Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

Abstract

Background Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders. Methods This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised. Results A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED. Conclusions This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.

The Follow-Up of Eating Disorders from Adolescence to Early Adulthood: A Systematic Review

“…Medical complications are primarily the result of malnutrition and rapid weight loss or can be caused by compensatory behaviors. In accordance with a recent review, medical comorbidities complicate 42% of ED cases [ 44 ]. They cause deficits at different levels of systems: in the integumentary system, symptoms, such as dry skin, hair loss, nail fragility, formation of pressure ulcers in conjunction with the bone protuberances [ 49 ], or acrocyanosis, a bluish discoloration of the skin caused by hypothermia and impaired blood circulation [ 50 ]; at the gastrointestinal level, there is abdominal pain, nausea, constipation, and bloating as a result of slow intestinal motility [ 51 ]; at the muscle level, there is a loss of skeletal muscle tissue and reduced strength [ 52 ]; for the hepatic system, liver disease can manifest itself in rapid and massive weight loss [ 53 ]; in the cardiovascular system, there are cardiovascular complications due to a reduced perfusion, and, moreover, pericardial effusion can occur [ 54 ] as well as a prolapse of the mitral valve [ 55 ].…”

“…Psychiatric complications are usually associated with the acute phase of EDs [ 44 ]. According to a study conducted by Micali et al [ 45 ] on a sample of adolescents with anorexia nervosa, the most frequent comorbid disorders in this age group are depression and anxiety disorders.…”

Suicidal Behavior in Eating Disorders

“…The most common comorbid mental disorders were anxiety disorders (62%), mood disorders (54%), substance-use disorders (27%), and post-traumatic stress disorder (27%). Since comorbidity increases mortality and suicidal behavior, it is crucial to detect it (Hambleton et al 2022).…”

Emergency room presentations of people with anorexia nervosa

“…In addition, there has been a significant COVID-19-related increase in outpatient volume of people with eating disorders seeking care [ 12 ]. The most common psychiatric comorbidities are depressive disorders and anxiety disorders (69%)—specifically obsessive–compulsive disorder and social anxiety [ 11 ]. The presentation of these psychiatric issues can take the focus off the underlying AN and associated medical complications.…”