Eating Disorders and Twins

Twin girls looking uncomfortable
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Is there an association between eating disorders and twins? A quick scan of headlines often seems to link the two subjects, especially with famous and celebrity twins. Did their status as twins have anything to do with their problems? In fact, a 2014 study found that in a survey of more than two million individuals, children that were a multiple were 33 percent more likely to be diagnosed with an eating disorder.

Eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating are disorders that include extreme emotions, attitudes, and behaviors surrounding weight and food issues.

While anyone can be a victim of these devastating disorders, the most common sufferers are females in early to mid-adolescence. According to the National Eating Disorder Association (NEDA), it is estimated that as many as 20 million females and 10 million males suffer from an eating disorder at some point.


They are complex conditions that arise from a combination of behavioral, emotional, psychological, interpersonal and social factors. While scientists don't know for sure what causes a person to become unhealthy and develop anorexia, studying multiples have given them some clues about the genetic impact of the disorder. A study of over 1,000 sets of female twins by the Medical College of Virginia helped scientists identify the risk factors for bulimia. Their research showed that pairs of identical (or monozygotic) twins had a much higher incidence of disorders than fraternal twins. Because identical twins share a genetic link (they have the same DNA), scientists made the connection that heredity plays a role in the disorder.​

Some of the other emotional, psychological and environmental factors that cause eating disorders may make twins and multiple particularly susceptible. For example:

  • Feelings of lack of control in life
  • History of being teased or ridiculed based on size
  • Cultural norms that value people based on the physical appearance.
  • Overachieving personality

Twins are constantly being compared, and often their physical attributes are the basis for comparison and contrast.

No matter how much alike they are, the public will always try to distinguish one twin as "bigger," "thinner," or "prettier."

Multiples may feel driven to rebel against such labeling or try to gain control over their physical appearance by using food to compensate. Because they are constantly compared to another individual, they may have a distorted body image, always viewing themselves in relation to their co-twin rather than having a true perception of themselves as an individual.

Effects of Eating Disorders

Eating disorders can be fatal. When someone with anorexia starves herself, her body is denied the essential nutrients it needs to function. The body slows down all its processes to conserve energy, putting the individual at risk for medical issues such as fatigue, weakness, hair loss, muscle loss, bone deterioration and ultimately, heart failure. Bulimia can lead to electrolyte imbalances, tooth decay, peptic ulcers, dehydration and can have the potential for gastric rupture, damage to the esophagus, and pancreatitis. However, not all individuals with bulimia develop these difficulties.

Many long-term health risks can be sustained, even after the individual with bulimia ceases their cycle of bingeing and purging, such as high blood pressure, high cholesterol, diabetes, and heart disease.

What Can Parents Do to Protect Their Twins?

NEDA makes some recommendations that parents can implement to prevent eating disorders in their children. They include:

  • Educate your kids about weightism and sexism.
  • Avoid overemphasizing body shape and appearance.
  • Discuss the value of a healthy, well-balanced diet combined with moderate exercise.
  • Identify and help children resist the ways that the media presents images based on body type.
  • Promote self-esteem and self-respect by providing opportunities and encouragement.

In addition, parents can set a good example for their kids. Don't bemoan the extra pounds of pregnancy or nitpick your body's flaws in front of your children. Avoid fad dieting, but rather implement a healthy lifestyle for the entire family.

Finally, treat your twins or multiples as individuals. Although they can't escape the comparisons inflicted on them by the public, they should feel that they are appreciated for their own merit at home. Avoid emphasizing their physical differences, especially as they grow and develop; rather, celebrate their unique features and abilities.

If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237. 

For more mental health resources, see our National Helpline Database.

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Article Sources
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  1. Goodman A, Heshmati A, Malki N, Koupil I. Associations between birth characteristics and eating disorders across the life course: findings from 2 million males and females born in sweden, 1975–1998American Journal of Epidemiology. 2014;179(7):852-863. doi:10.1093/aje/kwt445

  2. Thornton LM, Mazzeo SE, 10.1007/7854_2010_91Bulik CM. The heritability of eating disorders: methods and current findings. In: Adan RAH, Kaye WH, eds. Behavioral Neurobiology of Eating Disorders. Vol 6. Springer Berlin Heidelberg; 2010:141-156. doi:10.1007/7854_2010_91

Additional Reading
  • Berrettini, W.,"The Genetics of Eating Disorders." Psychiatry (Edgmont). 2004, pg. 18.
  • Kendler, K., et al."The structure of the genetic and environmental risk factors for six major psychiatric disorders in women. Phobia, generalized anxiety disorder, panic disorder, bulimia, major depression, and alcoholism." Archive of General Psychiatry. May, 1995. pg. 374.