Study findings highlight the need for clinicians to recognize comorbid eating disorders in patients with bipolar disorder.

M Fornaro (University of Genoa, Italy) and colleagues found that one in three women with bipolar disorder had at least one eating disorder. Also, the presence of comorbid eating disorders may influence both the clinical characteristics and course of bipolar disorder.

The researchers assessed the prevalence of comorbid DSM-IV-defined anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) in 148 women with a lifetime history of bipolar I disorder, bipolar II disorder, and/or cyclothymia.

In all, 46 (31%) of the patients reported a lifetime history of at least one eating disorder. AN was the most common, affecting 23 (15.5%) patients, followed by BED and BN, which affected 21 (14.2%) and eight (5.4%) patients, respectively. Six (4.1%) patients reported multiple lifetime eating disorders.

As expected, the researchers found that body mass index was highest in patients with BED and lowest in patients with AN.

Fornaro et al also note in the Journal of Affective Disorders that “the presence of BED among bipolar disorder patients has relevant clinical and therapeutic implications.”

They explain: “In these patients the use of anti-dopaminergic drugs may induce weight gain not only by an appetite increase, but also favoring impulsive eating.”

The type of eating disorder did not influence clinical characteristics such as diagnostic distribution, psychotic and melancholic features, suicidal thoughts and attempts, hospitalization, seasonal pattern, post-partum onset, or premenstrual dysphoria.

The researchers suggest that the female-only sample and the small number of women with eating disorders may have affected the ability of the study to detect group differences.

However, women with comorbid BED were more likely than women with comorbid AN and those without eating disorders to experience rapid cyclicity (42.9% versus 32.0% and 18.6%, respectively) and comorbid drug abuse (28.5% versus 16.0% and 20.7%, respectively).

“Our results prompt for the recognition of [eating disorder] comorbidity among bipolar spectrum patients, indicating that BED and AN may influence in different extents both clinical characteristics and course of the illness,” says the team.

“Focusing on a ‘BED versus non-BED’ distinction, potentially relevant therapeutic implications should also be taken into account.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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