_ref7","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-021-01161-7"},{"key":"S0007125026107636_ref36","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.03062"},{"key":"S0007125026107636_ref57","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-015-0070-2"},{"key":"S0007125026107636_ref63","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.b.32040"},{"key":"S0007125026107636_ref2","volume-title":"Diagnostic and Statistical Manual of Mental Disorders (DSM-5\u00ae)","year":"2013"},{"key":"S0007125026107636_ref1","unstructured":"1 Heart, Minds, and Genes Coalition for Eating Disorders. The Cost of Eating Disorders in the UK 2019 and 2020 . Heart, Minds, and Genes Coalition for Eating Disorders, 2021 (https:\/\/www.yumpu.com\/en\/document\/read\/65877873\/the-cost-of-eating-disorders-in-the-uk-2019-and-2020-with-annex)."},{"key":"S0007125026107636_ref6","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22897"},{"key":"S0007125026107636_ref18","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23580"},{"key":"S0007125026107636_ref67","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.128.5.825"},{"key":"S0007125026107636_ref56","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2892"},{"key":"S0007125026107636_ref68","doi-asserted-by":"publisher","DOI":"10.1037\/abn0000352"},{"key":"S0007125026107636_ref69","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-020-00754-2"},{"key":"S0007125026107636_ref71","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.33"},{"key":"S0007125026107636_ref49","doi-asserted-by":"publisher","DOI":"10.1002\/erv.830"},{"key":"S0007125026107636_ref51","doi-asserted-by":"publisher","DOI":"10.1007\/s40519-020-01002-6"},{"key":"S0007125026107636_ref33","unstructured":"33 National Institute for Health and Care Excellence. Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care . NICE, 2017 (https:\/\/www.nice.org.uk\/guidance\/cg61\/evidence\/full-guidance-pdf-196701661)."},{"key":"S0007125026107636_ref4","doi-asserted-by":"publisher","DOI":"10.1080\/10640266.2014.964623"},{"key":"S0007125026107636_ref32","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23834"},{"key":"S0007125026107636_ref22","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291715000215"},{"key":"S0007125026107636_ref72","doi-asserted-by":"publisher","DOI":"10.1038\/s41562-023-01579-9"},{"key":"S0007125026107636_ref46","unstructured":"46 NHS England. NHS Long Term Plan . NHS England, 2019 (https:\/\/www.longtermplan.nhs.uk\/wp-content\/uploads\/2019\/08\/nhs-long-term-plan-version-1.2.pdf)."},{"key":"S0007125026107636_ref15","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22201"},{"key":"S0007125026107636_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2006.05.013"},{"key":"S0007125026107636_ref70","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1002\/mpr.55","article-title":"Improving accuracy of major depression age-of-onset reports in the US National Comorbidity Survey","volume":"8","author":"Cannell","year":"1999","journal-title":"Int J Methods Psychiatr Res"},{"key":"S0007125026107636_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.chc.2019.05.002"},{"key":"S0007125026107636_ref43","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004342"},{"key":"S0007125026107636_ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajhg.2010.11.011"},{"key":"S0007125026107636_ref8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j5245"},{"key":"S0007125026107636_ref28","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1002\/eat.23481","article-title":"One size does not fit all. Genomics differentiates among anorexia nervosa, bulimia nervosa, and binge-eating disorder","volume":"54","author":"Abdulkadir","year":"2021","journal-title":"Int J Eat Disord"},{"key":"S0007125026107636_ref11","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20451"},{"key":"S0007125026107636_ref45","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-022-00665-z"},{"key":"S0007125026107636_ref54","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291708003310"},{"key":"S0007125026107636_ref53","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1520109113"},{"key":"S0007125026107636_ref66","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2012.02.013"},{"key":"S0007125026107636_ref17","doi-asserted-by":"publisher","DOI":"10.3390\/nu11081932"},{"key":"S0007125026107636_ref58","first-page":"347","article-title":"Eating disorders across cultures","volume":"8","author":"Nasser","year":"2009","journal-title":"Psychiatry (Abingdon)"},{"key":"S0007125026107636_ref64","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291721000829"},{"key":"S0007125026107636_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2017.04.002"},{"key":"S0007125026107636_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2006.03.040"},{"key":"S0007125026107636_ref44","doi-asserted-by":"publisher","DOI":"10.1192\/bjb.2021.109"},{"key":"S0007125026107636_ref50","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2020.13"},{"key":"S0007125026107636_ref39","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgen.1004269"},{"key":"S0007125026107636_ref55","doi-asserted-by":"publisher","DOI":"10.1016\/S0962-1849(05)80123-4"},{"key":"S0007125026107636_ref61","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-019-0439-2"},{"key":"S0007125026107636_ref21","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-022-01888-z"},{"key":"S0007125026107636_ref31","doi-asserted-by":"publisher","DOI":"10.1002\/eat.24037"},{"key":"S0007125026107636_ref52","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23769"},{"key":"S0007125026107636_ref3","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1002\/eat.20956","article-title":"A systematic review of dropout from treatment in outpatients with anorexia nervosa","volume":"45","author":"Broadbent","year":"2012","journal-title":"Int J Eat Disord"},{"key":"S0007125026107636_ref20","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811420485"},{"key":"S0007125026107636_ref42","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2017.08.001"},{"key":"S0007125026107636_ref60","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2889"},{"key":"S0007125026107636_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpsgos.2021.09.001"},{"key":"S0007125026107636_ref62","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-018-0115-4"},{"key":"S0007125026107636_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.chc.2008.07.013"},{"key":"S0007125026107636_ref10","doi-asserted-by":"publisher","DOI":"10.1080\/j.1440-1614.2006.01905.x"},{"key":"S0007125026107636_ref29","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1038\/s41431-023-01431-8","article-title":"Persistent thinness and anorexia nervosa differ on a genomic level","volume":"32","author":"Abdulkadir","year":"2024","journal-title":"Eur J Hum Genet"},{"key":"S0007125026107636_ref41","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291711001541"},{"key":"S0007125026107636_ref59","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajhg.2022.05.005"},{"key":"S0007125026107636_ref65","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-022-01285-8"},{"key":"S0007125026107636_ref12","volume-title":"Managing Transitions When the Patient has an Eating Disorder: Guidance for Good Practice","author":"Winston","year":"2017"},{"key":"S0007125026107636_ref13","unstructured":"13 NHS England. Children and Young People\u2019s Eating Disorders Programme . NHS England, 2026 (https:\/\/www.england.nhs.uk\/mental-health\/cyp\/eating-disorders\/)."},{"key":"S0007125026107636_ref23","doi-asserted-by":"publisher","DOI":"10.1038\/mp.2014.158"},{"key":"S0007125026107636_ref34","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2018.09.015"}],"container-title":["The British Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007125026107636","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:28:38Z","timestamp":1791365318000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007125026107636\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":72,"alternative-id":["S0007125026107636"],"URL":"https:\/\/doi.org\/10.1192\/bjp.2026.10763","relation":{},"ISSN":["0007-1250","1472-1465"],"issn-type":[{"value":"0007-1250","type":"print"},{"value":"1472-1465","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial licence (https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original article is properly cited. The written permission of Cambridge University Press or the rights holder(s) must be obtained prior to any commercial use.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}