Brief reportLifetime co-morbidity with different subtypes of eating disorders in 148 females with bipolar disorders
Introduction
Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED) are frequently associated with Mood Disorders, particularly with Major Depression. Higher rates of Eating Disorders (EDs) compared to general population have also been reported among Bipolar Disorder (BD) patients (Kawa et al., 2005, Krishnan, 2005, McElroy et al., 2005). Moreover, the prevalence of EDs not meeting the formal criteria for AN or BN, such as ‘Eating Disorders Not Otherwise Specified’ (EDNOS) or sub-threshold ED Spectrum disorders is considerably higher in BD patients (up to 3.6 to 10%) (McElroy et al., 2006). EDNOS and BED have also been associated with marked distress and functional impairment (Darby et al., 2007). EDs co-morbidity has been indicated as a possible marker for increased symptom load and burden in bipolar patients (Wildes et al., 2007). Co-morbid EDs have been also associated with early onset, high rates of obesity (McElroy et al., 2002), suicidal ideation (Post et al., 2003) residual symptoms (MacQueen et al., 2003) and worsening course of bipolar illness (McElroy et al., 2001, Wildes et al., 2007).
Several studies have focused on the relationships between different subtypes of EDs and BPs (Akiskal et al., 2006, McElroy et al., 2006, McElroy et al., 2005). A strong association has been shown for BN, Bipolar II disorder (BP-II) (Lunde et al., 2009) and related “soft”-bipolar spectrum disorders, such as cyclothymia (Benazzi and Akiskal, 2008, Perugi et al., 1990). To our knowledge, comparisons between different subtypes of EDs in BD patients are not yet reported. The aim of the current study was to investigate the prevalence of AN, BN and BED among female patients with BD and to assess the clinical impact of such co-morbidity. Considering that EDs are much more frequent in women than in men (F:M, 4.2:1 for AN and 11.4:1 for BN) (Woodside et al., 2001), we just enrolled females in order to exclude a possible gender effect.
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Participants
148 female outpatients and inpatients, aged ≥ 18 years (mean = 46.8 sd = 13.1), were consecutively enrolled at the San Martino University Hospital of Genova and its facilities (121 subjects), the Galliera Hospital of Genova (18 subjects), the Sarzana Psychiatric Mental Health Center “ASL 5” (9 subjects). Inpatients and outpatients ratio was approximately 1:1. All, but two, were of Italian and Caucasian ethnicities. All the patients met DSM-IV-TR diagnostic criteria for Bipolar I (n = 35, 31%), Bipolar
Results
Forty-six patients (31% of the cases) reported lifetime history of at least one EDs defined according to DSM-IV criteria: 23 met lifetime DSM-IV criteria for AN (15.5%), 8 for BN (5.4%), 21 for BED (14.2%); and 6 patients reported lifetime history of multiple ED; 2 were AN + BN (1.3%), 1 was AN + BN + BED (0.7%), and 3 were BED + BN (2%). Only 2 (1.3%) patients had BN without BED or AN, so we decided to include them into the AN group.
The age of onset of mood disorder was similar among the 3 groups (
Discussion
In interpreting our results, some methodological limitations must be taken into account. Since this study was conducted in a routine clinical service, clinicians who evaluated these patients could not be held entirely blind to the various measures administered. On the other hand, we submit that unintended biases due to lack of blindness were kept to a minimum using systematic semi-structured and structured instruments. The absence of the therapeutic history represents another limit of our study
Role of funding source
Data collection and statistical analysis were supported by the Department of Neurological Sciences, Ophthalmology and Genetics — Section of Psychiatry, University of Genova (Italy).
Conflict of interest
The authors report no conflict of interest relevant to this work.
Acknowledgement
The authors acknowledge Mrs. Rita Santi Amantini for her secretary service.
References (28)
- et al.
Bipolar II and anxious reactive “comorbidity”: toward better phenotypic characterization suitable for genotyping
J. Affect. Disord.
(2006) - et al.
Bipolar spectrum disorders in severely obese patients seeking surgical treatment
J. Affect. Disord.
(2007) - et al.
How best to identify a bipolar-related subtype among major depressive patients without spontaneous hypomania: superiority of age at onset criterion over recurrence and polarity?
J. Affect. Disord.
(2008) - et al.
The relationship of bulimia and anorexia nervosa with bipolar disorder and its temperamental foundations
J. Affect. Disord.
(2009) - et al.
Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations?
J. Affect. Disord.
(2005) - et al.
The soft bipolar spectrum redefined: focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions
Psychiatr. Clin. North Am.
(2002) - et al.
Bulimia nervosa in atypical depression: the mediating role of cyclothymic temperament
J. Affect. Disord.
(2006) - et al.
Eating disorders and illness burden in patients with bipolar spectrum disorders
Compr. Psychiatry
(2007) - et al.
Prevalence and correlates of eating disorder co-morbidity in patients with bipolar disorder
Psychiatry Res.
(2008) - et al.
Disordered eating behaviours and cognitions in young women with obesity: relationship with psychological status
Int. J. Obes. (Lond)
(2007)
Structured clinical interview for the DSM-IV Axis I disorders
Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation
Bipolar. Disord.
Psychiatric and medical comorbidities of bipolar disorder
Psychosom. Med.
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