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Psychiatric Comorbidities of Female Inpatients With Eating Disorders

Blinder, Barton J. MD, PhD; Cumella, Edward J. PhD; Sanathara, Visant A. MD

Psychosomatic Medicine:
doi: 10.1097/01.psy.0000221254.77675.f5
Original Articles

Objective: We analyze 27 point-prevalent DSM-IV Axis I comorbidities for eating disorder inpatients.

Methods: The sample included 2436 female inpatients treated between January 1, 1995, and December 31, 2000, for primary DSM-IV diagnoses of anorexia, bulimia, and eating disorder not otherwise specified. Analyses were multivariate analysis of variance and multinomial logistic regression; sociodemographics and severity-of-illness measures were controlled.

Results: Ninety-seven percent of patients evidenced ≥1 comorbid diagnoses; 94% evidenced comorbid mood disorders, largely unipolar depression, with no differences across eating disorders; 56% evidenced anxiety disorders, with no differences across eating disorders; and 22% evidenced substance use disorders, with significant differences across eating disorders (p < .0001). Five specific diagnoses differed across eating disorders. Alcohol abuse/dependence was twice as likely with bulimia (p < .0001); polysubstance abuse/dependence three times as likely with bulimia (p < .0001); obsessive-compulsive disorder twice as likely with restricting and binge/purge anorexia (p < .01); posttraumatic stress disorder twice as likely with binge-purge anorexia (p < .05); schizophrenia/other psychoses three times more likely with restricting anorexia (p < .05) and two times with binge-purge anorexia (p < .05).

Conclusions: New findings emerged: extremely high comorbidity regardless of eating disorder, ubiquitous depression across all eating disorders, no difference in overall rate of anxiety disorders across eating disorders, greater posttraumatic stress disorder in binge-purge anorexia, more psychotic diagnoses in anorexia. Certain previous findings were confirmed: more obsessive-compulsive disorder in anorexia; more substance use in bulimia; and a replicated comorbidity rank-ordering for eating disorder patients: mood, anxiety, and substance use disorders, respectively.

ANB = anorexia nervosa, binge-eating/purging type; ANOVA = analysis of variance; ANR = anorexia nervosa, restricting type; BMI = body mass index; BN = bulimia nervosa; ED = eating disorder; EDNOS = eating disorder not otherwise specified; LOS = length of stay; MANOVA = multivariate analysis of variance; OCD = obsessive-compulsive disorder; PTSD = posttraumatic stress disorder; SUD = substance use disorder.

Author Information

From the Department of Psychiatry and Human Behavior, University of California, Irvine, California (B.J.B., V.A.S.); Research Department, Remuda Ranch Center for Anorexia and Bulimia, Wickenburg, Arizona (E.J.C.).

Results were presented at the Eating Disorder Research Society annual meeting, Albuquerque, New Mexico, November 2001.

Address correspondence and reprint requests to Barton J. Blinder, MD, Department of Psychiatry and Human Behavior, University of California, Irvine, 400 Newport Center Drive, Newport Beach, CA 92660. E-mail:

Received for publication February 23, 2005; revisions received December 8, 2005.

Copyright © 2006 by American Psychosomatic Society

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