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Kouppis E, Björkenstam C, Gerdin B, Ekselius L, Björkenstam E. Childbearing and mortality among women with personality disorders: nationwide registered-based cohort study. BJPsych Open 2020; 6:e95. [PMID: 32838831 PMCID: PMC7488311 DOI: 10.1192/bjo.2020.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People with a personality disorder have a higher mortality and reduced life expectancy than the general population. Childbearing is thought to have a protective effect on morbidity and mortality. Yet, there are no studies on whether childbearing is related to a lower mortality among women with personality disorder. AIMS This study examined associations between childbearing and mortality among women with personality disorder. Our hypothesis was that parity would be associated with lower mortality. METHOD This register-based cohort study included 27 412 women treated for personality disorder in in-patient or specialised out-patient care between 1990 and 2015. We used nationwide population-based registers to obtain information on sociodemographics, child delivery, healthcare use and mortality. Mortality risk estimates were calculated as hazard ratios (HRs) with 95% CIs using Cox regression. Adjustments were made for year of birth, educational level, age at diagnosis, comorbidity and severity of personality disorder. RESULTS Nulliparous women had a nearly twofold increased mortality risk (adjusted HR = 1.78, 95% CI 1.50-2.12) compared with parous women and over twofold mortality risk (adjusted HR = 2.29, 95% CI 1.72-3.04) compared with those giving birth after their first personality disorder diagnosis. Those giving birth before their first personality disorder diagnosis had a 1.5-fold higher risk of mortality than those giving birth after their first personality disorder diagnosis (adjusted HR = 1.48, 95% CI 1.06-2.07). There was a threefold risk of suicide in nulliparous women compared with those giving birth after their first personality disorder diagnosis (adjusted HR = 2.90, 95% CI 1.97-4.26). CONCLUSIONS Childbearing history should be an integral part of the clinical evaluation of women with personality disorder.
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Affiliation(s)
| | | | - Bengt Gerdin
- Department of Surgical Sciences, Uppsala University, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Uppsala University, Sweden
| | - Emma Björkenstam
- Department of Neuroscience, Uppsala University, Sweden; and Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Tabler J, Schmitz RM, Geist C, Utz RL, Smith KR. Reproductive Outcomes Among Women with Eating Disorders or Disordered Eating Behavior: Does Methodological Approach Shape Research Findings? J Womens Health (Larchmt) 2018; 27:1389-1399. [PMID: 29963940 PMCID: PMC6909761 DOI: 10.1089/jwh.2017.6755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a well-documented link between eating disorders (EDs) and adverse health outcomes, including fertility difficulties. These findings stem largely from clinical data or samples using a clinical measure (e.g., diagnosis) of EDs, which may limit our understanding of how EDs or disordered eating behaviors (DEBs) shape female fertility. METHODS We compared reproductive outcomes from two longitudinal data sources, clinical and population-based data from the Utah Population Database (UPDB) (N = 6,046), and nonclinical community-based data from the National Longitudinal Study of Adolescent to Young Adult Health (Add Health) (N = 5,951). We examined age at first birth using Cox regression and parity using negative binomial regression. RESULTS Using the UPDB data, women with diagnosed ED experienced later ages of first birth (hazard rate ratio [HRR] = 0.38; p < 0.01) and lower parity (incidence rate ratio [IRR] = 0.38; p < 0.01) relative to women without EDs. Using the Add Health sample, women who self-reported DEB experienced earlier age of first birth (HRR = 1.16; p < 0.05) and higher parity (IRR = 1.17; p < 0.01) relative to women without DEB. CONCLUSIONS Conflicting results suggest two sets of mechanisms, physical/biological (sex specific) and social/behavioral (gender specific), may be simultaneously shaping the reproductive outcomes of women with histories of EDs or DEB. Discipline-specific methodology likely shapes Women's Health research outcomes.
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Affiliation(s)
- Jennifer Tabler
- Department of Sociology and Anthropology, The University of Texas Rio Grande Valley, Edinburg, Texas
| | - Rachel M. Schmitz
- Department of Sociology and Anthropology, The University of Texas Rio Grande Valley, Edinburg, Texas
| | - Claudia Geist
- Department of Sociology, The University of Utah, Salt Lake City, Utah
- Division of Gender Studies, The University of Utah, Salt Lake City, Utah
| | - Rebecca L. Utz
- Department of Sociology, The University of Utah, Salt Lake City, Utah
| | - Ken R. Smith
- Department of Family and Consumer Studies, Pedigree and Population Resource, The University of Utah, Salt Lake City, Utah
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Tabler J, Utz RL, Smith KR, Hanson HA, Geist C. Variation in reproductive outcomes of women with histories of bulimia nervosa, anorexia nervosa, or eating disorder not otherwise specified relative to the general population and closest-aged sisters. Int J Eat Disord 2018; 51:102-111. [PMID: 29331083 PMCID: PMC6599590 DOI: 10.1002/eat.22827] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study seeks to examine the long-term reproductive consequences of eating disorders (ED), to assess variation in reproductive outcomes by ED type, and to examine reproductive differences between women with previous ED diagnosis and their discordant sisters. METHOD Using a sample of women with previous ED diagnosis generated by the Utah Population Database, this study compares the fecundity (parity) and age at first birth of women by ED subtype (bulimia nervosa [BN], anorexia nervosa [AN], and ED not otherwise specified [EDNOS]) (n = 1,579). We also employed general population match case-control, and discordant sibling pair analyses, to estimate the magnitude of association between EDs and reproductive outcomes. RESULTS Women previously diagnosed with AN or EDNOS experienced delayed first birth (HRR = 0.33, HRR = 0.34, respectively) and lower parity (IRR = 0.19, IRR = 0.22, respectively) relative to BN (p < .05), the general population (p < .05), and closest-aged sisters (p < .05). Women previously diagnosed with BN experienced more moderate reductions and delays to their reproduction, and had similar reproductive outcomes as their discordant sisters. DISCUSSION Clinicians should consider ED type and family fertility histories when addressing the long-term reproductive health needs of women with prior AN, BN, or EDNOS diagnosis. Women previously diagnosed with AN or EDNOS likely experience the greatest reductions and delays in reproduction across their lifespan. Reproductive health screenings may be especially critical for the wellbeing of women with a history of AN or EDNOS.
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Affiliation(s)
- Jennifer Tabler
- Department of Sociology and Anthropology, The University of Texas Rio Grande Valley, Edinburg, Texas
| | - Rebecca L. Utz
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Ken R. Smith
- Department of Family and Consumer Studies, Pedigree and Population Resource, University of Utah, Salt Lake City, Utah,Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Heidi A. Hanson
- Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah,Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Claudia Geist
- Department of Sociology, University of Utah, Salt Lake City, Utah,Division of Gender Studies, University of Utah, Salt Lake City, Utah
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Nguyen AN, de Barse LM, Tiemeier H, Jaddoe VWV, Franco OH, Jansen PW, Voortman T. Maternal history of eating disorders: Diet quality during pregnancy and infant feeding. Appetite 2016; 109:108-114. [PMID: 27889494 DOI: 10.1016/j.appet.2016.11.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/09/2016] [Accepted: 11/22/2016] [Indexed: 02/06/2023]
Abstract
We studied associations of maternal history of eating disorders (EDs) with diet quality of pregnant women and their infants, and breastfeeding practices. We included 6196 mother-child pairs from Generation R, a population-based cohort in the Netherlands. Maternal history of lifetime EDs was assessed during pregnancy with a questionnaire. Dietary intake during pregnancy and in infancy was assessed with food-frequency questionnaires and diet quality scores were calculated, reflecting adherence to dietary guidelines. Breastfeeding practices were assessed with questionnaires at 2, 6, and 12 months. We observed that, after adjustment for socioeconomic and lifestyle factors, women with a history of EDs had a higher diet quality than women without a history of EDs (B = 0.24 SD, 95%CI: 0.15; 0.33). Mothers with a history of EDs were less likely to breastfeed (unadjusted OR = 0.68, 95%CI: 0.51; 0.93), although no longer statistically significant after adjustment (OR = 0.75, 95%CI: 0.55; 1.03). These findings suggest that mothers with a history of EDs seem slightly less likely to initiate breastfeeding, however, this warrants further investigation. At the age of 1 year, infants of mothers with a history of EDs had a higher diet quality (B = 0.15 SD, 95%CI: 0.02; 0.27). We conclude that mothers with a history of EDs and their infants have a relative good diet quality, although follow-up studies are needed to assess long-term associations with diet in later childhood and adolescence.
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Affiliation(s)
- Anh N Nguyen
- Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Lisanne M de Barse
- Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; The Generation R Study Group, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry / Psychology, Erasmus MC-University Medical Center, PO Box 2060, 3000 CB Rotterdam, The Netherlands; Department of Psychiatry, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; The Generation R Study Group, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC-University Medical Center, PO Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry / Psychology, Erasmus MC-University Medical Center, PO Box 2060, 3000 CB Rotterdam, The Netherlands; Institute of Psychology, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; The Generation R Study Group, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Toki S, Hashimoto E, Masuda M, Machino A, Yamawaki S. A case of chronic anorexia nervosa with child-bearing by in vitro fertilization necessitating comprehensive team support. JRSM Open 2014; 5:2054270414560039. [PMID: 25548655 PMCID: PMC4271762 DOI: 10.1177/2054270414560039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Generalists should be aware of the issues surrounding pregnancy in patients with anorexia nervosa and discuss well with patients and their families before in vitro fertilization.
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Affiliation(s)
- Shigeru Toki
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Eri Hashimoto
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Masayuki Masuda
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Akihiko Machino
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Shigeto Yamawaki
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
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Rosenvinge JH, Pettersen G. Epidemiology of eating disorders part II: an update with a special reference to the DSM-5. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/21662630.2014.940549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Anorexia nervosa is prevalent in adolescents and young adults, and endocrine changes include hypothalamic amenorrhoea; a nutritionally acquired growth-hormone resistance leading to low concentrations of insulin-like growth factor-1 (IGF-1); relative hypercortisolaemia; decreases in leptin, insulin, amylin, and incretins; and increases in ghrelin, peptide YY, and adiponectin. These changes in turn have harmful effects on bone and might affect neurocognition, anxiety, depression, and the psychopathology of anorexia nervosa. Low bone-mineral density (BMD) is particularly concerning, because it is associated with changes in bone microarchitecture, strength, and clinical fractures. Recovery leads to improvements in many--but not all--hormonal changes, and deficits in bone accrual can persist. Oestrogen-replacement therapy, primarily via the transdermal route, increases BMD in adolescents, although catch-up is incomplete. In adults, oral oestrogen--combined with recombinant human IGF-1 in one study and bisphosphonates in another--increased BMD, but not to the normal range. More studies are necessary to investigate the optimum therapeutic approach in patients with, or recovering from, anorexia nervosa.
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Affiliation(s)
- Madhusmita Misra
- Neuroendocrine Unit and Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Anne Klibanski
- Neuroendocrine Unit and Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Kostro K, Lerman JB, Attia E. The current status of suicide and self-injury in eating disorders: a narrative review. J Eat Disord 2014; 2:19. [PMID: 26034603 PMCID: PMC4450853 DOI: 10.1186/s40337-014-0019-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 06/23/2014] [Indexed: 11/14/2022] Open
Abstract
The aim of this paper is to review recent literature on suicide and self-injury in eating disorders (ED) including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Among psychiatric diagnoses, EDs are associated with increased mortality rates, even when specialized treatment is available. Of the mortalities that are reported in individuals with EDs, suicide is among the most commonly reported causes of death. Additionally, suicidal and non-suicidal self-injurious behaviors occur frequently in this clinical population. A literature search was undertaken using the databases of Medline/PubMed and PsycInfo to identify papers describing suicidality in individuals with ED diagnoses. The authors identified studies and review articles published between 2005-2013 (inclusive) that describe the relationship between EDs and suicide, and associated behaviors including self-injurious behaviors, or non-suicidal self-injury (NSSI). The initial search resulted in 1095 papers that met the a priori search criteria. After careful review, 66 papers were included. The majority of papers described clinical cohorts that were studied longitudinally. The diagnosis described most frequently in selected studies was AN. There are limited current data about the prevalence of suicide and NSSI among individuals with EDs. Among the published studies that focus specifically on the relationship between EDs and suicidality, most describe AN in more detail than other EDs. Nonetheless, rates of mortality, and specifically rates of suicide, are undeniably high in ED populations, as are the rates of self-harm. Therefore, it is critical for clinicians and caretakers to carefully evaluate these patients for suicide risk and to refer promptly for appropriate treatment.
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Affiliation(s)
| | | | - Evelyn Attia
- Columbia University Medical Center, New York, NY USA ; Weill Cornell Medical College, New York, NY USA
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Abstract
PURPOSE OF REVIEW To review the recent literature about the epidemiology, course, and outcome of eating disorders in accordance with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). RECENT FINDINGS The residual category 'eating disorder not otherwise specified' (EDNOS) was the most common DSM-IV eating disorder diagnosis in both clinical and community samples. Several studies have confirmed that the DSM-5 criteria for eating disorders effectively reduce the proportion of EDNOS diagnoses. The lifetime prevalence of DSM-5 anorexia nervosa among women might be up to 4%, and of bulimia nervosa 2%. In a cross-national survey, the average lifetime prevalence of binge eating disorder (BED) was 2%. Both anorexia nervosa and bulimia nervosa are associated with increased mortality. Data on long-term outcome, including mortality, are limited for BED. Follow-up studies of BED are scarce; remission rates in randomized controlled trials ranged from 19 to 65% across studies. On a community level, 5-year recovery rates for DSM-5 anorexia nervosa and bulimia nervosa are 69 and 55%, respectively; little is known about the course and outcome of BED in the community. SUMMARY Applying the DSM-5 criteria effectively reduces the frequency of the residual diagnosis EDNOS, by lowering the threshold for anorexia nervosa and bulimia nervosa, and adding BED as a specified eating disorder. Course and outcome studies of both anorexia nervosa and bulimia nervosa show that no significant differences exist between DSM-5 and DSM-IV definitions.
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