Hospitalization Outcomes and Comorbidities of Bulimia Nervosa: A Nationwide Inpatient Study

Abstract

ObjectiveTo evaluate inpatient outcomes and the prevalence of psychiatric and medical comorbidities in bulimia nervosa.MethodsWe used the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). We identified bulimia nervosa as the primary diagnosis and medical and psychiatric comorbidities using ICD­9-CM codes. The differences in comorbidities were quantified using the Chi-square (χ2) test, and a multinomial logistic regression model was used to quantify associations among comorbidities (odds ratio (OR)).ResultsThe sample consisted of 3,319 inpatient admissions with bulimia nervosa between 2010–2014. Overall, 88% patients were younger than 40 years of age (p < 0.001). Bulimia nervosa was seen in a higher proportion of females (92.5%). The mean inpatient stay was 9.15 days and had a variable trend, whereas inpatient charges have been increasing (p < 0.001), averaging $34,398 (USD). The odds of having a longer hospitalization > 7 days (median) was seen in patients with comorbid fluid/electrolyte disorders (OR = 1.816; p < 0.001) and comorbid depression (OR = 1.745; p < 0.001). The most prevalent psychiatric comorbidities were psychosis (52.4%), followed by depression (23.5%). Females had three times higher odds of comorbid diabetes (OR = 3.374; p < 0.001), hypertension (OR = 2.548; p-value < 0.001), comorbid depression (OR = 1.670; p = 0.002), and drug abuse (OR = 2.008; p < 0.001).ConclusionOur study established psycho-socio-demographic characteristics, hospitalization outcomes, and comorbidities of bulimia nervosa patients. We believe that medical and psychiatric comorbidities of bulimia nervosa should be carefully investigated by clinicians as they can further complicate the management of bulimia nervosa and result in adverse inpatient outcomes.

Volume and Connectivity Differences in Brain Networks Associated with Cognitive Constructs of Binge Eating

“…Despite widespread attention from the general public and the scientific community, bulimia nervosa (BN) and binge eating disorder (BED) remain a major societal problem, with an estimated prevalence of 2–3% ( Stice et al, 2013 ). Because of unhealthy eating behavior and a strong association with obesity, these disorders are associated with a number of diseases, such as type II diabetes, cancer, cardiovascular diseases, and higher mortality rates ( Hudson et al, 2007 ; Guh et al, 2009 ; Smink et al, 2012 ; Kessler et al, 2013 ; Patel et al, 2018 ). Both BN and BED are characterized by binge eating episodes, which have to meet two requirements ( American Psychiatric Association, 2013 ).…”

Neural correlates associated with processing food stimuli in anorexia nervosa and bulimia nervosa: an activation likelihood estimation meta-analysis of fMRI studies

“…Anorexia nervosa (AN) and bulimia nervosa (BN) are psychiatric disorders with a very high burden of disease. Eating disorder patients commonly suffer several medical complications involving endocrine, cardiovascular, gastrointestinal, renal and neurological systems [ 46 ]. Consequently, eating disorders are associated with increased rates of mortality compared with the general population [ 46 ], and individuals with AN have the highest mortality rates of all other psychiatric disorders [ 33 , 45 ].…”

“…Finally, cognitive control regions are interconnected with both, reward-related regions and areas involved in interoception, and are considered to modulate eating behavior [ 22 , 32 , 46 ]. Chiefly, the prefrontal cortex, is thought to integrate goals, affective valence, interoceptive states, and sensory input to guide control functions, such as behavioural inhibition, planning and decision making [ 21 , 22 , 41 , 47 , 65 ].…”

Differential diagnosis of perinatal Bartter, Bartter and Gitelman syndromes

“…EDs are the main differential diagnoses of BS and GS in adolescents and adults. They may result in life-threatening electrolyte derangements and are associated with a substantial cost of hospitalization [ 82 , 83 ]. Differences in the electrolyte pattern are observed in the clinical subtypes of EDs.…”