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The Habsburg Jaw and Other Royal Inbreeding Deformities

Funerary mask of King Tutankhamen, Egypt's boy king, also known as King Tut. He was frail and very young when he died. His parents were also brother and sister.

Funerary mask of King Tutankhamen, Egypt's boy king, also known as King Tut. He was frail and very young when he died. His parents were also brother and sister.

The Longterm Effects of Incest and Inbreeding

In some places in the United States, folks make jokes about inbreeding. My own mother was from West Virginia, and some of her friends would often make “pumpkin head” jokes about the inbred folks where she came from. (It is true that her parents, my grandparents, were second cousins; however, both my mother and her brother were adopted.)

For a long time, the dangers of inbreeding or having children with a close relative weren't completely understood. The biggest problem with inbreeding is that when close relatives choose to mate, it results in homozygosity, which can increase their offspring's chances of being affected by deleterious recessive traits for all kinds of physical and cognitive disabilities, including ailments like hemophilia and cystic fibrosis as well as deformities like the Habsburg jaw. These incestual pairings also run a greater risk of...

  • Reduced fertility (both for the related parents and in their offspring)
  • Lower birth rate and higher infant mortality
  • Congenital birth defects (including facial asymmetry)
  • Certain kinds of cancer
  • Suppressed immune systems
  • Smaller adult size (pedigree collapse)

These days, we have genetic testing and other valuable research tools to help us determine what may happen if we have kids with someone who is biologically related to us. But up until just a few centuries ago, it was common practice for people to marry their cousins and even their brothers and sisters (and in many remote rural regions, the practice continues today).

Historically, family line relations were often formed in royal houses to secure political alliances, strengthen the lines of succession, and ensure the noble purity of the bloodline. This practice caused a host of ailments and deformities that can still plague descendants of these royal houses to this day.

Charles II of Spain in his twenties. You can clearly see the Habsburg Jaw, and this portrait was likely being kind.

Charles II of Spain in his twenties. You can clearly see the Habsburg Jaw, and this portrait was likely being kind.

Charles II of Spain and the Habsburg Jaw

Also called the Habsburg Lip and the Austrian Lip, the Habsburg Jaw is a physical condition known by the modern term mandibular prognathism. It is characterized by a jutting lower jaw that is often accompanied by an abnormally thick lower lip and sometimes a tongue that is abnormally large.

It is believed that the Habsburg Jaw originated in a family of Polish royals, and the first person to have been known to have it was Maximilian I, a Holy Roman Emperor who ruled from 1486 to 1519. Many portraits of this monarch feature a pronounced underbite.

Through generations of royals marrying each other and therefore closing the ranks of their gene pools, the Habsburg Jaw manifested itself just about everywhere in Medieval Europe. The House of Habsburg, which is named after the Habsburg Castle in Switzerland, is associated with the Habsburg Jaw because so many of its members had it.

Charles II, the last Spanish Habsburg, was feeble-minded and physically deformed as a direct result of his limited gene pool. His ancestor, Joanna of Castile, actually appears in his family tree no less than fourteen times because of first and second cousins intermarrying. It is said that Charles II's genetic makeup was more muddled than it would have been if his parents had been brother and sister.

Charles II's mandibular prognathism was so pronounced that it was said that he could not chew his food and that the size of his tongue caused him to drool significantly. He also had mental issues and was considered mildly retarded. He didn't learn to talk until he was four and couldn't walk until the age of eight. As an adult, his speech was so poor that he was, for the most part, unable to be understood.

Charles II was also sterile, and when he died just shy of his 39th birthday, the country went to war to decide on an heir. The War of the Spanish Succession lasted for thirteen years, and Philip V began the House of Bourbon at the end of the war.

King Juan Carlos I, the current ruler of Spain, is a distant descendant of the House of Habsburg, although he does represent Philip V's House of Bourbon. He has the Habsburg Jaw, but only slightly.

Other Habsburgs with the pronounced jaw deformity included Charles V, Holy Roman Emperor, and Ferdinand I, Holy Roman Emperor, as well as countless others.

Alexei Nikolaevich, son of Nicholas II, the last Tsar of Russia. He was a hemophiliac, a trait that came from his great-grandmother, England's Queen Victoria.

Alexei Nikolaevich, son of Nicholas II, the last Tsar of Russia. He was a hemophiliac, a trait that came from his great-grandmother, England's Queen Victoria.

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Royal Hemophiliacs

Hemophilia has hit the royal houses of Europe pretty hard. Hemophilia isn't necessarily the product of inbreeding, but because these different monarchies intermarried to secure territorial and familial alliances, and because many were carrying the gene for hemophilia, they spread the disease throughout Europe.

It all began with England's Queen Victoria, who reigned from 1837 to 1901. So many of her children and grandchildren married into royal families that she is sometimes referred to as "the grandmother of Modern Europe." It is believed that she inherited the gene that causes hemophilia (haemophilia is the British spelling) from her father, Prince Edward, and not her mother, Princess Victoria of Saxe-Coburg-Saalfeld. According to some historians, however, there is a possibility that hemophilia hadn't been introduced into the royal bloodlines before Victoria because Prince Edward may not have been her biological father.

What happened with Queen Victoria's descendants, however, is well documented. Victoria passed the hemophilia gene to her son, Leopold, and some of her daughters who, in turn, passed it to their sons and daughters. The effects of this hereditary disease caused disastrous consequences in the lives of Victoria's descendants:

  • Prince Leopold, Duke of Albany - Queen Victoria's son, he died at the age of 31 after a brain hemorrhage caused by a fall.
  • Prince Friedrich of Hesse and by Rhine - The son of Louis IV, Grand Duke of Hesse and Princess Alice of England, Queen Victoria's daughter, Friedrich also died of a cerebral hemorrhage from falling out of a window twenty feet to the ground below. His injuries were not severe enough to have killed him; he died because his body could not stop bleeding. He was two and a half years old.
  • Prince Waldemar of Prussia - The son of Princess Irene of Hesse and by Rhine, who was the daughter of Princess Alice of England, Queen Victoria's daughter, died in 1945 at the age of 56. During World War II, he desperately needed a blood transfusion, which does help hemophiliacs. His doctor had been diverted to help the victims of a concentration camp, and Prince Waldemar died awaiting his return.
  • Lord Leopold Mountbatten - His mother was Princess Henry of Battenberg, known before her marriage as Princess Beatrice, a daughter of Queen Victoria. He died on the operating table during surgery for his hip. He was 32.
  • Prince Heinrich of Prussia - Great-grandson of Queen Victoria through his mother and father, the little prince died at the age of four after a fall. His brother was Prince Waldemar of Prussia. Their brother, Sigismund, did not have hemophilia.
  • Infante Alfonso and Infante Gonzalo of Spain -These two guys, both princes of Spain, were descended from Queen Victoria by way of their mother, Princess Victoria Eugenie of Battenberg, who was the Queen's granddaughter. Both of them died after car accidents that they could have survived if they had not had hemophilia. Alfonso was 31, Gonzalo was 19.
  • Tsarevich Alexei Nikolaevich of Russia - Alexei's story is a sad one. He inherited hemophilia from his mother, Empress Alexandra Feodorovna, a granddaughter of Queen Victoria. His father Nicholas was the last Tsar of Russia and the whole family—mom, dad, four daughters, and Alexei—were murdered during the Russian Revolution of 1918. Some say that this civil war came about in part because of Alexei's parents' patronage of a man named Rasputin, whom history still calls "the mad monk." Because he was able to control Alexei's hemophilia symptoms, Rasputin was also called upon for advice in other areas which, in turn, angered the Russian people.
Bust of Ptolemy II, who married his sister Arsinoe.

Bust of Ptolemy II, who married his sister Arsinoe.

Children of Egypt: Elongated Skulls of King Tut and Family, a Video by Brien Foerster

Egyptian Royal Inbreeding Disorders

Philadelphia may be the City of Brotherly Love, but the ancient Greek word philadelphoi was used to describe a whole different kind of thing. It was a nickname given to the brother and sister marriage of Ptolemy II and Arsinoe. In fact, Ptolemy II's name is often given as Ptolemy II Philadelphos.

The ancient Egyptian royal families were expected to marry their brothers and sisters and it happened in virtually every dynasty. There were not only brother and sister marriages, but there were what was called "double niece" marriages, where a man married a girl whose parents were his own brother and sister. This may have been done because of the ancient Egyptian belief that the god Osiris married his sister, Isis, to keep their bloodline pure.

King Tutankhamen, more widely known as King Tut or the Boy King, was the product of a marriage between brother and sister. It is also possible that Tut's wife, Ankhesenamun, was either his full or half sister or his niece. Tests on the mummies of two stillborn children found in Tut's tomb have confirmed that Tut was the father and that the mother and father were related.

Cleopatra, the last pharaoh, was at one time married to her own brother before she (may have) had him killed.

Because of close marriages like these, stillbirths were common in the royal families, as were birth defects and genetic disorders. By the same DNA testing that identified Tutankhamen's children, we also now know that Tut himself was plagued by illnesses and disorders caused by his limited gene pool. Tut had a cleft palate, a club foot (as well as missing bones in his feet), and scoliosis, all of which either occurred or were worsened due to his parentage.

Unfortunately, many other deformities were present in almost every dynasty because of inbreeding. All through the 18th dynasty, we see huge overbite problems as well as elongated skulls in almost all of the royals, evidence of the shallow gene pool.

Royal wedding: William and Kate on their big day. Fortunately, they're no biologically closer than 11th cousins.

Royal wedding: William and Kate on their big day. Fortunately, they're no biologically closer than 11th cousins.

Outbreeding Saves European Royals

Today, we understand the dangers and consequences of inbreeding. Most societies have attached taboos and stigmas to marrying inside one's family, and it is rarely done. In fact, today there are only a few places where marrying within the family is still condoned, mostly because of the remoteness of those locations (and their relatively small populations).

The term "outbreeding" is the exact opposite of inbreeding and has become the norm, even amongst royals. As people became aware of the damage they were causing their descendants, they began to reach further for potential mates and, in some cases, brought commoners into the royal bloodlines.

Morganatic marriages, which occur when a royal marries someone of a lesser status, are becoming increasingly common and necessary to inflate the gene pool. Prince Charles and Princess Diana were seventh cousins, once removed, but their marriage was considered morganatic because Diana was not royalty (she was nobility, but not royalty). Prince Charles and his second wife, Camilla Parker-Bowles, are ninth cousins, once removed. Their marriage is also morganatic.

When Prince William, son of Prince Charles and Princess Diana, married Catherine Middleton in 2011, many people spent days digging up ancestry charts to see if the two shared any relatives. If they had, then any children they had could have had serious issues with recessive genes or a myriad of diseases and disorders. Fortunately for these two, their closest possible connection would be as eleventh cousins.

Fortunately, royal inbreeding is now virtually non-existent. Although it is still practiced in a few societies, technology and awareness are catching up. The days of the Habsburg Jaw may be over.

Questions & Answers

Question: what advice could be given to people who are related by blood and still want to get married to one another?

Answer: Truthfully? Don’t have kids. My grandparents were related and adopted.

Question: Did facial asymmetry originate from the Habsburg royal family?

Answer: Not hardly.

Question: What else have you written?

Answer: Hundreds of articles, dozens of short stories and a few novellas. That’s about it.

© 2012 Georgie Lowery


Swan Viaduct on June 02, 2020:

Dearest Galpal, 

I'm just lovin' your article I'm in the process of reading, with a minor(s) editorial suggestion for your pop-up additives: 

Fyi: People, immigrants emigrain'ts, and whatnot, ain't "Illegals"; Hopes spring eternal, future historians will substantiate thus, by the grace of God. 

Take care of yourself - they say a surgical mask may help, there either.

Your 'umble savant, 

Swan Viaduct

Kate P from The North Woods, USA on January 01, 2020:

Fantastically researched and very well written. Readable, informative, and I learned something new!

Gash on December 24, 2019:

If we called the vulnerable and the less fortunate in our society ‘inbred benefit cheats’ we’d be rightly be pilloried for our comments. And yet, here we are...

Jef on December 03, 2019:

Aristocrats should marry high quality members in their own people they are champions of. Not other royals of other peoples. Its not patriotic, its too cosmopolitan. Secondly, aristocracy of the blood should be abolished and instead an aristocracy of arete should be established like in ancient Greece, its the origin of aristocracy.

NotHereForBS on June 10, 2019:

Greek not Roman*

Lorraine Jerkins on May 27, 2019:

I found this so interesting and informative. Most of the things I run across are very light weight or way over my head. This was perfect.

DMiller1966 on April 29, 2019:

Not only is this piece poorly written, it contains some major errors.

I am not qualified to comment on the scientific aspects, but I am a historian. The final section regarding the expansion of morganatic marriages to address issues with the gene pool is wildly incorrect. First, the definition of a morganatic marriage is not merely one between two people of vastly different status. The children of such a marriage do not inherit their father’s title or position, nor does a wife assume her husband’s title. Such a marriage excludes offspring from the line of succession. The article then describes various marriages are morganatic which are not. For example, the marriage of Prince Charles and Lady Diana Spencer is described as morganatic because she was a commoner. While she was a commoner, it was not morganatic. If it were, she would not have assumed her husband’s title and their children would not be heirs to the throne.

In fact, morganatic marriage has never had widespread use in England. It certainly isn’t expanding, as claimed. It was considered a possible option as a means by which HM King Edward VIII might marry Wallis Simpson, but was rejected.

This is such a sloppy and careless error that it calls into question the validity of all of the research done for the article. This piece should be withdrawn.

John on March 05, 2019:

I find the Hapsburg Jaw story very informative, having studied this Austrian Royals to the point of WWI. though no longer in power, the line is not extinct. They still hold the practice of marrying of equal or higher title. They have a pretend hierarchy of royalty

five some on February 13, 2019:

this is so interesting and amazing. I lernt so mutch!

Sean on February 07, 2019:

K. Though many cultures have practiced headbinding, the Egyptians are not known to be one of them. This is indeed a genetic trait.

Bryan on February 04, 2019:

Though inbreeding does bring out recessive traits, if you remove the bad traits from the gene pool you actually purify the genetics, and it is how most purebred breeds of animals were created throughout history. It is the only way to have stable genes that create the same result over and over.

The first generations of incest would bring out a lot of the problems, and modern populations far removed from it would likely have far more problems than more stable genetics it had already been done awhile in.

But through incest selective breeding works fast because it progresses faster at isolating and changing genes and eventually becomes a new breed or race.

Bryan on February 04, 2019:

Everything mentioned is true. Yet it does not acknowledge any of the positives or other results.

When people have inbreeding the offspring are more like the parents, and in places where they practiced infanticide (Hawaii for example) on any child born with clear problems incest actually preserved old genetics and over time through infanticide most of the bad recessive traits would be bred out. Essentially creating a pure bred much as you would create a new dog breed.

Close genetic breeding leads to more rapid adaptions and changes, some bad, some good. You evolve faster essentially.

It is the source of the creation of most races in fact, as in ancient times the ruling classes often had many wives and so you had a lot of the same male gene breeding with itself and its own offspring. The giant royal harems in some places would increase this. However it also preserves genes too as brother sister offspring multiple generations in a row would be so close to the genes of generations before that if you consider the royalty the direction of that race, preserves a baseline the rest of the population mixes with.

I am not in favor of incest, but it is interesting to consider that the only real way to have another almost copy of someone decades later would be brother sister unions over long periods of time to the point that the genes from great great grandparents to current offspring are almost identical. You essentially get as close to the same people over and over again.

Tim Truzy from U.S.A. on January 01, 2019:

Excellent article. I'd always heard that the royals were inbred in the past, in Europe and in ancient Egypt. I knew this contributed to many defects, including the ones you mentioned. This was a very good article, and I'm glad Prince Harry married Meghan.

Great read and very informative.



Dale Anderson from The High Seas on January 01, 2019:

Well this hub is certainly a talking point. Kudos to you for having the bravery to write and post it. Keep them coming. Hearing other people's ideas and opinions is how I learn new things.

Jane on November 29, 2018:

In reply to Cheryl Love. Your post is inspired by bigotry and I suggest that if you do some research, you will find most English people have normal, moleless faces. Noses however may be a different matter!

TriciaN on April 19, 2018:

I was interested to read about the elongated skulls. That would explain the so-called "alien" skulls that have been found.

Lynn Weisen from South Amboy on April 18, 2018:

Hemophilia is carried on the X chromosome, passed through the female lineage from both father and mother's side. Spontaneous hemophilia is a theory, yet to be proven. One proven link is if the paternal parent was older than normal. Queen Victoria's father was in his 50's when she was conceived. While no other ancestors had the gene, it is possible that there were two carriers of the hemophilia gene, a female ancestor on both paternal and maternal sides in Queen Victoria's case; or that Victoria was a carrier, as well as a female ancestor of Alfred. If the paternal age of one's father is a factor, later studies may show that age can deteriorate some other gene that exists, as yet unidentified, creating the hemophiliac gene

The use of Hapsburg or Habsburg is hardly relevant; the Hapsburgs spelled their name with a 'p', later, it was spelled phonetically after the family became extinct. I still love this article, and recommend to others.

M on April 14, 2018:

All animals we eat today are battery bred and are a product of incest. It is done because it works.Contrary to popular ignorance, once you have specific genetic characteristics you want to preserve, this technique is the way to preserve those characteristics. In ancient times farmers already knew and practiced this. The argument that there are recessive genes that produce defects is moot, the resulting less than physically perfect offspring need only be kept separate from the breeding pool to eliminate the problem they pose. Once you have a specimen that is "pure in it's generations" this type of breeding guarantees repetition of the favorable traits you are trying to conserve. This is why commercial breeding of livestock follows this path.

Mickey on March 16, 2018:

The "hapsburg jaw", IS NOT race specific. I say this because, as a so called African American, during my childhood, I was teased and bullied about it. Now, in my 70s, no bullying, but still noticable to others. I wonder if there is a DNA test that would show me as somewhere in that royal line?

Leland Johnson from Midland MI on March 08, 2018:

what interesting hub.

Oriflamme on February 14, 2018:

Check further on Queen Victoria. Several people at my local hemophilia center confirm that hers was a spontaneous mutation (no previous ancestors had the gene). Something like 40% of hemophilia carriers (women) have spontaneous mutations rather than an hereditary history. It would have bee rather noticeable if any of her predecessors had hemophilia, and they didn't.

Deborah W on February 12, 2018:


What an arrogant comment.

HABSBURG is the older and more traditional spelling of the name HAPSBURG. I suggest you look at your own grammar before attempting to correct spelling which isn’t incorrect, “please get your spelling correct” is hardly fluent or correct English.

linda on February 11, 2018:

I found the articles very interesting, never heard of the HAPSBURG jaw.(please get your spelling correct)

bree on February 06, 2018:

well this was certainly interesting.

Missybrain24 on February 04, 2018:

I think that the head binding in some communities was due to the fact that royalty had elongated skulls.

Susan Jones on January 28, 2018:

I inherited a small jaw from my father's side of the family. This has resulted in crowded lower teeth and an overbite.

fiachramac on August 06, 2017:

I have to say the incest question does throw me a bit, I've always understood that incest would cause health problems for the kids and deformities. Yet when I look at the Irish travelling community, I see health problems which could just as well be from their general lifestyle and I don't see deformities. The women very often are beautiful and big breasted, as the saying goes "they've tits before they've teeth" and are certainly highly fertile as they produce large families still to this day

dave on June 28, 2017:

Several Africans ruled as Holy Roman Emperors. As a result many European aristocracies were started or heavily infiltrated by African genes. After white supremacists banded together to rid Europe of its African influences, then the anglo inbreeding, along with the Spanish inquisition commenced as an attempt to decimate any remains of African influences.

Alan R Lancaster from Forest Gate, London E7, U K (ex-pat Yorkshire) on May 09, 2017:

Both Princess Anne and Prince Charles show the same jaw-line as their father and uncle, Lord Louis Mountbatten, although it's not as noticeable on the males.

Away from the Royals, though, there are other sections of society in Britain who show the worse signs of genetic disorder through kinship marriages. We have many migrants from the Indian sub-continent who have brought cousins into the country as spouses - male and female - and over two/three generations their inbreeding has begun to show.

I live in an eastern London borough with a sizeable migrant population from central southern Asia, where the effects are increasingly obvious in physical and mental disorders, sometimes combined in one person. Whether they've been made aware of the outcome of such marriages I don't know, but if it hasn't already the effect will take its toll on the medical and social services.

Geo on March 04, 2017:

That really explains a lot about England's royals they have that long face, almost like a horse &that first comment says your wrong about queen Victoria getting it from her father then ends by saying "she could only have gotten it from her father .I question some folks IQ in these debates

anitabooks888 on January 09, 2017:

Very interesting and educational hub.

Gregg on December 27, 2016:

Interesting article, however, I have also read where studies have shown that deformities in incest families was no more significant than deformities in non incest families. I have read of incest couples (usually brother and sister) that have perfectly normal children. I thought about this when our radio group used to provide communications at Special Olympics Events, local, county wide, and State level. Is someone going to tell me that the hundreds of deformed children at all of these events were all incest families? I think not. The problem with many studies, regardless of topic, will always have die hard advocates of one side while other die hards believe the opposite, whether incest, health foods, medical treatments, global warming, etc. Believing the truth is trying to believe which side is the real truth.

Livvy Carson on December 10, 2016:

My understanding of a morganatic marriage is that it is between a man of high standing and a woman of lesser standing and importantly the woman does not take her husband's rank nor can their children inherit his titles. Therefore the marriages of Charles & Diana and of William and Catherine Middleton are NOT morganatic as both women acquired royal status on marriage. It was suggested that Edward Vlll should marry Wallis Simpson morganatically, i.e. she would have been his legal wife but NOT queen, but this was rejected.

44044 on October 19, 2016:

FDR and Elenor were second cousins

Mark on September 13, 2016:

Interesting article -- I'm currently reading "The Accursed Kings" series from Maurice Druon, and he frequently touches upon the topic of incest, pederasty and other deviant mating methods of aristocrats. However, I'd disagree with your statement that people in the olden days didn't know about the dangers of incest or pederasty. On the contrary! Both pedophilia and incest are banned in the Bible; Paul mentioned that promiscuity and homosexuality resulted in disease and was therefore unnatural and sinful.

The Carmina Burana frequently talks of older men liking young girls, and how such a relationship was frowned upon by society. Doctors DID exist back then, and understanding that incest/ pedophilia is wrong is part of basic human instincts. It's a bit extreme to say that without microscopes and neurosurgeons people are fundamentally retarded and will mate with the first thing on two legs :/ People don't change, really. Technology changes, politics change, economy change, but people's behavior doesn't change (Darwin already explained that evolution does not affect humans physically or behaviorally, but manifests itself through technology and political understanding -- Le Bon and Lenin confirmed this, and so far nobody's been able to disprove it, but countless books and paintings from bygone centuries appears to actually further cement these theories).

Mona Sabalones Gonzalez from Philippines on July 10, 2016:

I used to wonder why those guys like King Tut had such big heads. I thought it might have been a head-like hat to add to his dignity. What way to live. The commoners had it better, it would seem.

marie on June 25, 2016:

I seen a program on the Royal Hab Jaw line on t v some time ago. When doing a portrait, an artist would likely enhance the person they were painting. and also about Prince John. He was always kept hidden when company was about. and when this became impossible as he grew older, as he was quite a handful and being a big fella, they moved him to another place such as a palace the King And Queen owned or used. Both these articles are very important to know and I'm sure your readers are right as to why King Henry v111 th had a weak son and I do believe Anne B. miscarried a few children.

dgduhon on June 06, 2016:

I would like to point out that neither one of Prince Charles' marriages were morganatic, because morganatic marriages don't exist in the UK

Ced Yong from Asia on June 01, 2016:

Actually I always wondered how Cleopatra really looked like. Given, hmm, they pretty much perfected the whole royal concept of it.

Dom on May 12, 2016:


stella vadakin from 3460NW 50 St Bell, Fl32619 on May 08, 2016:

Interesting article on incest and the consequences of the practice. There was plenty of inbreeding in this country also. Large farms had to stay in the family. It went on in Indiana for years.

FlourishAnyway from USA on May 05, 2016:

what a well written and researched hub on a topic that is relevant well beyond the royals.

Sahana from India on April 25, 2016:

Very interesting and enlightening read. Came to know lot of unknown facts about different royal families.

Sarah H on April 18, 2016:

This is very interesting and not looked at enough in school!

job on April 18, 2016:

Great explained it well on a topic i have little intrest in....

Mary Kelly Godley from Ireland on April 18, 2016:

Very interesting article. It is also of note that there has been suggestions of autism within the British royal family, I spoke of this a bit in my own article, t whereas King Edward VIII may have had Aspergers Syndrome, there was no doubt that his younger brother Prince John, was epileptic and also said to have a more severe form of autism. Little is known about him as he was sent away to live with a maid and never allowed in the public eye. While autism is sometimes genetic, it often isn't but it is thought that susceptible genes can enhance the possibility of it developing. Also dysfunctions of the immune system can play a significant role also. Also of note is the fact that none of the royals are ever vaccinated which again indicates they are aware of their genetic susceptibilities.