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Yakovleva YV, Kasyanov ED, Mazo GE. Prevalence of eating disorders in patients with bipolar disorder: a scoping review of the literature. CONSORTIUM PSYCHIATRICUM 2023; 4:91-106. [PMID: 38250644 PMCID: PMC10795952 DOI: 10.17816/cp6338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/29/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Eating disorder (ED) and bipolar disorder (BD) exhibit certain phenomenological similarities rooted in eating behavior and emotional regulation. However, despite the growing body of research on the comorbidity of ED and BD, scientific data on the concurrent course of these disorders has remained poorly systematized. AIM To conduct a scoping review of published data on the prevalence of various types of ED among patients with BD types I and II in the context of the sex and clinical features of the concurrent course of these disorders. METHODS The analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The search was conducted in the MEDLINE electronic database. Studies were included if they were focused samples of patients diagnosed with BD and ED, and the Diagnostic and Statistical Manual of Mental Disorders, fourth and fifth editions (DSM-IV, DSM-5), or International Statistical Classification of Diseases and Related Health Problems, tenth Revision (ICD-10), were used for the verification of the ED and BD diagnoses. The descriptive analysis method was used to summarize the review findings. RESULTS A total of 41 studies were selected for the review. Lifetime ED in patients with BD ranged from 2.2% to 31.1%, and the prevalence rates of BD among patients with ED varied from 11.3% to 68.1%. ED nominally had a higher prevalence among individuals with BD type II and females. Additionally, the presence of ED in patients with BD was associated with earlier onset of mood disorder, a higher number of depressive episodes, higher levels of atypical depressive symptoms, suicide attempts, as well as a higher frequency of comorbid obsessive-compulsive and anxiety disorders, addictions, and various metabolic disorders. CONCLUSION Despite the high degree of volatility in the results, the prevalence rates of a concurrent course of ED and BD are rather high. For this reason, screening for ED in patients with BD and vice versa holds significant value in the accurate diagnosis and selection of the most effective therapy. The patterns of comorbidity among different types of ED and BD, depending on gender, need further exploration in future research.
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Affiliation(s)
- Yana V. Yakovleva
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
| | - Evgeny D. Kasyanov
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
| | - Galina E. Mazo
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
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2
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Girela-Serrano BM, Guerrero-Jiménez M, Spiers ADV, Gutiérrez-Rojas L. Obesity and overweight among children and adolescents with bipolar disorder from the general population: A review of the scientific literature and a meta-analysis. Early Interv Psychiatry 2022; 16:113-125. [PMID: 33735937 DOI: 10.1111/eip.13137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/05/2021] [Accepted: 03/06/2021] [Indexed: 11/27/2022]
Abstract
There is substantial evidence of the high prevalence of obesity (OB) and overweight (OW) and their association with increased medical and psychiatric burden among adults with bipolar disorder (BD). However, little is known regarding its prevalence among young people with BD, other than the risk from psychotropic medication, which has been the focus of research in this population. We present a systematic review and meta-analysis of the literature on prevalence and correlates of OB and OW children and adolescents with BD using a different perspective than impact of medication. Four studies met inclusion criteria. The prevalence of OB in children and adolescents with BD was 15% (95% CI 11-20%). We observed a higher prevalence of OB in comparison to the general population. Different studies found significant associations between OB, OW, and BD in young populations including non-Caucasian race, physical abuse, suicide attempts, self-injurious behaviours, psychotropic medication, and psychiatric hospitalizations.
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Affiliation(s)
| | - Margarita Guerrero-Jiménez
- Department of Psychiatry, University of Granada, Granada, Spain.,Virgen de las Nieves University Hospital, Granada, Spain
| | - Alexander D V Spiers
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - Luis Gutiérrez-Rojas
- Department of Psychiatry, University of Granada, Granada, Spain.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,San Cecilio University Hospital, Granada, Spain
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3
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Fornaro M, Daray FM, Hunter F, Anastasia A, Stubbs B, De Berardis D, Shin JI, Husain MI, Dragioti E, Fusar-Poli P, Solmi M, Berk M, Vieta E, Carvalho AF. The prevalence, odds and predictors of lifespan comorbid eating disorder among people with a primary diagnosis of bipolar disorders, and vice-versa: Systematic review and meta-analysis. J Affect Disord 2021; 280:409-431. [PMID: 33227671 DOI: 10.1016/j.jad.2020.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/16/2020] [Accepted: 11/07/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND There are scarce and discrepant data about the prevalence and correlates of co-occurring eating disorders (EDs) among people with a primary diagnosis of bipolar disorder (BD), and vice-versa, compelling a systematic review and meta-analysis on the matter. METHODS MEDLINE/PsycINFO databases were systematically searched for original studies documenting BD⇌ED comorbidity across the lifespan, from inception up until April 20th, 2020. Random-effects meta-analysis and meta-regression analyses were conducted, accounting for multiple moderators. RESULTS Thirty-six studies involved 15,084 primary BD patients. Eleven studies encompassed 15,146 people with primary EDs. Binge eating disorder (BED) occurred in 12.5% (95%C.I.=9.4-16.6%, I2=93.48%) of BDs, while 9.1% (95%C.I.=3.3-22.6%) of BEDs endorsed BD. Bulimia Nervosa (BN) occurred in 7.4% (95%C.I.=6-10%) of people with BD, whereas 6.7% (95%C.I.=12-29.2%) of subjects with BN had a diagnosis of BD. Anorexia Nervosa (AN) occurred in 3.8% (95%C.I.=2-6%) of people with BDs; 2% (95%C.I.=1-2%) of BD patients had a diagnosis of AN. Overall, BD patients with EDs had higher odds of being female vs. non-ED controls. Several moderators yielded statistically significant differences both within- and between different types of BDs and EDs. LIMITATIONS Scant longitudinal studies, especially across different EDs and pediatric samples. High heterogeneity despite subgroup comparisons. Limited discrimination of the quality of the evidence. CONCLUSIONS The rates of BD⇌ED comorbidity vary across different diagnostic groups, more than they do according to the "direction" of BD⇌ED. Further primary studies should focus on the risks, chronology, clinical impact, and management of the onset of intertwined BD⇌ED across different ages, promoting a continuum approach.
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Affiliation(s)
- Michele Fornaro
- Department of Psychiatry, Federico II University, Naples, Italy; Polyedra Research Foundation, Teramo, Italy.
| | - Federico Manuel Daray
- The University of Buenos Aires, School of Medicine, Institute of Pharmacology, Argentina.
| | - Fernando Hunter
- The University of Buenos Aires, School of Medicine, Institute of Pharmacology, Argentina
| | | | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK; Health Service and Population Research Department and the Department of Psychological, London, UK
| | | | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Muhammad Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden University, Linköping, Sweden; Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, University Campus, Ioannina, Greece
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; Neurosciences Department, University of Padua, Italy; Padua Neuroscience Center, University of Padua, Italy
| | - Michael Berk
- Department of Psychiatry, the University of Melbourne, Parkville, VIC, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Orygen Youth Health Research Centre, Centre for Youth Mental Health, the University of Melbourne, Parkville, VIC, Australia; The Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Parkville, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - André Ferrer Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
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4
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Romo-Nava F, Blom TJ, Guerdjikova A, Winham SJ, Cuellar-Barboza AB, Nunez NA, Singh B, Biernacka JM, Frye MA, McElroy SL. Evening chronotype, disordered eating behavior, and poor dietary habits in bipolar disorder. Acta Psychiatr Scand 2020; 142:58-65. [PMID: 32335894 DOI: 10.1111/acps.13179] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our aim was to evaluate the relationship between evening chronotype, a proxy marker of circadian system dysfunction, and disordered eating behavior and poor dietary habits in individuals with bipolar disorder (BD). METHODS In this cross-sectional study, we evaluated 783 adults with BD. Chronotype was determined using item 5 from the reduced Morningness-Eveningness Questionnaire. The Eating Disorder Diagnostic Scale (EDDS) and the Rapid Eating Assessment for Participants-Shortened Version (REAP-S) were used to assess disordered eating behavior and dietary habits respectively. General linear models and logistic regression models were utilized to evaluate differences between chronotype groups. RESULTS Two hundred and eight (27%) BD participants self-identified as having evening chronotypes. Compared to non-evening types, evening types were younger (P < 0.01) and, after controlling for age, had higher mean EDDS composite z-scores (P < 0.01); higher rates of binge-eating (BE) behavior (P = 0.04), bulimia nervosa (P < 0.01), and nocturnal eating binges (P < 0.01); and a higher body mass index (P = 0.04). Compared to non-evening types, evening chronotypes had a lower REAP-S overall score (P < 0.01) and scored lower on the 'healthy foods' and 'avoidance of unhealthy food' factors. Evening types also skipped breakfast more often (P < 0.01), ate less fruit (P = 0.02) and vegetables (P = 0.04), and consumed more fried foods (P < 0.01), unhealthy snacks (P = 0.02), and soft drinks (P = 0.01). CONCLUSIONS Our findings suggest that the circadian system plays a role in the disordered eating and unhealthy dietary behaviors observed in BD patients. The circadian system may therefore represent a therapeutic target in BD-associated morbidity that warrants further investigation.
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Affiliation(s)
- F Romo-Nava
- Lindner Center of HOPE, Mason, OH, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - T J Blom
- Lindner Center of HOPE, Mason, OH, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - A Guerdjikova
- Lindner Center of HOPE, Mason, OH, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - S J Winham
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - A B Cuellar-Barboza
- Department of Psychiatry, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - N A Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - B Singh
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - J M Biernacka
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - M A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - S L McElroy
- Lindner Center of HOPE, Mason, OH, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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5
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Buyukkurt A, Bourguignon C, Antinora C, Farquhar E, Gao X, Passarella E, Sibthorpe D, Gou K, Saury S, Beaulieu S, Storch KF, Linnaranta O. Irregular eating patterns associate with hypomanic symptoms in bipolar disorders. Nutr Neurosci 2019; 24:23-34. [PMID: 30873919 DOI: 10.1080/1028415x.2019.1587136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: We present novel dimensional methods to describe the timing of eating in psychopathology. We focused on the relationship between current mood in bipolar disorder (BD) and the stability of the temporal pattern of daily eating events. Methods: Consenting BD patients (n = 69) from an outpatient, tertiary care clinic completed hourly charts of mood and eating for two weeks. Mood was also evaluated with Montgomery-Åsberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). Results: Illustrative displays, or eatograms, enabling visualization of all recorded eating events were used to guide assessment of the temporal structure of eating across the two week assessment period. We computed indices to quantify irregularities in timing of eating, namely IFRQ, ITIM and IINT for the variability of frequency, timing, and interval of eating events, respectively. In this cohort, irregular temporal pattern of eating correlated with hypomanic symptoms (YMRS with IFRQ, Spearman rank order rh = 0.28, p = .019, with ITIM, rh = 0.44, p < .001, and with IINT rh = 0.38, p = .001), but not depressive symptoms or anthropometric measures. Conclusions: Our data suggest a link between the instability of the temporal order of daily eating and mood. The dimensional measures for eating pattern introduced here enable future investigations of correlations with psychopathology.
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Affiliation(s)
- Asli Buyukkurt
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Clément Bourguignon
- Integrated Program in Neuroscience, McGill University, Montreal, Canada.,Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | | | | | - Xiaoya Gao
- Faculty of Medicine, McGill University, Montreal, Canada
| | | | | | - Karine Gou
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Sybille Saury
- Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Serge Beaulieu
- Douglas Mental Health University Institute, McGill University, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Kai-Florian Storch
- Douglas Mental Health University Institute, McGill University, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Outi Linnaranta
- Douglas Mental Health University Institute, McGill University, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
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6
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Thiebaut S, Godart N, Radon L, Courtet P, Guillaume S. Crossed prevalence results between subtypes of eating disorder and bipolar disorder: A systematic review of the literature. Encephale 2019; 45:60-73. [DOI: 10.1016/j.encep.2018.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 12/28/2017] [Accepted: 06/12/2018] [Indexed: 02/06/2023]
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7
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Solmi F, Melamed D, Lewis G, Kirkbride JB. Longitudinal associations between psychotic experiences and disordered eating behaviours in adolescence: a UK population-based study. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:591-599. [PMID: 30119718 PMCID: PMC6054050 DOI: 10.1016/s2352-4642(18)30180-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Psychotic experiences might represent non-specific markers of poor mental health in adolescence. However, only a few predominantly cross-sectional studies have tested their association with disordered eating behaviours in adolescent and adult populations. The aim of this study was to explore the association between psychotic experiences at age 13 years, and disordered eating behaviours and body-mass index (BMI) at age 18 years. METHODS We used data from the Avon Longitudinal Study of Parents and Children, a longitudinal birth cohort based in Avon (England, UK) including mothers with an expected delivery date between April 1, 1991, and Dec 31, 1992, and their children. Psychotic experiences (such as delusions and hallucinations) and BMI were measured at clinical assessments when children were nearly aged 13 years, and data on disordered eating behaviours (ie, presence of binge eating, purging, fasting, or excessive exercise for weight loss; any of these behaviours [included to increase statistical power]; and number of behaviours [included to investigate severity]) were obtained via a postal questionnaire that used adapted questions from the Youth Risk Behaviour Surveillance System questionnaire at approximately age 18 years. For each outcome, we ran a univariable model and four multivariable models (logistic, linear [for BMI], or negative binomial [for the number of behaviours] regression), progressively adjusting for child and maternal sociodemographic, physical, and mental health characteristics (including child's sex, and maternal age, marital status, and highest academic qualification); autistic traits at age 7 years (measured with the Social and Communication Disorder Checklist); baseline BMI at age 13 years, and depressive symptoms at baseline (ie, at age 13 years when psychotic experiences were measured: childs' symptoms measured with the Moods and feelings Questionnaire, and maternal symptoms measured at 32 weeks' gestation with the Edinburgh Postnatal Depression Scale). We imputed missing outcome and covariate data. FINDINGS Our sample included 6361 children, of whom 734 (12%) reported psychotic experiences at age 13 years. In univariable models, psychotic experiences were associated with greater odds of reporting any disordered eating behaviours (odds ratio [OR] 1·92, 95% CI 1·46-2·52; p<0·0001), and more severe symptoms (as measured by the number of disordered eating behaviours: 0·58, 0·32-0·84; p<0·0001) at age 18 years. These associations were slightly attenuated by adjustment for maternal and child characteristics (any disordered eating behaviours OR 1·82, 95% CI 1·35-2·44, p<0·0001; number of disordered eating behaviours 0·49, 95% CI 0·23-0·75, p<0·00001), autistic traits at age 7 years (any disordered eating behaviours OR 1·80, 95% CI 1·34-2·41, p<0·0001; number of disordered eating behaviours 0·48, 95% CI 0·22-0·74, p<0·00001), and BMI (any disordered-eating behaviours OR 1·83, 95% CI 1·36-2·46, p<0·0001; number of disordered-eating behaviours 0·32, 95% CI 0·06-0·57, p<0·00001) Adjusting for baseline depressive symptoms attenuated, but not removed, these associations (any disordered eating OR 1·50, 95% CI 1·10-2·03, p=0·010; more severe symptoms 0·32, 0·06-0·57, p=0·017). Psychotic experiences were also associated with greater binge eating, purging, and fasting behaviours, although some associations weakened after controlling for depressive symptoms. We noted no associations between psychotic experiences and excessive exercise or BMI in any of the models. INTERPRETATION Our findings suggested that psychotic experiences are markers of increased risk for several disordered eating behaviours in late adolescence, possibly by indicating more severe psychopathology in early adolescence. More research investigating shared risk factors for psychotic experiences and eating disorders is warranted to elucidate shared and specific causal pathways. FUNDING Wellcome Trust, the Royal Society, University College London Hospitals National Institute for Health Research Biomedical Research Centre, UK Medical Research Council, and the University of Bristol.
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Affiliation(s)
- Francesca Solmi
- Division of Psychiatry, University College London, London, UK.
| | - Daniela Melamed
- Division of Psychiatry, University College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
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8
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McAulay C, Mond J, Touyz S. Early intervention for bipolar disorder in adolescents: A psychosocial perspective. Early Interv Psychiatry 2018; 12:286-291. [PMID: 28836352 DOI: 10.1111/eip.12474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 06/19/2017] [Accepted: 07/11/2017] [Indexed: 01/28/2023]
Abstract
AIM Early intervention in bipolar disorder (BD) has received increasing attention in recent years. The identification of risk factors has improved, but researchers continue to struggle to find an effective treatment once the illness has become established. The aetiology of BD and feasibility of early intervention present a challenge, making it difficult to decide who to target, as well as how. METHODS This essay seeks to address the lack of guidance for managing patients with a possible emerging bipolar illness, by presenting a rough roadmap to psychological care. The psychological techniques currently showing the most potential for this challenging group are reviewed. Markers of risk and supplementary clinical targets, such as anxiety and sleep disruption, are also discussed. RESULTS While research in this group remains in its infancy, various avenues of enquiry show promise, such as family-based approaches, CBT that targets features beyond the core illness, psychoeducation, and interventions that consider physical health. However, clearer pathways for establishing the course and stage of the illness are required to inform the intensity and type of treatment. CONCLUSION It is argued that treating early, indistinct symptoms of psychological distress, that may or may not signify prodromal BD, is valuable beyond its utility as an early intervention tool, as it has the capacity to improve help-seeking behaviour, quality of life and the likelihood of functional recovery in those who go on to develop the illness as adults.
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Affiliation(s)
- Claire McAulay
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Mond
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Stephen Touyz
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
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9
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Boulanger H, Tebeka S, Girod C, Lloret-Linares C, Meheust J, Scott J, Guillaume S, Courtet P, Bellivier F, Delavest M. Binge eating behaviours in bipolar disorders. J Affect Disord 2018; 225:482-488. [PMID: 28865369 DOI: 10.1016/j.jad.2017.08.068] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 08/04/2017] [Accepted: 08/20/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Recent research, especially from the USA, suggests that comorbid binge eating (BE) behaviour and BE disorder are frequent in individuals with Bipolar Disorder (BD). Although basic clinical associations between BD and BE have been investigated, less is known about psychological or temperamental dimensions and qualitative aspects of eating habits. In a French cohort of patients with BD, we investigated the prevalence of BE behaviour and any associations with illness characteristics, anxiety, impulsivity, emotional regulation and eating habits. METHODS 145 outpatients with BD (I and II) were assessed for the presence of BE behaviour using the Binge Eating Scale (BES). Characteristics identified in univariate analyses as differentiating BD cases with and without BE behaviour were then included in a backward stepwise logistic regression (BSLR) model. RESULTS In this sample, 18.6% of BD patients met criteria for BE behaviour. Multivariate analysis (BSLR) indicated that shorter duration of BD, and higher levels of anxiety and emotional reactivity were observed in BD with compared to BD without BE behaviour. LIMITATIONS Relatively small sample referred to specialist BD clinics and cross-sectional evaluation meant that it was not possible to differentiate between state and trait levels of impulsivity, emotional instability and disinhibition. These dimensions may also overlap with mood symptoms. CONCLUSION BE behaviour is common in females and males with BD. Emotional dysregulation and anxiety may represent important shared vulnerability factors for worse outcome of BD and increased likelihood of BE behaviour.
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Affiliation(s)
- Hortense Boulanger
- AP-HP, GH Saint-Louis, Lariboisière, Fernand Widal, Departement de Psychiatrie et de Médecine Addictologique, Paris, France; Centre Hospitalier Sainte-Anne, 3ème Secteur de Psychiatrie Adulte, Paris, France
| | - Sarah Tebeka
- AP-HP, GH Saint-Louis, Lariboisière, Fernand Widal, Departement de Psychiatrie et de Médecine Addictologique, Paris, France; AP-HP, Louis Mourier, Department of Psychiatry, Colombes, France / Centre for Psychiatry and Neurosciences, Inserm U894, Paris, France
| | - Chloé Girod
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier / INSERM U1061, University of Montpellier, Montpellier, France
| | - Célia Lloret-Linares
- AP-HP, GH Saint-Louis, Lariboisière, Fernand Widal, Therapeutic Research Unit, Department of Internal Medicine, Paris, France; Inserm, UMR-S 1144, Université Paris Descartes- Paris Diderot, Paris, France
| | - Julie Meheust
- AP-HP, GH Saint-Louis, Lariboisière, Fernand Widal, Departement de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Jan Scott
- Department of Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK / Centre for Affective Disorders, Department of Psychological Medicine, IPPN, Kings College, London, UK
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier / INSERM U1061, University of Montpellier, Montpellier, France; Fondation FondaMental, Créteil, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier / INSERM U1061, University of Montpellier, Montpellier, France; Fondation FondaMental, Créteil, France
| | - Frank Bellivier
- AP-HP, GH Saint-Louis, Lariboisière, Fernand Widal, Departement de Psychiatrie et de Médecine Addictologique, Paris, France; Inserm, UMR-S 1144, Université Paris Descartes- Paris Diderot, Paris, France; Fondation FondaMental, Créteil, France.
| | - Marine Delavest
- AP-HP, GH Saint-Louis, Lariboisière, Fernand Widal, Departement de Psychiatrie et de Médecine Addictologique, Paris, France; Inserm, UMR-S 1144, Université Paris Descartes- Paris Diderot, Paris, France; Fondation FondaMental, Créteil, France
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10
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Liu X, Kelsoe JR, Greenwood TA. A genome-wide association study of bipolar disorder with comorbid eating disorder replicates the SOX2-OT region. J Affect Disord 2016; 189:141-9. [PMID: 26433762 PMCID: PMC4640946 DOI: 10.1016/j.jad.2015.09.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bipolar disorder is a heterogeneous mood disorder associated with several important clinical comorbidities, such as eating disorders. This clinical heterogeneity complicates the identification of genetic variants contributing to bipolar susceptibility. Here we investigate comorbidity of eating disorders as a subphenotype of bipolar disorder to identify genetic variation that is common and unique to both disorders. METHODS We performed a genome-wide association analysis contrasting 184 bipolar subjects with eating disorder comorbidity against both 1370 controls and 2006 subjects with bipolar disorder only from the Bipolar Genome Study (BiGS). RESULTS The most significant genome-wide finding was observed bipolar with comorbid eating disorder vs. controls within SOX2-OT (p=8.9×10(-8) for rs4854912) with a secondary peak in the adjacent FXR1 gene (p=1.2×10(-6) for rs1805576) on chromosome 3q26.33. This region was also the most prominent finding in the case-only analysis (p=3.5×10(-7) and 4.3×10(-6), respectively). Several regions of interest containing genes involved in neurodevelopment and neuroprotection processes were also identified. LIMITATIONS While our primary finding did not quite reach genome-wide significance, likely due to the relatively limited sample size, these results can be viewed as a replication of a recent study of eating disorders in a large cohort. CONCLUSIONS These findings replicate the prior association of SOX2-OT with eating disorders and broadly support the involvement of neurodevelopmental/neuroprotective mechanisms in the pathophysiology of both disorders. They further suggest that different clinical manifestations of bipolar disorder may reflect differential genetic contributions and argue for the utility of clinical subphenotypes in identifying additional molecular pathways leading to illness.
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Affiliation(s)
- Xiaohua Liu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | | | - John R. Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,San Diego Veterans Affairs Healthcare System, San Diego, CA,Institute for Genomic Medicine, University of California, San Diego, La Jolla, CA
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Álvarez Ruiz EM, Gutiérrez-Rojas L. Comorbilidad entre el trastorno bipolar y los trastornos de la conducta alimentaria. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2015; 8:232-41. [DOI: 10.1016/j.rpsm.2014.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 12/13/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
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Westman J, Hällgren J, Wahlbeck K, Erlinge D, Alfredsson L, Ösby U. Cardiovascular mortality in bipolar disorder: a population-based cohort study in Sweden. BMJ Open 2013; 3:bmjopen-2012-002373. [PMID: 23604348 PMCID: PMC3641504 DOI: 10.1136/bmjopen-2012-002373] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To estimate the cardiovascular mortality among persons with bipolar disorder in Sweden compared to the general population. DESIGN Population register-based cohort study with a 20-year follow-up. SETTING Sweden. PARTICIPANTS The entire population of Sweden (n=10.6 million) of whom 17 101 persons were diagnosed with bipolar disorder between 1987 and 2006. MAIN OUTCOME MEASURES Mortality rate ratios (MRR), excess mortality (excess deaths), cardiovascular disorder (CVD) and specifically cerebrovascular disease, coronary heart disease, acute myocardial infarction, sudden cardiac deaths and hospital admission rate ratio (ARR). RESULTS Persons with bipolar disorder died of CVD approximately 10 years earlier than the general population. One third (38%) of all deaths in persons with bipolar disorder were caused by CVD and almost half (44%) by other somatic diseases, whereas suicide and other external causes accounted for less than a fifth of all deaths (18%). Excess mortality of both CVD (n=824) and other somatic diseases (n=988) was higher than that of suicide and other external causes (n=675 deaths). MRRs for cerebrovascular disease, coronary heart disease and acute myocardial infarction were twice as high in persons with bipolar disorder compared to the general population. Despite the increased mortality of CVD, hospital admissions (ARR) for CVD treatment were only slightly increased in persons with bipolar disorder when compared to the general population. CONCLUSIONS The increased cardiovascular mortality in persons with bipolar disorder calls for renewed efforts to prevent and treat somatic diseases in this group. Specifically, our findings further imply that it would be critical to ensure that persons with bipolar disorder receive the same quality care for CVD as persons without bipolar disorder.
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Affiliation(s)
- Jeanette Westman
- Department of Neurobiology, Care Sciences, and Society, Centre for Family Medicine (CeFAM), Karolinska Institutet, Stockholm, Sweden
| | - Jonas Hällgren
- Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden
| | - Kristian Wahlbeck
- Department of Mental Health and Substance Abuse Services, THL, National Institute for Health and Welfare, Helsinki, Finland
| | - David Erlinge
- Department of Cardiology, Lunds Universitet, Lund, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Urban Ösby
- Department of Neurobiology, Care Sciences, and Society, Centre for Family Medicine (CeFAM), Karolinska Institutet, Stockholm, Sweden
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Impulsividad, búsqueda de sensaciones y agresividad en pacientes bipolares tipo I y II. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2011; 4:195-204. [DOI: 10.1016/j.rpsm.2011.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/15/2011] [Accepted: 07/25/2011] [Indexed: 11/20/2022]
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Brietzke E, Moreira CLR, Toniolo RA, Lafer B. Clinical correlates of eating disorder comorbidity in women with bipolar disorder type I. J Affect Disord 2011; 130:162-5. [PMID: 21071093 DOI: 10.1016/j.jad.2010.10.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 09/22/2010] [Accepted: 10/10/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To report on the presence of current and lifetime eating disorders (ED) in a well-defined sample of 137 female individuals with bipolar disorder type I. METHODS Trained psychiatrists interviewed the patients, and the diagnoses of BD and comorbidities were confirmed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Axis I Disorders. Clinical and demographic characteristics of both groups (group with ED vs. group without ED) were compared. RESULTS Female patients with ED had an earlier onset of BD and an increased number of mood episodes, predominantly depressive. Women in the ED group also had higher rates of comorbidity with substance use disorders and anxiety disorders and reported a history of suicide attempts more frequently than women without ED. CONCLUSION The presence of ED is a correlate of severity of BD type I, and interventions should be developed to minimize distress and suicide risk and to improve treatment outcome.
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Affiliation(s)
- Elisa Brietzke
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
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Lundgren JD, Rempfer MV, Brown CE, Goetz J, Hamera E. The prevalence of night eating syndrome and binge eating disorder among overweight and obese individuals with serious mental illness. Psychiatry Res 2010; 175:233-6. [PMID: 20031234 PMCID: PMC3666565 DOI: 10.1016/j.psychres.2008.10.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 08/13/2008] [Accepted: 10/24/2008] [Indexed: 10/20/2022]
Abstract
The prevalence of night eating syndrome (NES) and binge eating disorder (BED) was assessed among overweight and obese, weight-loss-seeking individuals with serious mental illness (SMI). Sixty-eight consecutive overweight (BMI > or = 25 kg/m(2)) and obese (BMI > or = 30 kg/m(2)) individuals with SMI (mean age = 43.9 years; mean BMI = 37.2 kg/(2); 67.6% Caucasian, 60.3% female) who were enrolled in a group behavioral weight loss treatment program were assessed at baseline for NES and BED with clinician-administered diagnostic interviews. Using conservative criteria, 25.0% met criteria for NES, 5.9% met criteria for BED, and only one participant met criteria for both NES and BED. This is the first study to find that obese individuals with SMI, compared with previously studied populations, are at significantly greater risk for NES, but are not at greater risk for BED. Stress, sleep, and medication use might account for the high prevalence of NES found in this population.
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Affiliation(s)
- Jennifer D. Lundgren
- University of Missouri-Kansas City, Kansas City, MO, United States,Corresponding author. Department of Psychology, University of Missouri-Kansas City, Kansas City, MO 64110, United States. Tel.: +1 816 235 5384; fax: +1 816 235 1062. (J.D. Lundgren)
| | | | - Catana E. Brown
- Touro University, United States,University of Kansas Medical Center, Kansas City, MO, United States
| | - Jeannine Goetz
- University of Kansas Medical Center, Kansas City, MO, United States
| | - Edna Hamera
- University of Kansas Medical Center, Kansas City, MO, United States
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Castrogiovanni S, Soreca I, Troiani D, Mauri M. Binge eating, weight gain and psychosocial adjustment in patients with bipolar disorder. Psychiatry Res 2009; 169:88-90. [PMID: 19625088 DOI: 10.1016/j.psychres.2008.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 09/25/2007] [Accepted: 06/12/2008] [Indexed: 01/01/2023]
Abstract
Binge Eating (BE) is a common eating pattern in patients with Bipolar Disorder (BD). BE may confer an increased risk for obesity, morbidity, mortality and poorer quality of life. We assessed the presence of BE and its impact on body weight, body image and self-esteem in 50 patients with BD and 50 age- and gender-matched controls. The presence and severity of BE was assessed with the Binge Eating Scale (BES). The Body Image and Self-Esteem Evaluation Scale (B-WISE) was used to assess the psychosocial impact of weight gain. Body Mass Index (BMI) was calculated. Nine (18%) patients had a score >27, indicating a likely diagnosis of BE. None of the control subjects had a BES score >17. No association between BES score and the medications was found. Patients had a significantly higher BES score, significantly higher BMI, waist circumference and fasting blood glucose. Although the B-Wise score was higher in the controls, the difference was not statistically significant. This study suggests that BE is prevalent in patients with BD. The presence of BE eating is a predictor of higher BMI, indicating that the disruption of eating behavior may be a pathway to weight gain.
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Affiliation(s)
- Silvia Castrogiovanni
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, School of Medicine, University of Pisa, Pisa, Italy
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Thomas JJ, Vartanian LR, Brownell KD. The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM. Psychol Bull 2009; 135:407-33. [PMID: 19379023 DOI: 10.1037/a0015326] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder (ED) diagnosis. In this meta-analysis, the authors aimed to inform Diagnostic and Statistical Manual of Mental Disorders revisions by comparing the psychopathology of EDNOS with that of the officially recognized EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). A comprehensive literature search identified 125 eligible studies (published and unpublished) appearing in the literature from 1987 to 2007. Random effects analyses indicated that whereas EDNOS did not differ significantly from AN and BED on eating pathology or general psychopathology, BN exhibited greater eating and general psychopathology than EDNOS. Moderator analyses indicated that EDNOS groups who met all diagnostic criteria for AN except for amenorrhea did not differ significantly from full syndrome cases. Similarly, EDNOS groups who met all criteria for BN or BED except for binge frequency did not differ significantly from full syndrome cases. Results suggest that EDNOS represents a set of disorders associated with substantial psychological and physiological morbidity. Although certain EDNOS subtypes could be incorporated into existing Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) categories, others-such as purging disorder and non-fat-phobic AN-may be best conceptualized as distinct syndromes. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
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Fagiolini A, Chengappa KNR, Soreca I, Chang J. Bipolar disorder and the metabolic syndrome: causal factors, psychiatric outcomes and economic burden. CNS Drugs 2008; 22:655-69. [PMID: 18601304 DOI: 10.2165/00023210-200822080-00004] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Overweight and obesity are highly prevalent in patients with bipolar disorder, and metabolic disorders also affect a significant portion of this population. Obesity and metabolic disorders cause significant economic burden and impair quality of life in both the general population and patients with bipolar disorder. This review examines the relationship between bipolar disorder and the metabolic syndrome, and the associated economic impact. The metabolic syndrome and bipolar disorder appear to share common risk factors, including endocrine disturbances, dysregulation of the sympathetic nervous system, and behaviour patterns, such as physical inactivity and overeating. In addition, many of the commonly used pharmacological treatments for bipolar disorder may intensify the medical burden in bipolar patients by causing weight gain and metabolic disturbances, including alterations in lipid and glucose metabolism, which can result in an increased risk for diabetes mellitus, hypertension, dyslipidaemia, cardiovascular disease and the metabolic syndrome. These medical co-morbidities and obesity have been associated with a worse disease course and likely contribute to the premature mortality observed in bipolar patients. Weight gain is also a major cause of treatment noncompliance, increased use of outpatient and inpatient services and, consequently, higher healthcare costs. Prevention of weight gain and metabolic disturbances or early intervention when these are present in bipolar disorder could result in significant health and economic benefits.
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Affiliation(s)
- Andrea Fagiolini
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania, USA.
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Wildes JE, Marcus MD, Fagiolini A. Prevalence and correlates of eating disorder co-morbidity in patients with bipolar disorder. Psychiatry Res 2008; 161:51-8. [PMID: 18782643 PMCID: PMC2643248 DOI: 10.1016/j.psychres.2007.09.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 06/22/2007] [Accepted: 09/14/2007] [Indexed: 11/19/2022]
Abstract
This study was designed to document eating disorder symptoms in a well-defined sample of patients with bipolar disorder and to evaluate the relationship of current loss of control over eating (LOC) to demographic and clinical features hypothesized to characterize bipolar patients at risk for disordered eating. Eighty-one patients enrolled in the Bipolar Disorder Center for Pennsylvanians provided demographic information and completed the Structured Clinical Interview for DSM-IV Axis I Disorders. The Eating Disorder Examination was administered by independent clinicians to evaluate current and lifetime eating disorder symptomatology. Twenty-one percent of participants met DSM-IV criteria for a lifetime eating disorder, and 44% reported a history of LOC. Patients who endorsed weekly LOC during the past six months (n=18) were heavier, had more atypical depressive symptoms, and were more likely to have a lifetime substance use disorder compared to patients in the rest of the sample (n=63). These findings indicate that eating disorder symptoms are prevalent in patients with bipolar disorder and are associated with obesity and other psychiatric morbidity. Screening for eating disorders in bipolar patients is warranted, as intervention may minimize distress and improve treatment outcome.
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Affiliation(s)
- Jennifer E Wildes
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Awareness of Metabolic Concerns in Patients With Bipolar Disorder: A Survey of European Psychiatrists. Eur Psychiatry 2007; 23:169-77. [DOI: 10.1016/j.eurpsy.2007.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 08/27/2007] [Accepted: 10/20/2007] [Indexed: 11/18/2022] Open
Abstract
AbstractPurpose.An online survey of European psychiatrists assessed awareness of the metabolic syndrome and its influence on the management of bipolar disorder.Materials and methods.Psychiatrists in the United Kingdom, France, Germany, Spain, and Italy were surveyed from April to June 2006. Eligibility criteria w ere 4–30 years in practice, ≥50% of time in direct patient care, had seen ≥10 bipolar patients in the preceding month. Aggregate data were weighted to represent the practicing physician population per country.Results.of 718 respondents, 56% had diagnosed metabolic syndrome. Respondents reported that metabolic syndrome prevalence was higher in bipolar patients (25%) than in the general population (20%). Seventy-two percent felt that metabolic syndrome poses significant health risks, warranting monitoring/treatment, and were most concerned with the bipolar medication adverse effects of weight gain, cognitive impairment, and glucose intolerance. Survey respondents recognized clear differences among psychotropic agents in the propensity to induce metabolic adverse effects. Sixty-five percent of respondents indicated that they had made interviewing and monitoring changes in the past three years as a result of metabolic concerns.Conclusions.European psychiatrists view metabolic syndrome as highly prevalent in the general population and in bipolar patients; twothirds have changed their management of bipolar patients because of metabolic health concerns.
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Wildes JE, Marcus MD, Fagiolini A. Eating disorders and illness burden in patients with bipolar spectrum disorders. Compr Psychiatry 2007; 48:516-21. [PMID: 17954136 PMCID: PMC2077842 DOI: 10.1016/j.comppsych.2007.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 05/21/2007] [Accepted: 05/28/2007] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The objectives of the study were to evaluate the clinical significance of lifetime eating disorder comorbidity in a well-defined sample of patients with bipolar spectrum disorders and to describe cognitive correlates of disordered eating in this group. METHOD Twenty-six bipolar patients with a lifetime history of a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-defined eating disorder (n = 17) or a clinically significant subthreshold eating disorder (n = 9) (ED group) were compared with 46 bipolar patients with no history of an eating disorder (no-ED group) on demographic and clinical characteristics at study presentation, history of bipolar illness, and other psychiatric comorbidity. Measures included the Structured Clinical Interview for the DSM-IV Axis I Disorders, the Clinical Global Impression-Severity Scale-Bipolar Version (CGI-S-BP), and the Eating Disorder Examination. Height and weight were recorded to calculate body mass index. RESULTS Patients in the ED group were heavier and were rated as more symptomatic on the CGI-S-BP than were patients in the no-ED group. The ED group also had a higher number of lifetime depressive episodes and greater psychiatric comorbidity, excluding eating and mood disorders. Finally, after controlling for body mass index and CGI-S-BP rating, patients in the ED group had significantly higher Eating Disorder Examination Restraint, Eating Concern, Shape Concern, Weight Concern, and Global scores than did patients in the no-ED group. CONCLUSIONS These findings highlight the need for a renewed emphasis on the evaluation and management of weight and eating in the mood disorders. In particular, this research suggests that eating disorder comorbidity may be a marker for increased symptom load and illness burden in bipolar disorder.
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Affiliation(s)
- Jennifer E Wildes
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Abstract
OBJECTIVES To review the scientific evidence examining the comorbidity among eating disorders and bipolar disorder (BD). METHODS We reviewed all published English-language studies addressing the comorbidity of anorexia nervosa, bulimia, bulimia nervosa, and binge eating disorder in patients with BD and studies of comorbidity of BD in patients with eating disorders. In addition, we discuss the pharmacologic treatment implications from reviewed studies of agents used in BD and eating disorders. RESULTS Community and clinical population studies of the lifetime prevalence rates of eating disorders in patients with BD, and of BD in patients with eating disorders, particularly when subthreshold and spectrum manifestations of these disorders are included, indicate high rates of comorbidity among these illnesses. CONCLUSIONS Pharmacologic treatment approaches to patients with BD and a co-occurring eating disorder require examination of the possible adverse effects of the treatment of each syndrome on the other and attempts to manage both syndromes with agents that might be beneficial to both.
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Affiliation(s)
- Susan L McElroy
- Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
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Perugi G, Toni C, Passino MCS, Akiskal KK, Kaprinis S, Akiskal HS. Bulimia nervosa in atypical depression: the mediating role of cyclothymic temperament. J Affect Disord 2006; 92:91-7. [PMID: 16436300 DOI: 10.1016/j.jad.2005.12.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Recent data indicate significant clinical, biological, and treatment response overlap between eating and bipolar disorders, especially when soft symptoms of either spectrum disorders are considered. The aim of the present analyses is to evaluate the lifetime prevalence of bulimia nervosa (BN) in patients with atypical depression (AD) and to delineate any demographic, clinical, personality or temperamental factors that may characterize this subgroup. METHOD We examined in a semi-structured format 107 consecutive patients who met DSM-IV criteria for major depressive episode with atypical features and we separated them into two groups according to the co-occurring criteria for BN. They were further evaluated on the basis of the Atypical Depression Diagnostic Scale (ADDS), the Hopkins Symptoms Check-list (HSCL 90), and the Hamilton Rating Scale for Depression (HRSD), coupled with its modified form for reverse vegetative features, as well as Axis I and II comorbidity and temperamental dispositions. RESULTS Seventeen (17.8%) percent of AD met the DSM-IV criteria for Bulimia Nervosa (BN+). These patients, compared with those who did not meet criteria for BN (BN-), were indistinguishable on all demographic and most psychopathologic and clinical features (including bipolar I and II), but were significantly higher in lifetime comorbidity for Narcissistic, Histrionic, Borderline and Dependent personality disorders as well as that for Cyclothymic temperament. BN+ also scored higher on the ADDS items of reactivity of mood and interpersonal sensitivity. LIMITATIONS Correlational clinical study in which doctors could not be entirely blind to the variables under investigation. CONCLUSIONS Cyclothymic temperament and related mood reactivity and interpersonal sensitivity may account for much of the relationship between AD and BN. Narcissistic, histrionic and borderline traits, too, seem to be related to the presence of a cyclothymic disposition. The data overall, in particular the cyclothymic reactivity in the absence of differences in BP-I and II, all support the hypothesis that places BN in the "ultra-soft" bipolar realm.
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Affiliation(s)
- Giulio Perugi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, Psychiatry Section, University of Pisa, Pisa, Italy.
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Guarin MBR. Associated variables with bipolar disorder risk in a sample of Colombian women with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2006. [DOI: 10.1002/erv.727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ramacciotti CE, Paoli RA, Marcacci G, Piccinni A, Burgalassi A, Dell'Osso L, Garfinkel PE. Relationship between bipolar illness and binge-eating disorders. Psychiatry Res 2005; 135:165-70. [PMID: 15922456 DOI: 10.1016/j.psychres.2004.04.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2003] [Accepted: 04/06/2004] [Indexed: 10/25/2022]
Abstract
In this study we describe the frequency of eating disorders (EDs) in a group of bipolar (BP) patients. We evaluated a sample of 51 outpatients, diagnosed as having BP I disorder on the basis of the Structured Clinical Interview for DSM-IV (SCID). Each of these subjects was administered the Binge Eating Disorder Clinical Interview (BEDCI) to determine the presence of binge eating disorder (BED) or bulimia nervosa (BN). Of the 51 BP patients, 14 (9 BED, 5 BN) met criteria for an ED. Most patients developed binge eating coincident with the first episode of BP disorder or after the onset of it. This was true for those who developed BED as well as BN, and involved both manic and depressive phases. All BN patients were women (5/5), and family history of binge eating was present in 80% of BN subjects, but only in 22.2% of BED and 29.7% of non-ED BP patients. We found a high frequency of concordance between BP illness and binge eating problems in our sample of BP patients. Given the temporal sequence of the mood disorder, which generally preceded the ED, we suggest a model in which the ED evolves due to modulation of emotions with food, as well as use of medications to treat BP disorder that disrupt hunger and satiety mechanisms. Given differences in gender distribution and family history, cultural and familial influences may also be significant in the minority of BP binge-eating patients who develop BN.
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Affiliation(s)
- Carla E Ramacciotti
- Department of Psychiatry, University of Pisa, via Roma 67, 56126, Pisa, Italy.
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McElroy SL, Kotwal R, Keck PE, Akiskal HS. Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations? J Affect Disord 2005; 86:107-27. [PMID: 15935230 DOI: 10.1016/j.jad.2004.11.008] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Accepted: 11/30/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND The co-occurrence of bipolar and eating disorders, though of major clinical and public health importance, remains relatively unexamined. METHODS In reviewing the literature on this comorbidity, we compared bulimia, anorexia nervosa, bulimia nervosa, binge eating disorders and bipolar disorders on phenomenology, course, family history, biology, and treatment response. RESULTS Epidemiological studies show an association between subthreshold bipolar disorder and eating disorders in adolescents, and between hypomania and eating disorders, especially binge eating behavior, in adults. Of the clinical studies, most show that patients with bipolar disorder have elevated rates of eating disorders, and vice versa. Finally, the phenomenology, course, comorbidity, family history, and pharmacologic treatment response of these disorders show considerable overlap on all of these parameters. In particular, on phenomenologic grounds--eating dysregulation, mood dysregulation, impulsivity and compulsivity, craving for activity and/or exercise--we find many parallels between bipolar and eating disorders. Overall, the similarities between these disorders were more apparent when examined in their spectrum rather than full-blown expressions. LIMITATIONS Despite an extensive literature on each of these disorders, studies examining their overlap across all these parameters are relatively sparse and insufficiently systematic. CONCLUSIONS Nonetheless, the reviewed literature leaves little doubt that bipolar and eating disorders--particularly bulimia nervosa and bipolar II disorder--are related. Although several antidepressants and mood stabilizers have shown promise for eating disorders, their clinical use when these disorders co-exist with bipolarity is still very much of an art. We trust that this review will stimulate more rigorous research in their shared putative underlying psychobiologic mechanisms which, in turn, could lead to more rational targeted treatments.
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Affiliation(s)
- Susan L McElroy
- Psychopharmacology Research Program, University of Cincinnati College of Medicine, P.O. Box 670559, 231 Bethesda Avenue, Cincinnati, OH 45267-0559, USA.
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Rodríguez M, Pérez V, García Y. Impact of traumatic experiences and violent acts upon response to treatment of a sample of Colombian women with eating disorders. Int J Eat Disord 2005; 37:299-306. [PMID: 15856503 DOI: 10.1002/eat.20091] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The current article compared the impact of exposure to sexual trauma and other types of physical threats against the patient or the patient's family on response to treatment, relapse, and dropout rates in 160 Colombian women between 12 and 49 years of age with eating disorders. METHOD A comparison was made to 70 cases with unsatisfactory response to treatment and 90 controls with a better response to treatment goals. RESULTS Forty-five percent had a history of sexual abuse, other violent traumas, or both. Significant statistical differences were observed between both groups in exposure variables. The highest probability of poor outcome was observed in patients with sexual abuse and exposure to other violent acts (odds ratio [OR] = 6.37, 95% confidence interval [CI] = 2.1-19.07). The risk of dropout or relapse was, respectively, 10 and 3 times greater among those exposed. DISCUSSION Violent social conditions should be noted as another form of trauma with potential impact on outcome in Colombian women with eating disorders. (
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Affiliation(s)
- Maritza Rodríguez
- Equilibrio: Outpatient Program for The Treatment of Eating and Related Disorders, Bogotá, Colombia.
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Abstract
OBJECTIVES This review summarizes the literature on psychiatric and medical comorbidities in bipolar disorder. The coexistence of other Axis I disorders with bipolar disorder complicates psychiatric diagnosis and treatment. Conversely, symptom overlap in DSM-IV diagnoses hinders definition and recognition of true comorbidity. Psychiatric comorbidity is often associated with earlier onset of bipolar symptoms, more severe course, poorer treatment compliance, and worse outcomes related to suicide and other complications. Medical comorbidity may be exacerbated or caused by pharmacotherapy of bipolar symptoms. METHODS Articles were obtained by searching MEDLINE from 1970 to present with the following search words: bipolar disorder AND, comorbidity, anxiety disorders, eating disorder, alcohol abuse, substance abuse, ADHD, personality disorders, borderline personality disorder, medical disorders, hypothyroidism, obesity, diabetes mellitus, multiple sclerosis, lithium, valproate, lamotrigine, carbamazepine, atypical antipsychotics. Articles were prioritized for inclusion based on the following considerations: sample size, use of standardized diagnostic criteria and validated methods of assessment, sequencing of disorders, quality of presentation. RESULTS Although the literature establishes a strong association between bipolar disorder and substance abuse, the direction of causality is uncertain. An association is also seen with anxiety disorders, attention-deficit/hyperactivity disorder, and eating disorders, as well as cyclothymia and other axis II personality disorders. Medical disorders accompany bipolar disorder at rates greater than predicted by chance. However, it is often unclear whether a medical disorder is truly comorbid, a consequence of treatment, or a combination of both. CONCLUSION To ensure prompt, appropriate intervention while avoiding iatrogenic complications, the clinician must evaluate and monitor patients with bipolar disorder for the presence and the development of comorbid psychiatric and medical conditions. Conversely, physicians should have a high index of suspicion for underlying bipolar disorder when evaluating individuals with other psychiatric diagnoses (not just unipolar depression) that often coexist with bipolar disorder, such as alcohol and substance abuse or anxiety disorders. Anticonvulsants and other mood stabilizers may be especially helpful in treating bipolar disorder with significant comorbidity.
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Affiliation(s)
- K Ranga Rama Krishnan
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (3050A), 4584 Hospital South, Box 3950, Durham, NC 27710, USA.
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Abstract
Bipolar disorders are prevalent, disabling, and costly diseases that often pursue an inexorable course. Underdetection, misdiagnosis, and diagnostic delay frequently and unnecessarily interfere with appropriate treatment of the disorder. Mortality studies in bipolar disorder underscore the relevance of both unnatural and natural causes of death, inviting the need for improved preventative and primary health care for bipolar patients. The treatment framework for bipolar disorder must recognize and anticipate the multidimensionality and comorbidity of this illness. Pharmacotherapy is necessary, with multiple concomitant medications required for most patients. In addition, adjunctive psychosocial interventions offer enhanced compliance and may beneficially influence psychopathological and functional outcomes. This article emphasizes the public health concern of bipolar disorder, and provides tactics to enhance detection of cryptic bipolar states, underscore the clinical and pathophysiological relevance of comorbidity in bipolar disorder, and provide a framework for multimodality therapy for this condition.
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Affiliation(s)
- Roger S McIntyre
- University Health Network, Edith Cavell Wing 3D-003, 399 Bathurst St, M5T 2S8, Ontario, Canada.
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Srebnik D, Comtois K, Stevenson J, Hoff H, Snowden M, Russo J, Ries R. Eating disorder symptoms among adults with severe and persistent mental illness. Eat Disord 2003; 11:27-38. [PMID: 16864285 DOI: 10.1080/10640260390167465] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article presents pilot data examining the: (1) prevalence of eating disorder symptoms among adults with severe and persistent mental illness (SPMI) and (2) clinical and demographic predictors of eating disorder symptoms. Participants were 149 adults with SPMI who were receiving community mental health services. The Eating Attitudes Test, Body Image Avoidance Questionnaire, purging questions, and Body Mass Index were used to assess eating disorder symptoms. Forty percent of participants indicated eating disorder symptoms. Predictors of eating disorder symptoms included female gender and greater clinical severity. The findings suggest the need for clinical attention to eating disorders for this population.
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Affiliation(s)
- Debra Srebnik
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington 98104, USA.
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Kalman D, Cascarano H, Krieger DR, Incledon T, Woolsey M. Frequency of binge eating disorder in an outpatient weight loss clinic. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:697-9. [PMID: 12008996 DOI: 10.1016/s0002-8223(02)90158-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Douglas Kalman
- Endocrinology and Nutrition Division of Miami Research Associates, Fla 33143, USA
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Mazzetti di Pietralata M, Florentino MT, Guidi M, Leonardi C. Night eating syndrome. Preliminary results. Eat Weight Disord 2000; 5:92-101. [PMID: 10941607 DOI: 10.1007/bf03327484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Clinical aspects of the "night eating syndrome" (NES) are described. Recent studies, also referred to in the present report, have revealed certain triggering factors of this syndrome, but do not reveal the nature of the relationship between awakening and compulsory need for food. According to the psychodynamic interpretation, these subjects eat at night to replace dreaming, to which they offer strong resistance, whilst according to the psychobiological interpretation, motivational stimuli develop the irresistible and repeated desire for food. Within a post-rational cognitive theoretical model, the compulsion to food would be the mode through which subjects obtain a modified conscious state necessary to appease the suffering due to an experience of emptiness and incapacity. Psychological support associated with pharmacological treatment (benzodiazepine, gamma-hydroxybutyric acid) has been shown, in a personal series, to be effective both upon the sleep disorder and craving.
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Ramacciotti CE, Coli E, Passaglia C, Lacorte M, Pea E, Dell'Osso L. Binge eating disorder: prevalence and psychopathological features in a clinical sample of obese people in Italy. Psychiatry Res 2000; 94:131-8. [PMID: 10808038 DOI: 10.1016/s0165-1781(00)00130-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Binge eating disorder (BED) is a recently conceptualized eating disturbance, and its clinical features and prevalence are still a matter of debate. This study uses interview methodology to estimate the prevalence of BED in Italy in a sample of 66 obese people presenting for treatment, and examines potential related features typical of patients with anorexia and bulimia nervosa. The lifetime and the 6-month prevalences of BED were 18.1 and 12.1%, respectively. Breaking the group down on the basis of the current as well as lifetime presence of BED, we found that the weight and shape primary to self-esteem, and the interpersonal distress related to body image, were associated with lifetime BED (P<0.05). All-or-none thinking about food and dieting was typical of BED patients as a whole, either current (P<0.01) or remitted (P<0.05). We discuss two important findings from our study: (a) the key role of self-esteem depending upon weight and shape in discriminating the eating-disordered obese from non-eating-disordered individuals; and (b) the need to explore the whole lifespan when screening for BED, so pointing to the state-trait issue.
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Affiliation(s)
- C E Ramacciotti
- Department of Psychiatry, Pharmacology, Neurobiology and Biotechnologies, Section of Psychiatry, University of Pisa, Italy.
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Abstract
Little is known about the long-term course of binge eating disorder (BED). The aim of the study was to assess the 3- and 6-year course and outcome of 68 consecutively treated females with BED. Their mean age was 29.3 years and they were assessed longitudinally at four timepoints: (1) beginning of therapy; (2) end of therapy; (3) 3-year follow-up; and (4) 6-year follow-up. Self rating as well as expert ratings were used for assessment. Symptoms of specific eating disorder as well as general psychopathology were measured. The general pattern of results over time was as follows: substantial improvement during therapy; slight (in most cases nonsignificant) decline during the first 3 years after the end of treatment, and further improvement and stabilization in years 4, 5, and 6 after the end of treatment. At the 6-year follow-up, the majority showed no major DSM-IV eating disorder, 5.9% had BED, 7.4% had shifted to bulimia nervosa (purging type) (DSM-IV), 7.4% were classified as ED-NOS, and one patient died. Based on an operationalized global outcome score for the complete sample, 57.4% had good outcome, 35.3% intermediate outcome, 5.9% poor outcome, and one person (1.4%) died. BED and BNP patients showed very similar intermediate and long-term course in self ratings as well as expert ratings.
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Affiliation(s)
- M M Fichter
- Department of Psychiatry, University of Munich, Germany.
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