The Major Affective Disorder in Anorexia Nervosa and Bulimia

Abstract

In recent years, several lines of evidence have emerged suggesting that eating disorders in general, and bulimia in particular, are in some way linked to the major affective disorder. ' Studies, however, on the phenomenological relationship between the two illnesses have shown inconsistent results, which might be partly due to the heterogeneity of eating disorders and shortcomings of a diagnostic assessment of affective disorders. We looked for depressive syndromes in subtypes of eating disorders using standardized assessment and DSM-111 diagnostic criteria.Characteristics of the study groups are depicted on TABLE 1. Diagnostic assessment was made using the National Institute of Mental Health Diagnostic Interview Schedule and the Eating Disorder Inventory. Sixty-three patients were interviewed as inpatients and 22 as outpatients, one year after hospital treatment.DSM-111 lifetime rates of affective disorders are depicted in FIGURE 1. The three bulimic groups differed significantly from the restrictors. The onset of the major affective disorder occurred significantly more frequently (in 72% of the patients) at least one year after onset of the eating disorder than before the eating disorder (9.4%). The rate of the current major affective disorder in the 63 inpatients with an active and severe eating disorder was significantly higher (31.7%) than in the outpatients whose eating disorder was in remission (4.5%).In some contrast to previous results,* our data on temporal relationship indicate that the affective disturbance was likely to be secondary to an eating disorder. This is further supported by our finding a very low rate of depression in patients after treatment of the eating disorder. The higher frequency of major affective disorders in bulimics than in restrictors could partly be explained by the longer duration of illness in the bulimics. Our data are also consistent, however, with recent suggestions that bulimia is related to a more severe unspecific psychopathology and has a poorer prognosis. This view is further supported by our finding that in most patients developing bulimia after anorexia nervosa, the onset of major depression occurs only when bulimia is present. REFERENCES

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Kann eine störungsorientierte Psychotherapie komorbide Symptome der Bulimia Nervosa verändern?

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