Axis-I comorbidity is linked to prospective instability of diagnoses within eating disorders

BMC Psychiatry

Anja Spindler²  Sabina Muehlebach²  Volker Baur¹  Gabriella F Milos² 

[1] Division Neuropsychology, Institute of Psychology, University of Zurich, Binzmuhlestr 14/25, Zurich CH-8050, Switzerland;Centre for Eating Disorders, Department of Psychiatry and Psychotherapy, University Hospital Zurich, Culmannstr. 8, CH-8091 Zurich, Switzerland

关键词: Affective disorder;    Diagnostic instability;    Comorbidity;    Bulimia Nervosa;    Anorexia Nervosa;    Eating disorders;   

Others  :  1123901
DOI  :  10.1186/1471-244X-13-295

 received in 2013-04-05, accepted in 2013-08-21,  发布年份 2013

【 摘 要 】

Background

Eating disorders (ED) are classified into Anorexia Nervosa, Bulimia Nervosa, and eating disorder not otherwise specified. Prospectively, the diagnostic instability within ED is high, but it is not clear which factors may account for this instability. So far, there is no evidence of whether psychiatric comorbidity may play a role in ED diagnostic crossover. We sought to determine possible influences of comorbidities of axis I and II on diagnostic crossover within ED.

Methods

Longitudinal data of 192 female patients were collected. All patients had a diagnosis of a current ED at study entry (baseline, T0). Diagnoses were re-established both 12 months (T1) and 30 months (T2) after T0. Comorbid psychiatric diagnoses were grouped into axis I and axis II according to DSM-IV.

Results

Patients with instable ED diagnoses had lifetime axis-I comorbidity more frequently than patients with stable ED diagnoses (χ² = 4.74, df = 1, p < 0.05). Post-hoc exploratory tests suggested that the effect was mainly driven by affective disorders like major depression. There was no difference for axis-II comorbidity between stable and instable diagnostic profiles.

Conclusions

Following previous reports of diagnostic crossover in ED, the present investigation points to an influence of a life-time psychiatric comorbidity, in particular of axis I, on follow-up diagnoses of ED. Comorbid affective disorders like major depression might facilitate a switching between clinical phenotypes. The understanding of mechanisms and causes of the symptoms fluctuation will be subject of future studies.

【 授权许可】

   
2013 Milos et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Fairburn CG, Bohn K: Eating disorder NOS (EDNOS): an example of the troublesome “not otherwise specified” (NOS) category in DSM-IV. Behav Res Ther 2005, 43(6):691-701.
• [2]Fairburn CG, Cooper Z, Shafran R: Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther 2003, 41(5):509-528.
• [3]American Psychiatric Association: Diagnostic and statistical manual of mental disorders (4th edn, text revision) (DSM-IV-TR). 4th edition. Washington DC: APA; 2000.
• [4]Hudson JI, Hiripi E, Pope HG Jr, Kessler RC: The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biol Psychiatry 2007, 61(3):348-358.
• [5]Treasure J, Claudino AM, Zucker N: Eating disorders. Lancet 2010, 375(9714):583-593.
• [6]Castellini G, Lo Sauro C, Mannucci E, Ravaldi C, Rotella CM, Faravelli C, Ricca V: Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: a 6-year follow-up study. Psychosom Med 2011, 73(3):270-279.
• [7]Eddy KT, Dorer DJ, Franko DL, Tahilani K, Thompson-Brenner H, Herzog DB: Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. Am J Psychiatry 2008, 165(2):245-250.
• [8]Milos G, Spindler A, Schnyder U, Fairburn CG: Instability of eating disorder diagnoses: prospective study. Br J Psychiatry 2005, 187:573-578.
• [9]Monteleone P, Di Genio M, Monteleone AM, Di Filippo C, Maj M: Investigation of factors associated to crossover from anorexia nervosa restricting type (ANR) and anorexia nervosa binge-purging type (ANBP) to bulimia nervosa and comparison of bulimia nervosa patients with or without previous ANR or ANBP. Compr Psychiatry 2011, 52(1):56-62.
• [10]Tozzi F, Thornton LM, Klump KL, Fichter MM, Halmi KA, Kaplan AS, Strober M, Woodside DB, Crow S, Mitchell J, et al.: Symptom fluctuation in eating disorders: correlates of diagnostic crossover. Am J Psychiatry 2005, 162(4):732-740.
• [11]Steinhausen HC: The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 2002, 159(8):1284-1293.
• [12]Steinhausen HC, Weber S: The outcome of bulimia nervosa: findings from one-quarter century of research. Am J Psychiatry 2009, 166(12):1331-1341.
• [13]Milos G, Spindler A, Schnyder U: Psychiatric comorbidity and Eating Disorder Inventory (EDI) profiles in eating disorder patients. Can J Psychiatry 2004, 49(3):179-184.
• [14]Milos GF, Spindler AM, Buddeberg C, Crameri A: Axes I and II comorbidity and treatment experiences in eating disorder subjects. Psychother Psychosom 2003, 72(5):276-285.
• [15]Braun DL, Sunday SR, Halmi KA: Psychiatric comorbidity in patients with eating disorders. Psychol Med 1994, 24(4):859-867.
• [16]Spindler A, Milos G: Links between eating disorder symptom severity and psychiatric comorbidity. Eat Behav 2007, 8(3):364-373.
• [17]Wittchen H-U, Zaudig M, Fydrich T: Strukturiertes Klinisches Interview für DSM-IV. Achse I und II. Handanweisung. Göttingen: Hogrefe; 1997.
• [18]Hasler G, Lissek S, Ajdacic V, Milos G, Gamma A, Eich D, Rossler W, Angst J: Major depression predicts an increase in long-term body weight variability in young adults. Obes Res 2005, 13(11):1991-1998.
• [19]Abbate-Daga G, Gramaglia C, Marzola E, Amianto F, Zuccolin M, Fassino S: Eating disorders and major depression: role of anger and personality. Depres Res Treat 2011. Article ID: 194732
• [20]Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K: Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry 2004, 161(12):2215-2221.
• [21]Milos G, Spindler A, Ruggiero G, Klaghofer R, Schnyder U: Comorbidity of obsessive-compulsive disorders and duration of eating disorders. Int J Eat Disord 2002, 31(3):284-289.
• [22]Anderluh MB, Tchanturia K, Rabe-Hesketh S, Treasure J: Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype. Am J Psychiatry 2003, 160(2):242-247.
• [23]Fassino S, Abbate-Daga G, Amianto F, Leombruni P, Boggio S, Rovera GG: Temperament and character profile of eating disorders: a controlled study with the Temperament and Character Inventory. Int J Eat Disord 2002, 32(4):412-425.
• [24]Steinhausen HC: Outcome of eating disorders. Child Adolesc Psychiatr Clin N Am 2009, 18(1):225-242.
• [25]Anderluh M, Tchanturia K, Rabe-Hesketh S, Collier D, Treasure J: Lifetime course of eating disorders: design and validity testing of a new strategy to define the eating disorders phenotype. Psychol Med 2009, 39(1):105-114.
• [26]Mischoulon D, Eddy KT, Keshaviah A, Dinescu D, Ross SL, Kass AE, Franko DL, Herzog DB: Depression and eating disorders: treatment and course. J Affect Disord 2011, 130(3):470-477.