Axes I and II Comorbidity and Treatment Experiences in Eating Disorder Subjects

Abstract

Background: The present study determined the psychiatric comorbidity of Axes I and II in a sample of subjects with eating disorders (EDs). The objective was to investigate associations between comorbidity and current and past treatment. Methods: In a sample of 248 women (77 anorexia nervosa, 137 bulimia nervosa, 34 eating disorders not otherwise specified), psychiatric comorbidity of Axes I and II was determined with the Structured Clinical Interview of DSM-IV. Current and past treatment since ED onset were also assessed. Results: High levels of psychiatric comorbidity were found in the total sample (71% Axis I and 68% Axis II). Only 17% of cases had no psychiatric comorbidity. Anxiety (52%) and affective disorders (50%) were the most common Axis I diagnoses. Personality disorders of Clusters C (52%) and B (23%) were most common for Axis II. Twenty-one percent of participants who were not in treatment at the time had a history of inpatient treatment, and an additional 59% had a history of outpatient treatment. Thirty-eight percent of participants currently in outpatient treatment had a history of inpatient treatment. Participants with multiple comorbidity (Axes I and II) had the highest proportion of cases who had been treated by health professionals. Higher levels of comorbidity were associated with experiences in more intense treatment settings (ranging from no treatment to inpatient treatment). Conclusions: ED subjects with greater comorbidity require more treatment encounters and more intense treatment settings. The association between comorbidity and treatment experiences may represent a bias in the assessment of comorbidity when samples with heterogeneous treatment history are recruited.

The epidemiology of eating disorders in six European countries: Results of the ESEMeD-WMH project

“…This finding is consistent with past survey showing a high level of comorbidity in both clinical samples (Godart et al, 2002;Halmi et al, 2005;Hudson et al, 1987;Kaye et al, 2004;McElroy et al, 2005;Milos et al, 2003), and in population-based studies (Bulik et al, 2002;Bushnell et al, 1990;Garfinkel et al, 1995Garfinkel et al, , 1996Jacobi et al, 2004;Vollrath et al, 1992) of anorexia nervosa, bulimia nervosa and binge ED. The reason for this high level of comorbidity is not known, but genetic factors are likely to play an important role, at least for the cooccurrence of EDs with mood disorders (Ribasés et al, 2008;Wade et al, 2000;Walters et al, 1992).…”

“…However, despite high comorbidity with other mental disorders, which should enhance the search for new treatments (Jacobi et al, 2004;Milos et al, 2003), only a scant proportion of cases sought contact with mental health services for emotional problems: failure in recognizing ED in the medical setting (Hoek, 1991;Keski-Rahkonen et al, 2007), and the egosyntonic nature of symptoms in most cases might contribute to the low degree of service utilization among people with EDs (Fairburn and Harrison, 2003;Halmi et al, 2005).…”

Repetitive Transcranial Magnetic Stimulation in Bulimia Nervosa: Preliminary Results of a Single-Centre, Randomised, Double-Blind, Sham-Controlled Trial in Female Outpatients

“…On the other hand, there is strong evidence for a sociocultural influence and psychological antecedents [3]. In addition, BN coaggregates with a high number of psychiatric comorbidities [4]. BN as well as depression seem to be based on alterations of serotonin activity [5, 6] and there is evidence that BN may respond to antidepressants [7].…”

Childhood Body-Focused Behaviors and Social Behaviors as Risk Factors of Eating Disorders

“…Another body of studies has noted an elevated prevalence of various psychiatric disorders in individuals with eating disorders [21]and their relatives [22, 23, 24, 25, 26, 27, 28, 29, 30]. Furthermore, adverse childhood events appear associated with the development of eating disorders [31, 32, 33, 34]and other psychiatric disorders [19, 20, 35].…”