Common comorbidities with eating disorders

 

Individuals with eating disorders commonly experience additional psychiatric conditions. This is also known as comorbidity, which is generally defined as two or more physical or mental health problems co-occurring simultaneously in an individual.

Alongside the physical health problems that exist within eating disorders, research has found that more than 70% of male and female patients also had at least one other psychiatric disorder (Splinder & Milos, 2007). This can range from a diagnosis of anxiety disorders, substance abuse, bi-polar and personality disorders. More recent studies by Professor Tchanturia and her team have also been able to identify the links with eating disorder and autism spectrum condition (ASC). It has been demonstrated that most of these comorbidities are linked with increased severity of eating disorder symptoms, standing as an extra barrier to recovery (Splinder & Milos, 2007). Hence, it is important for clinicians and carers to be aware of them in order to shine a light on ways that we can effectively help the people we work with or care for. On a wider level, improved understanding can also lead to better tailoring of intervention in different eating disorder services (i.e. inpatient, day care, or outpatient).

Autism spectrum condition 

Women with anorexia nervosa (AN) has been found to possess greater number of autistic traits than typical women. A measure that helped to determine this is called Autism Spectrum Quotient (AQ-10), which identified that factors such as inflexibility of thinking and problems with social interactions suggest that autistic traits may worsen factors that maintain the eating disorder (Westwood & Tchanturia, 2017). The work from the Pathway for Eating disorders and Autism developed from Clinical Experience (PEACE) has already demonstrated promising results, leading to reduced lengths of admission for patients with comorbidity of ASC, saving £22, 837 per patient (Tchanturia et al., 2020)

Anxiety

About 60% of individuals with eating disorders also have one lifetime anxiety disorder, with the most common being obsessive-compulsive disorder (OCD) and social phobia (Kaye et al., 2004). This meant that they would present more with symptoms of perfectionism and obsession which is already prevalent in eating disorders. The rates were similar for AN, bulimia nervosa (BN) and binge eating disorder (BED). Majority of the patients reported a childhood onset of OCD, social phobia, specific phobia and generalised anxiety disorder before their eating disorder. 

Substance abuse 

The rates for eating disorder and substance abuse disorders have been found to be high. A study by The National Centre on Addiction and Substance abuse [CASA] (2003) reported that 50% of individuals with eating disorders abused alcohol or other substances compared to 9% of the general population. For adolescence presenting with eating disorder behaviours, it has been found that they are 20-40% more likely to use or abuse substance compared to their normal weight peers. It is also reported that BN has stronger association with substance use compared with AN.

Bi-polar (BP) disorder

BED and BN are found to be common in BP patients. A study by McElroy et al. (2016) found that eating disorder patients with BP were younger and more likely to be women, had an earlier age of onset of bipolar, with higher degrees of suicidality and mood instability. This comorbidity is also associated with higher rates of self-harm, substance abuse and treatment resistance.

Personality disorder

In a study of individuals with eating disorder from in-patient settings, it was found that  69% met criteria for at least one personality disorder diagnosis (Braun, Sunday & Halmi, 1994). Patients with this comorbidity were also more like to be diagnosed with mood disorder or substance abuse 

As a result of studies that demonstrate the occurrence of psychiatric comorbidities with eating disorders, it is crucially vital to understand the relationship between these differing but similar mental health issues. While this can lead to enhanced knowledge for clinicians and carers, it can also harness more individualised treatment and recovery. It can be beneficial then, to have screening measures to determine comorbidities in eating disorder patients before starting treatment in order to plan for their care whilst in services. 

Contributed by:

References

1) Braun, D., Sunday, S., & Halmi, K. (1994). Psychiatric comorbidity in patients with eating disorders. Psychological Medicine, 24(4), 859-867. doi: 10.1017/s0033291700028956

2) The National Center on Addiction and Substance Abuse (CASA) at Columbia University Food for thought: Substance abuse and eating disorders. 2003 Retrieved August 3, 2020, from http://www.casacolumbia.org/templates/Publications_Reports.aspx.

3) Kaye, W., Bulik, C., Thornton, L., Barbarich, N., & Masters, K. (2004). Comorbidity of Anxiety Disorders With Anorexia and Bulimia Nervosa. American Journal Of Psychiatry, 161(12), 2215-2221. doi: 10.1176/appi.ajp.161.12.2215

4) McElroy, S., Crow, S., Blom, T., Biernacka, J., Winham, S., & Geske, J. et al. (2016). Prevalence and correlates of DSM-5 eating disorders in patients with bipolar disorder. Journal Of Affective Disorders, 191, 216-221. doi: 10.1016/j.jad.2015.11.010

5) Spindler, A., & Milos, G. (2007). Links between eating disorder symptom severity and psychiatric comorbidity. Eating Behaviors, 8(3), 364-373. doi: 10.1016/j.eatbeh.2006.11.012

6) Tchanturia, K., Dandil, Y., Li, Z., Smith, K., Leslie, M., & Byford, S. (2020). A novel approach for autism spectrum condition patients with eating disorders: Analysis of treatment cost‐savings. European Eating Disorders Review. doi: 10.1002/erv.2760

7) Westwood, H., & Tchanturia, K. (2017). Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review. Current Psychiatry Reports, 19(7). doi: 10.1007/s11920-017-0791-9

Keep Reading

You might find these interesting too!

2022 PEACE Pathway Conference

Download presentations from the 2022 PEACE Pathway Conference

Brain imaging Of Emotion And Cognition Of adolescents with anorexia Nervosa (BEACON) project

BEACON is a brain imaging project looking at how the brain processes emotion and cognition in individuals with anorexia nervosa. We are also interested in how autistic characteristics affect these brain processes and how these processes change over time.

See All