The relationship of bulimia and anorexia nervosa with bipolar disorder and its temperamental foundations.
Lunde AV, Fasmer OB, Akiskal KK, Akiskal HS, Oedegaard KJ.
Source
Department of Clinical Psychiatry Risskov, Aarhus University Hospital, Denmark; International Mood Center, University of California, La Jolla, CA, USA.
Abstract
BACKGROUND:
Earlier studies have suggested a relationship between bipolar disorder (BP) and eating disorders (ED), more specifically, bulimia nervosa (BN) and bipolar II disorder (BP-II). In the present report we extend this relationship to broader definitions of bipolarity.
METHODS:
Semi-structured interview of 201 patients with DSM-IV criteria for major affective disorders combined with Akiskal and Mallya criteria for Affective temperaments. To diagnose lifetime comorbid eating disorders DSM-IV criteria for eating disorders (Bulimia Nervosa, BN, Anorexia, AN) were used.
RESULTS:
33 patients had an eating disorder. When compared to patients without ED the patients with ED had a higher prevalence of bipolar disorders. Using strict DSM-IV criteria, this association was only significant for BN (OR) 4.5 (95% CI 1.1-17.6). When using a broader index of bipolarity including patients having affective temperaments, a significant relation was found for BN (OR) 9.1 (95% CI 1.1-73.6), and for patients with a lifetime history of both BN and AN (OR) 8.6 (95% CI 1.1-70.2).We also found patients with ED to have a significantly higher prevalence of affective temperaments, an earlier onset of major affective disorder and to have more depressive episodes.
LIMITATIONS:
Non-blind evaluation of diagnosis for mood, eating disorders and affective temperaments.
CONCLUSION:
In line with previous reports we describe an association between bulimia nervosa and bipolar disorder. Furthermore we report a relationship between lifetime bulimia and anorexia and cyclothymic and related affective temperaments.