Eating Disorders and Illness Burden in Patients with Bipolar Spectrum Disorders

Objectives: The objectives of the study were to evaluate the clinical significance of lifetime eating disorder comorbidity in a well-defined sample of patients with bipolar spectrum disorders and to describe cognitive correlates of disordered eating in this group. Method: Twenty-six bipolar patients with a lifetime history of a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-defined eating disorder (n = 17) or a clinically significant subthreshold eating disorder (n = 9) (ED group) were compared with 46 bipolar patients with no history of an eating disorder (no-ED group) on demographic and clinical characteristics at study presentation, history of bipolar illness, and other psychiatric comorbidity. Measures included the Structured Clinical Interview for the DSM-IV Axis I Disorders, the Clinical Global Impression-Severity Scale-Bipolar Version (CGI-S-BP), and the Eating Disorder Examination. Height and weight were recorded to calculate body mass index. Results: Patients in the ED group were heavier and were rated as more symptomatic on the CGI-S-BP than were patients in the no-ED group. The ED group also had a higher number of lifetime depressive episodes and greater psychiatric comorbidity, excluding eating and mood disorders. Finally, after controlling for body mass index and CGI-S-BP rating, patients in the ED group had significantly higher Eating Disorder Examination Restraint, Eating Concern, Shape Concern, Weight Concern, and Global scores than did patients in the no-ED group. Conclusions: These findings highlight the need for a renewed emphasis on the evaluation and management of weight and eating in the mood disorders. In particular, this research suggests that eating disorder comorbidity may be a marker for increased symptom load and illness burden in bipolar disorder. © 2007 Elsevier Inc. All rights reserved.