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International Journal of Bipolar Disorders

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Open Access 01-12-2013 | Research

Occurrence of bipolar spectrum disorder and comorbidities in women with eating disorders

Authors: Rodolfo Nunes Campos, Rodrigues Domingos dos Santos Junior, Táki Athanássios Cordás, Jules Angst, Ricardo Alberto Moreno

Published in: International Journal of Bipolar Disorders | Issue 1/2013

Abstract

Background

Eating disorder (ED) patients often have comorbidities with other psychiatric disorders, especially with mood disorders. Although recent studies suggest an intimate relationship between ED and bipolar disorder (BD), the study on a broader bipolar spectrum definition has not been done in this population. We aimed to study the occurrence of bipolar spectrum (BS) and comorbidities in eating disorder patients of a tertiary service provider.

Methods

Sixty-nine female patients diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified were evaluated. The assessment comprised the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), clinical criteria for diagnosis of the Zurich bipolar spectrum. Mann–Whitney tests compared means of continuous variables. The association between categorical variables and the groups was described using contingency tables and analyzed using the chi-square or Fisher's exact test. The level of significance alpha was set at 5%.

Results

The results showed that 68.1% of patients had comorbidity with bipolar spectrum, and this was associated with higher family income, proportion of married people, and comorbidity with substance use. The ED with BS group showed higher rates of substance use comorbidity (40.4%) than the ED without BS group (13.6%).

Discussion

These results showed that the bipolar spectrum is a common comorbidity in patients with eating disorders and is associated with correlates of clinical importance, notably the comorbidity with substance use. Due to the pattern of similarity between the groups with and without comorbid bipolar spectrum in relation to various outcomes evaluated, the identification of comorbidity can be difficult. However, the precise diagnosis and careful identification of clinical correlates may contribute to future advances in treating these conditions. Further studies are necessary to evaluate the association of other clinical correlates and its possible causal association.

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Akiskal HS, Bourgeois ML, Angst J, Post R, Möller H, Hirschfeld R: Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord. 2000,59(Suppl 1):S5–30.PubMedCrossRef

Alciati A, D'Ambrosio A, Foschi D, Corsi F, Mellado C, Angst J: Bipolar spectrum disorders in severely obese patients seeking surgical treatment. J Affect Disord. 2007, 101: 131–8. 10.1016/j.jad.2006.11.008PubMedCrossRef

Angst J: Psychiatric diagnoses: the weak component of modern research. World Psychiatr. 2007,6(2):94–5.

Angst J, Gamma A, Benazzi F, Ajdacic V, Eich D, Rössler W: Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord. 2003,73(1–2):133–46.PubMedCrossRef

Blinder BJ, Cumella EJ, Sanathara VA: Psychiatric comorbidities of female inpatients with eating disorders. Psychosom Med. 2006,68(3):454–62. 10.1097/01.psy.0000221254.77675.f5PubMedCrossRef

Brietzke E, Moreira CL, Toniolo RA, Lafer B: Clinical correlates of eating disorder comorbidity in women with bipolar disorder type I. J Affect Disord. 2011,130(1–2):162–5.PubMedCrossRef

Bschor T, Angst J, Azorin JM, Bowden CL, Perugi G, Vieta E, Young AH, Krüger S: Are bipolar disorders underdiagnosed in patients with depressive episodes? Results of the multicenter BRIDGE screening study in Germany. J Affect Disord. 2012,142(1–3):45–52.PubMedCrossRef

Bulik CM, Klump KL, Thornton L, Kaplan AS, Devlin B, Fichter MM, Halmi KA, Strober M, Woodside DB, Crow S, Mitchell JE, Rotondo A, Mauri M, Cassano GB, Keel PK, Berrettini WH, Kaye WH: Alcohol use disorder comorbidity in eating disorders: a multicenter study. J Clin Psychiatry. 2004,65(7):1000–6. 10.4088/JCP.v65n0718PubMedCrossRef

Campos RN, Angst J, Cordas TA, Moreno RA: ESPECTRA: searching the bipolar spectrum in eating disorder patients. BMC Psychiatry. 2011, 11: 59. 10.1186/1471-244X-11-59PubMedCentralPubMedCrossRef

Fedorowicz VJ, Falissard B, Foulon C, Dardennes R, Divac SM, Guelfi JD, Rouillon F: Factors associated with suicidal behaviors in a large French sample of inpatients with eating disorders. Int J Eat Disord. 2007, 40: 589–95. 10.1002/eat.20415PubMedCrossRef

First MB, Spitzer RL, Williams Gibbon MJBW: Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Clinician Version (SCID-CV). Washington, D.C: American Psychiatric Press; 1996.

Halmi KA, Eckert E, Marchi P, Sampugnaro V, Apple R, Cohen J: Comorbidity of psychiatric diagnoses in anorexia nervosa. Arch Gen Psychiatry. 1991, 48: 712–8. 10.1001/archpsyc.1991.01810320036006PubMedCrossRef

Hudson JI, Hiripi E, Pope HG Jr, Kessler RC: The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007,61(3):348–58. 10.1016/j.biopsych.2006.03.040PubMedCentralPubMedCrossRef

Judd LL, Akiskal HS: The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord. 2003, 73: 123–31. 10.1016/S0165-0327(02)00332-4PubMedCrossRef

Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K: Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry. 2004, 161: 2215–21. 10.1176/appi.ajp.161.12.2215PubMedCrossRef

Mantere O, Suominen K, Leppämäki S, Valtonen H, Arvilommi P, Isometsä E: The clinical characteristics of DSM-IV bipolar I and II disorders: baseline findings from the Jorvi Bipolar Study (JoBS). Bipolar Disord. 2004,6(5):395–405. 10.1111/j.1399-5618.2004.00140.xPubMedCrossRef

Markon KE, Krueger RF: Categorical and continuous models of liability to externalizing disorders: a direct comparison in NESARC. Arch Gen Psychiatry. 2005,62(12):1352–9. 10.1001/archpsyc.62.12.1352PubMedCentralPubMedCrossRef

Matza LS, Rajagopalan KS, Thompson CL, de Lissovoy G: Misdiagnosed patients with bipolar disorder: comorbidities, treatment patterns, and direct treatment costs. J Clin Psychiatry. 2005,66(11):1432–40. 10.4088/JCP.v66n1114PubMedCrossRef

McElroy SL, Altshuler LL, Suppes T, Keck PE Jr, Frye MA, Denicoff KD, Nolen WA, Kupka RW, Leverich GS, Rochussen JR, Rush AJ, Post RM: Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. Am J Psychiatry. 2001,158(3):420–6. 10.1176/appi.ajp.158.3.420PubMedCrossRef

McElroy SL, Kotwal R, Keck PE Jr, Akiskal HS: Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations? J Affect Disord. 2005,86(2–3):107–27.PubMedCrossRef

Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, Viana MC, Andrade LH, Hu C, Karam EG, Ladea M, Medina-Mora ME, Ono Y, Posada-Villa J, Sagar R, Wells JE, Zarkov Z: Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011,68(3):241–51. 10.1001/archgenpsychiatry.2011.12PubMedCentralPubMedCrossRef

Moreno DH, Andrade LH: The lifetime prevalence, health services utilization and risk of suicide of bipolar spectrum subjects, including subthreshold categories in the São Paulo ECA study. J Affect Disord. 2005,87(2–3):231–41.PubMedCrossRef

Moreno DH, Andrade LH: Latent class analysis of manic and depressive symptoms in a population-based sample in São Paulo. Brazil J Affect Disord. 2010,123(1–3):208–15.PubMedCrossRef

Wildes JE, Marcus MD, Gaskill JA, Ringham R: Depressive and manic-hypomanic spectrum psychopathology in patients with anorexia nervosa. Compr Psychiatry. 2007,48(5):413–8. 10.1016/j.comppsych.2007.05.009PubMedCrossRef

Woodside DB, Garfinkel PE, Lin E, Goering P, Kaplan AS, Goldbloom DS, Kennedy SH: Comparisons of men with full or partial eating disorders, men without eating disorders, and women with eating disorders in the community. Am J Psychiatry. 2001, 158: 570–4. 10.1176/appi.ajp.158.4.570PubMedCrossRef

Title: Occurrence of bipolar spectrum disorder and comorbidities in women with eating disorders
Authors: Rodolfo Nunes Campos
Rodrigues Domingos dos Santos Junior
Táki Athanássios Cordás
Jules Angst
Ricardo Alberto Moreno
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Bipolar Disorders / Issue 1/2013
Electronic ISSN: 2194-7511
DOI: https://doi.org/10.1186/2194-7511-1-25

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Occurrence of bipolar spectrum disorder and comorbidities in women with eating disorders

Abstract

Background

Methods

Results

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Discussion

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