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Psychiatric comorbidity in patients with eating disorders1

  • D. L. Braun (a1), S. R. Sunday (a1) and K. A. Halmi (a1)

The Structured Clinical Interview for DSM-III-R (SCID and SCID II) was administered to 105 eating disorder in-patients in order to examine rates of comorbid psychiatric disorders and the chronological sequence in which these disorders developed. Eighty-six patients, 81·9% of the sample, had Axis I diagnoses in addition to their eating disorder. Depression, anxiety and substance dependence were the most common comorbid diagnoses. Anorexic restrictors were significantly more likely than bulimics (all subtypes) to develop their eating disorder before other Axis I comorbid conditions.

Personality disorders were common among the subjects; 69% met criteria for at least one personality disorder diagnosis. Of the 72 patients with personality disorders, 93% also had Axis I comorbidity. Patients with at least one personality disorder were significantly more likely to have an affective disorder or substance dependence than those with no personality disorder.

Corresponding author
2Address for correspondence: Dr Devra L. Braun, Department of Psychiatry. New York Hospital/Cornell University Medical Center, 21 Bloomingdale Road, White Plains, NY 10605USA
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Part of this paper was presented by Dr Braun at the International Conference on Eating Disorders, in New York, NY, USA on 24–26 April 1992.

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Ames-Frankel, J., Devlin, M. J., Walsh, B. T., Strasser, T. J., Sadik, C., Oldham, J. M. & Roose, S. P. (1992). Personality disorder diagnoses in patients with bulimia nervosa: clinical correlates and changes with treatment. Journal of Clinical Psychiatry 53, 9096.
Brewerton, T. D., Lydiard, R. B., Ballenger, J. C. & Herzog, D. B. (1993). Eating disorders and social phobia. Archives of General Psychiatry 50, 70.
Bulik, C. M., Sullivan, P. F., Epstein, L. H., McKee, M., Kaye, W. H., Dahl, R. E. & Weltzin, T. E. (1992). Drug use in women with anorexia and bulimia nervosa. International Journal of Eating Disorders 11, 213225.
Cantwell, D. P., Sturzenberger, S., Burroughs, J., Salkin, B. & Green, J. K. (1977). Anorexia nervosa: an affective disorder? Archives of General Psychiatry 34, 10871093.
Devlin, M. J. & Walsh, B. T. (1989). Eating disorders and depression. Psychiatric Annals 19, 473476.
First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B., Davies, M., Borus, J., Howes, M. J., Kane, J., Pope, H. G. & Rounsaville, B. (1994). The Structured Clinical Interview for DSM-III-R Personality Disorders: multi-site test–retest reliability study. Journal of Personality Disorders. (In the press.)
Fornari, V., Kaplan, M., Sandberg, D. E., Matthews, M., Skolnick, N. & Katz, J. L. (1992). Depressive and anxiety disorders in anorexia nervosa and bulimia nervosa. International Journal of Eating Disorders 12, 2129.
Garner, D. M., Garfinkel, P. E. & O'Shaughnessy, M. (1985). The validity of the distinction between bulimia with and without anorexia nervosa. American Journal of Psychiatry 142, 581587.
Gartner, A. F., Marcus, R. N., Halmi, K. & Loranger, A. W. (1989). DSM-III-R personality disorders in patients with eating disorders. American Journal of Psychiatry 146, 15851591.
Halmi, K. A., Eckert, E., Marchi, P., Sampugnaro, V., Apple, R. & Cohen, J. (1991). Comorbidity of psychiatric diagnoses in anorexia nervosa. Archives of General Psychiatry 48, 712718.
Herzog, D. B., Keller, M. B., Lavori, P. W., Kenny, G. M. & Sacks, N. R. (1992). The prevalence of personality disorders in 210 women with eating disorders. Journal of Clinical Psychiatry 53, 147152.
Hsu, L. K. G., Crisp, A. H. & Callender, J. S. (1992). Psychiatric diagnoses in recovered and unrecovered anorectics 22 years after onset of illness: a pilot study. Comprehensive Psychiatry 33, 123127.
Hudson, J. I., Pope, H. G., Jonas, J. M. & Yurgelun-Todd, D. (1983). Phenomenologic relationship of eating disorders to major affective disorder. Psychiatry Research 9, 345354.
Hudson, J. I., Pope, H. G., Yurgelun-Todd, D., Jonas, J. M. & Frankenburg, F. R. (1987). A controlled study of lifetime prevalence of affective and other psychiatric disorders in bulimic outpatients. American Journal of Psychiatry 144, 12831287.
Hyler, S. E., Skodol, A. E., Kellman, H. D., Oldham, J. M. & Rosnick, L. (1990). Validity of the personality diagnostic questionnaire-revised: comparison with two structured interviews. American Journal of Psychiatry 147, 10431048.
Kendler, K. S., MacLean, C., Neal, M., Kessler, R., Heath, A. & Eaves, L. (1991). The genetic epidemiology of bulimia nervosa. American Journal of Psychiatry 148, 16271637.
Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C. & Eaves, L. J. (1992). The genetic epidemiology of phobias in women: the interrelationship of agoraphobia, social phobia, situational phobia and simple phobia. Archives of General Psychiatry 49, 273281.
Kennedy, S. H., McVey, G. & Katz, R. (1990). Personality disorders in anorexia nervosa and bulimia nervosa. Journal of Psychiatric Research 24, 259269.
Laessle, R. G., Kittl, S., Fichter, M. M., Wittchen, H. & Pirke, K. M. (1987). Major affective disorder in anorexia nervosa and bulimia: a descriptive diagnostic study. British Journal of Psychiatry 151, 785789.
Laessle, R. G., Wittchen, H. U., Fichter, M. M. & Pirke, K. M. (1989). The significance of subgroups of bulimia and anorexia nervosa: lifetime frequency of psychiatric disorders. International Journal of Eating Disorders 8, 569574.
Loranger, A. W., Lenzenweger, M. F., Gartner, A. F., Susman, V. L., Herzig, J., Zammit, G. K., Gartner, J. D., Abrams, R. C. & Young, R. C. (1991). Trait-state artifacts and the diagnosis of personality disorders. Archives of General Psychiatry 48, 720728.
Nestadt, G., Romanoski, A. J., Samuels, J. F., Folstein, M. F. & McHugh, P. R. (1992). The relationship between personality and DSM-III Axis I disorders in the population: results from an epidemiological survey. American Journal of Psychiatry 149, 12281233.
Perry, J. C. (1992). Problems and considerations in the valid assessment of personality disorders. American Journal of Psychiatry 149, 16451653.
Piran, N., Lerner, P., Garfinkel, P. E., Kennedy, S. H. & Brouillette, C. (1988). Personality disorders in anorexic patients. International Journal of Eating Disorders 7, 589599.
Pope, H. G. & Hudson, J. I. (1989). Are eating disorders associated with borderline personality disorder? A critical review. International Journal of Eating Disorders 8, 19.
Powers, P. S., Coovert, D. L., Brightwell, D. R. & Stevens, B. A. (1988). Other psychiatric disorders among bulimic patients. Comprehensive Psychiatry 29, 503508.
Rossiter, E. M., Agras, W. S., Telch, C. F. & Schneider, J. A. (1993). Cluster B personality disorder characteristics predict outcome in the treatment of bulimia nervosa. International Journal of Eating Disorders 13, 349357.
Sanderson, W. C., Beck, A. T. & Beck, J. (1990). Syndrome comorbidity in patients with major depression or dysthymia: prevalence and temporal relationships. American Journal of Psychiatry 147, 10251028.
Schlesier-Carter, B., Hamilton, S. A., O'Neil, P. M., Lydiard, R. B. & Malcolm, R. (1989). Depression and bulimia: the link between depression and bulimic cognitions. Journal of Abnormal Psychology 98, 322325.
Schmidt, N. B. & Telch, M. J. (1990). Prevalence of personality disorders among bulimics, nonbulimic binge eaters, and normal controls. Journal of Psychopathology and Behavioral Assessment 12, 170185.
Schneier, F. R., Johnson, J., Hornig, C. D., Liebowitz, M. R. & Weissman, M. M. (1992). Social phobia: comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry 49, 282288.
Schwalberg, M. D., Barlow, D. H., Alger, S. A. & Howard, L. J. (1992). Comparison of bulimics, obese binge eaters, social phobics, and individuals with panic disorder on comorbidity across DSM-III-R anxiety disorders. Journal of Abnormal Psychology 101, 675681.
Spitzer, R. L., Williams, J. B., Gibbon, M. & First, M. B. (1989). Structured Clinical Interview for DSM-III-R, Patient Edition (with Psychotic Screen) and Nonpatient Edition, 9/1/89 version. Biometrics Research Dept., NY State Psychiatric Institute: New York.
Swift, W. J., Andrews, D. & Barklage, N. E. (1986). The relationship between affective disorder and eating disorders: a review of the literature. American Journal of Psychiatry 143, 290299.
Toner, B. B., Garfinkel, P. E. & Garner, D. M. (1988). Affective and anxiety disorders in the long-term follow-up of anorexia nervosa. International Journal of Psychiatry in Medicine 18, 357364.
Van Ameringen, M., Mancini, C., Styan, G. & Donison, D. (1991). Relationship of social phobia with other psychiatric illness. Journal of Affective Disorders 21, 9399.
Walsh, B. T., Roose, S. P., Glassman, A. H., Gladis, M. A. & Sadik, C. (1985). Bulimia and depression. Psychosomatic Medicine 47, 123131.
Williams, J. B., Gibbon, M., First, M. B., Spitzer, R. L., Davies, M., Borus, J., Howes, M. J., Kane, J., Pope, H. G., Rounsaville, B. & Wittchen, H. (1992). The structured clinical interview for DSM-III-R (SCID): II. Multisite test–retest reliability. Archives of General Psychiatry 49, 630636.
Wonderlich, S. A., Swift, W. J., Slotnick, H. B. & Goodman, S. (1990). DSM-III-R personality disorders in eating-disorder subtypes. International Journal of Eating Disorders 9, 607616.
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