Eating Disorders and Depression

Z Kinder Jugenpsychiatr 1987;15(3):198-207 [Anorexia nervosa and depression–a case study]. [Article in German]

Herpertz-Dahlmann B

Klinik und Poliklinik fur Kinder- und Jugendpsychiatrie, Philipps-Universitat Marburg.

Associations between anorexia nervosa and affective disorders have often been suggested. A case is described of a 14-year-old girl who develops anorexia nervosa on the basis of major depressive disorder. After improvement of anorectic symptomatology during inpatient treatment depressed mood becomes present again. Etiologic aspects are discussed. As demonstrated by this case report patients with anorexia nervosa might not only exhibit depressive symptoms at follow-up, but also in the premorbid state during early childhood.

Compr Psychiatry 1988 Jul;29(4):427-432
Differential diagnosis of anorexia nervosa and depressive illness: a review of 11 studies.

Rothenberg A

Department of Research, Austen Riggs Center, Stockbridge, MA 01262.
A review of differential diagnostic information from 11 studies of patients with anorexia nervosa is provided. Both intercurrent depressive and obsessive-compulsive features are most frequently reported overall. In seven of these studies providing information about premorbid and intercurrent personality disturbances, obsessive-compulsive characteristics are reported as most frequent in four. It is suggested that presumed connections between anorexia nervosa and depressive illness may be secondary to a more direct link with the obsessive-compulsive syndrome.
Am J Psychiatry 1984 Dec;141(12):1594-1597
Are anorexic and bulimic patients depressed?

Herzog DB

The presence of depression was assessed in 82 female outpatients with anorexia nervosa and bulimia by means of a structured interview. The Research Diagnostic Criteria for major depressive disorder were met by 55.6% of the anorexic patients and 23.6% of the bulimic patients. On the Extracted Hamilton Depression Rating Scale, 40.7% of the patients with anorexia and 23.6% of those with bulimia had scores in the moderately or severely depressed range.
J Psychosom Res 1994 Oct;38(7):773-782
Depression in anorexia nervosa and bulimia nervosa: discriminating depressive symptoms and episodes.

Kennedy SH, Kaplan AS, Garfinkel PE, Rockert W, Toner B, Abbey SE

Department of Psychiatry, University of Toronto, Toronto Hospital, Canada.

In a clinical sample of 198 female patients with anorexia nervosa (N = 83) and bulimia nervosa (N = 115), 43% met criteria for major depression using the Structured Clinical Interview for DSMIII-R. This group had a mean score of 30.9 +/- 8.7 on the Beck Depression Inventory (BDI) which was significantly higher than the BDI mean score of 20.5 +/- 8.9 among the remainder of the sample (p < 0.0001). A score of 26 yielded the highest levels of sensitivity and specificity, while five items from the BDI (loss of satisfaction, discouragement, weight loss, suicidal ideation and decision-making) correctly classified approximately 80% of subjects into “depression-positive” or “depression-negative” categories. Detection of co-morbid depression in patients with eating disorders may have practical implications for treatment.
Am J Psychiatry 1985 Dec;142(12):1495-1497
Depressive disorders in relatives of anorexia nervosa patients with and without a current episode of nonbipolar major depression.

Biederman J, Rivinus T, Kemper K, Hamilton D, MacFadyen J, Harmatz J

The first-degree relatives of anorexia nervosa patients with current nonbipolar major depression had a higher rate of depression than the relatives of anorexic patients without current depression, whose rate was similar to that for relatives of normal control subjects.
Am J Psychiatry 1987 Mar;144(3):362-364
Short-term course of depressive symptoms in patients with eating disorders.

Wamboldt FS, Kaslow NJ, Swift WJ, Ritholz M

After inpatient treatment focused on aberrant eating behavior, six depressed normal-weight bulimic patients showed little improvement in depressive or eating symptoms. Four depressed anorexic patients with bulimic behavior improved in both areas, and five restricting anorexic patients had an intermediate response.
Pharmacopsychiatry 1997 May;30(3):85-92
Effects of fluvoxamine on depression, anxiety, and other areas of general psychopathology in bulimia nervosa.
Fichter MM, Leibl C, Kruger R, Rief W

Klinik Roseneck, Hospital fur Behavioral Medicine, Prien, Germany.

The efficacy of fluvoxamine in maintaining improvement of general psychopathology (depression, obsessive-compulsive symptoms, anxieties, interpersonal trust, and body perception) was tested in a double-blind placebo-controlled study of 72 patients with bulimia nervosa who were being treated successfully with inpatient behavioral psychotherapy. Over a period of about 15 weeks (2-3 weeks inpatient titration phase, 12 weeks outpatient relapse-prevention phase), fluvoxamine or placebo were given. The relapse-prevention design was used to avoid potential confounding effects of other concomitant treatments. Assessments concerning general psychopathology were made on the basis of expert ratings (CGI, HDRS) and self ratings (HSCL, Eating Disorders Inventory (EDI)-subscales “ineffectiveness,” “perfectionism,” “maturity fears,” “interpersonal distrust,” and “interoceptive awareness”). Fluvoxamine had significant effects in preventing relapse as measured on the basis of the Clinical Global Impression (CGI) scale “severity of illness”, and a positive trend for relapse preventing effects was observed for the HSCL “general symptomatic index”. Further, a relapse preventing effect was observed for the HSCL subscale “obsessive-compulsive symptoms”, but not for the EDI subscale “perfectionism”. Various dependent variables measuring depression showed no significant relapse-preventing effects of fluvoxamine, but only positive trends. Fluvoxamine had no relapse preventing effects according to our results for dependent variables assessing anxieties, interpersonal trust, and body perception. During a final short (4-week) off-medication phase, no statistically significant effects of discontinuation of medication, but some trends in the expected directions, were observed.
J Nerv Ment Dis 1997 Mar;185(3):140-144
Eating disorder symptomatology in major depression.

Fava M, Abraham M, Clancy-Colecchi K, Pava JA, Matthews J, Rosenbaum JF

Depression Clinical and Research Program, Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.

This study evaluated the relationship between eating disorder symptomatology and severity of depression in depressed outpatients before and after antidepressant treatment and assessed the effect of treatment on eating disorder symptomatology. One hundred thirty-nine outpatients (82 women and 57 men) with major depressive disorder (MDD) filled out the eating disorder inventory (EDI) before and after 8 weeks of treatment with fluoxetine 20 mg/day. Diagnoses of MDD and possible comorbid eating disorders were made with the Structured Clinical Interview for DSM-III-R-Patient Edition. Several EDI subscales correlated significantly with severity of depression both at baseline and endpoint. Additionally, all EDI subscales showed a statistically significant decrease following fluoxetine treatment, and changes in depression severity following treatment were significantly related to changes in EDI bulimia, ineffectiveness, perfectionism, and interpersonal distress subscale scores. These results suggest that several symptoms characteristic of eating disordered patients are linked to the severity of depressive symptoms. Decreases in eating disorder symptomatology following antidepressant treatment may be related to changes in depressive symptoms.
Acta Psychiatr Scand 1997 Feb;95(2):140-144
Eating disorder in women admitted to hospital following deliberate self-poisoning.

Kent A, Goddard KL, van den Berk PA, Raphael FJ, McCluskey SE, Lacey JH

Department of Mental Health Sciences, St George’s Hospital Medical School, London, UK.

Measures of abnormal eating behaviour in 48 women referred for psychiatric assessment following an act of deliberate self-poisoning (subjects) were compared with those in 50 women attending an accident and emergency department following minor accidental injury (controls). Disordered eating behaviour was significantly more prevalent in the subject group, even when the effect of depression was removed. Four subjects fulfilled the diagnostic criteria for bulimia nervosa, but none of the subjects met the diagnostic criteria for anorexia nervosa. The prevalence of obesity was the same in both subject and control groups. The degree of abnormal eating was very strongly correlated with a measure of inwardly directed irritability in both subjects and controls, and was strongly associated with measures of impulsiveness, outwardly directed irritability and anxiety in subjects.
Int J Eat Disord 1996 May;19(4):399-404

Discriminant function analysis of depressive symptoms in binge eating disorder, bulimia nervosa, and major depression.

Crow SJ, Zander KM, Crosby RD, Mitchell JE

Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.

OBJECTIVES: To examine the frequency and distribution of depressive symptoms among subjects with binge eating disorder (BED), bulimia nervosa (BN), and major depression. METHODS: This study examined depressive symptoms from the Hamilton Depression Scale in 122 BED, 142 BN, and 200 major depression subjects using discriminant function analysis. RESULTS: All three groups differed significantly on the Hamilton Depression Scale totals with major depressive disorder (MDD) subjects having the highest and BED subjects the lowest totals. Eighteen items differentiated MDD from the eating disorder groups. Three items-gastrointestinal (GI) somatic symptoms, paranoid symptoms, and obsessional symptoms-distinguished BED and BN. In each case these symptoms were more common in BN subjects. DISCUSSION: This study attempted to differentiate BN from BED on a basis other than eating behavior. The results provide limited support for the hypothesis that BN and BED can be distinguished on the basis of depressive symptoms.
J Clin Psychopharmacol 1996 Feb;16(1):9-18
Fluvoxamine in prevention of relapse in bulimia nervosa: effects on eating-specific psychopathology.

Fichter MM, Kruger R, Rief W, Holland R, Dohne J

Klinik Roseneck, Hospital for Behavioural Medicine, Prien, Germany.

In a double-blind, placebo-controlled study of 72 patients with bulimia nervosa treated successfully with inpatient psychotherapy, the efficacy of fluvoxamine in maintaining improvement was tested. Fluvoxamine and placebo, respectively, were given over a period of about 15 weeks (2-3 weeks inpatient titration phase, 12 weeks outpatient relapse-prevention [maintenance] phase). The variables assessed concerned bulimic behavior and other aspects of eating disorders, global status, depression, anxieties, obsessive-compulsive behavior, and other aspects of psychopathology. Because the dropout rate was relatively high (N = 27 [33%]) and because it was considerably higher in the fluvoxamine group (19 out of 37 subjects), analyses were performed on the intent-to-treat sample (ideally including all 72 subjects). Results of the completer sample analyses (including only those subjects who finished the study) are briefly presented for comparison. In both the intent-to-treat and the completer analyses, the following scales showed fluvoxamine to have a significant effect in reducing the return of bulimic behavior: (1) self-ratings: Eating Disorder Inventory (EDI)-bulimia, urges to binge in previous week and the number of actual binges in the previous week; (2) expert ratings: Psychiatric Status Rating Scales for Bulimia nervosa, Structured Interview for Anorexia and Bulimia nervosa (SIAB)-“total score,” SIAB-subscale “fasting,” and SIAB-subscale “vomiting.” Two further variables (EDI-total score and SIAB-subscale “bulimia”) showed the superior relapse prevention effects of fluvoxamine compared with placebo for the completer sample, while they did not reach significance for group-by-time interactions in the intent-to-treat sample. During a final, short (4-week) off-medication phase, no effect of the discontinuation of medication was observed.
J Psychiatry Neurosci 1996 Jan;21(1):9-12
Bulimia and anorexia nervosa in winter depression: lifetime rates in a clinical sample.

Gruber NP, Dilsaver SC

Department of Psychiatry and Behavioral Sciences, University of Texas-Houston Health Science Center, USA.

Symptoms of an eating disorder (hyperphagia, carbohydrate craving, and weight gain) are characteristic of wintertime depression. Recent findings suggest that the severity of bulimia nervosa peaks during fall and winter months, and that persons with this disorder respond to treatment with bright artificial light. However, the rates of eating disorders among patients presenting for the treatment of winter depression are unknown. This study was undertaken to determine these rates among 47 patients meeting the DSM-III-R criteria for major depression with a seasonal pattern. All were evaluated using standard clinical interviews and the Structured Clinical Interview for DSM-III-R. Twelve (25.5%) patients met the DSM-III-R criteria for an eating disorder. Eleven patients had onset of mood disorder during childhood or adolescence. The eating disorder followed the onset of the mood disorder. Clinicians should inquire about current and past symptoms of eating disorders when evaluating patients with winter depression.
Br J Clin Psychol 1995 Feb;34( Pt 1):37-52
Depression and eating disorders following abuse in childhood in two generations of women.

Andrews B, Valentine ER, Valentine JD

Department of Psychology, Royal Holloway and Bedford New College, University of London, Surrey, UK.

The relation of sexual and physical abuse in childhood to subsequent depression and eating disorders was explored in a community sample of mothers and their teenage and young adult daughters respectively. It was hypothesized that age would be a moderating influence on diagnosis following abuse in that depression would be more common in the mothers and eating disorders more common in the daughters. Depression was more common in mothers than daughters, using Bedford College caseness criteria (Finlay-Jones, et al., 1980), but the difference decreased when Research Diagnostic Criteria (RDC: Spitzer, Endicott & Robbins, 1978) were used. Bulimia was more common in the daughters using DSM-III criteria. Both physical and sexual abuse were associated with chronic and recurrent depression but not with single short episodes of depression in the mothers. However, the relationship of depression to abuse showed only a weak trend in the daughter sample. Both physical and sexual abuse were related to bulimia in the daughters, but not in the mothers, as only one mother had such a disorder.
Compr Psychiatry 1995 Jan;36(1):53-60
Alexithymia, depression, and treatment outcome in bulimia nervosa.

de Groot JM, Rodin G, Olmsted MP

Toronto Hospital-Western Division, University of Toronto, Department of Psychiatry, Ontario, Canada.

Disturbances in emotional awareness, sometimes referred to as alexithymia, have been hypothesized to contribute to the development of binge/purge symptoms among women with bulimia nervosa (BN) and/or are considered secondary to the state of depression and/or disordered eating. The present study was designed to assess alexithymia among women with BN, to evaluate the interrelationship between alexithymia, depression, and somatic symptoms, and to determine whether an intensive group psychotherapy program contributes to a reduction in the degree of alexithymia. Thirty-one of 50 BN women (62%) who completed The Toronto Hospital Day Hospital Program for Eating Disorders (DHP) were administered pretreatment and posttreatment questionnaires. Findings from this clinical sample were compared with those from 20 non-eating-disordered women who completed the same battery. Using the Toronto Alexithymia Scale (TAS), significantly more BN women were alexithymic at pretreatment (61.3%) and post-treatment (32.3%) than in the comparison group (5.0%), even when depression was controlled for. At discharge, abstinence from binge/purge episodes was associated with a significant reduction in alexithymia, although there was a significant correlation between TAS scores, depression, and vomit frequency. Alexithymia among BN women is not simply a concomitant of disordered eating. Its partial reversibility following an intensive psychotherapy program may be a direct effect of the treatment and/or may be secondary to a reduction in depressive and/or binge/purge symptoms.
Psychol Med 1994 Nov;24(4):859-867
Psychiatric comorbidity in patients with eating disorders.

Braun DL, Sunday SR, Halmi KA

Department of Psychiatry, New York Hospital, Cornell University Medical Center, White Plains 10605.

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.
Br J Clin Psychol 1994 Sep;33( Pt 3):259-276
Bulimia nervosa and depression: a theoretical and clinical appraisal in light of the binge-purge cycle.

Beebe DW

Psychology Department, Loyola University of Chicago, IL 60626.

This review seeks to familiarize clinicians with several major theoretical perspectives on the relationship between bulimia nervosa and depression. It begins by clarifying the affective changes which occur within the binge-purge cycle. Six hypotheses relating negative affect to bulimia nervosa are then reviewed in light of these changes, with their strengths, weaknesses and clinical implications clearly outlined. The author concludes that, although none of these perspectives has received universal support, recent hypotheses which focus upon specific portions of the binge-purge cycle are best suited to integration. These include the restraint, escape and hopelessness hypotheses. An integrative model is proposed to account for data across the binge-purge cycle, to assist in understanding the maintenance of bulimia nervosa, and to guide clinical intervention.
Psychol Rep 1993 Jun;72(3 Pt 1):1003-1010
Factors related to depression and eating disorders: self-esteem, body image, and attractiveness.

Grubb HJ, Sellers MI, Waligroski K

East Tennessee State University.

To test hypotheses that women suffering from some form of eating disorder would experience lower self-esteem and higher depression and that women with lower self-esteem and greater depression would rate their attractiveness lower and see themselves as heavier than less depressed individuals, 42 college undergraduate women were individually administered the Eating Disorders Inventory, Beck Depression Inventory, Coopersmith Self-esteem Inventory, and a Body Image/Attractiveness Perception Scale. A Pearson correlation indicated a substantial relation between scores on depression and scores on eating disorders, but nonsignificant values between self-esteem scores and scores on either eating disorders or on depression. Depression scores correlated significantly with rated body size, but not attractiveness, while self-esteem scores were significantly correlated with rated attractiveness, not body size. These results contradict literature on the relation between self-esteem and depression. Directions for additional research are discussed.
Compr Psychiatry 1993 Jan;34(1):70-74
Effects of depression and borderline personality traits on psychological state and eating disorder symptomatology.

Sunday SR, Levey CM, Halmi KA

Department of Psychiatry, Cornell University Medical College, Westchester Division, White Plains, NY.

The incidence of current or lifetime affective disorder and borderline personality characteristics were measured in bulimia nervosa patients. The relationship of these variables to the severity of eating disorder symptomatology (Eating Disorder Inventory [EDI]) and general psychiatric symptoms (Hopkins Symptom Checklist [SCL]) was examined. Categorical diagnostic assessments of affective disorder and borderline personality disorder (BPD) were made by Structured Clinical Interviews for DSM-III-R (SCID-I and -II). Affective disorder diagnosis (both current and lifetime) strongly influenced EDI and SCL profiles, while borderline personality characteristics had little influence. An understanding of the broad psychological symptomatology in bulimics requires the consideration of comorbid psychiatric illnesses, especially affective disorders.
J Am Acad Child Adolesc Psychiatry 1992 Sep;31(5):810-818
Psychiatric comorbidity in treatment-seeking anorexics and bulimics.

Herzog DB, Keller MB, Sacks NR, Yeh CJ, Lavori PW

Harvard Medical School, Massachusetts General Hospital, Boston 02114.

Current and lifetime psychiatric diagnoses were compared in 229 female patients seeking treatment for current episodes of anorexia nervosa (N = 41), bulimia nervosa (N = 98) and mixed anorexia nervosa and Schizophrenia-Lifetime Version, which was modified to include a section for DSM-III-R eating disorders, the Longitudinal Interval Follow-up Evaluation, and the Structured Interview for DSM-III Personality Disorders. Seventy-three percent of the anorexia nervosa subjects, 60% of the bulimia nervosa subjects, and 82% of the mixed anorexia nervosa and bulimia nervosa subjects had a current comorbid Axis I diagnosis. Major depression was the most commonly diagnosed comorbid disorder. Low rates of alcohol and substances abuse disorder were diagnosed, and personality disorder occurred in a minority of the sample. The subjects with mixed disorder manifested a higher lifetime prevalence of kleptomania than either the anorexics or the bulimics. High levels of comorbidity were noted across the eating disorder samples. Mixed disorder subjects manifested the most comorbid psychopathology and especially warrant further study.
Psychol Med 1992 Aug;22(3):617-622
Bulimia nervosa and major depression: a study of common genetic and environmental factors.

Walters EE, Neale MC, Eaves LJ, Heath AC, Kessler RC, Kendler KS

Department of Psychiatry, Medical College of Virginia/Virginia Commonwealth University, Richmond.

A genetic analysis of the co-occurrence of bulimia and major depression (MD) was performed on 1033 female twin pairs obtained from a population based register. Personal interviews were conducted and clinical diagnoses made according to DSM-III-R criteria. Additive genes, but not family environment, are found to play an important aetiological role in both bulimia and MD. The genetic liabilities of the two disorders are correlated 0.456. While unique environmental factors account for around half of the variation in liability to both bulimia and MD, these risk factors appear to be unrelated, i.e., each disorder has its own set of unique environmental risk factors. Thus, the genetic liability of bulimia and MD is neither highly specific nor entirely non-specific. There is some genetic correlation between the two disorders as well as some genetic and environmental risk factors unique to each disorder. Limitations and directions for future research are discussed.
Addict Behav 1991;16(5):295-301
Depression, dietary restraint, and binge eating in female runners.

Prussin RA, Harvey PD

St. Lukes Hospital/Columbia University, New York, NY.

Female runners (n = 174) were assessed on their levels of dietary restraint, depression, and binge eating, as well as a number of exercise variables. Thirty-eight (19%) of the women in the sample were found to meet diagnostic criteria for DSM-IIIR Bulimia Nervosa. The level of exercise was unassociated with any of the affective and eating variables as was the risk for meeting diagnostic criteria for bulimia nervosa. Severity scores for depression in bulimic runners were notably lower than in earlier nonexercising samples. The relationships between the variables were similar to those found in previous research, with dietary restraint, particularly in interaction with depression, predicting the severity of binge eating in both bulimic and nonbulimic runners. These data suggest that bulimia, rather than anorexia, may be the most prevalent eating problem in female runners.
Psychosomatics 1997 Mar;38(2):126-131
Temperament in juvenile eating disorders.

Shaw RJ, Steiner H

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA.

Previous studies have suggested an association between temperament and eating disorder pathology. The purpose of this study was to differentiate on the basis of temperament among patients with anorexia, bulimia, and major depression. In this study, 101 adolescent girls completed the Revised Dimensions of Temperament Survey (Self), a self-report measure that identifies nine dimensions of temperament. Significant differences were found between the diagnostic groups while controlling for disturbances in mood and defensiveness. Specific subscales differentiated the subjects with anorexia from those with bulimia. These data support the concept of using temperament to differentiate patients with related psychiatric syndromes.
Br J Psychiatry 1991 Oct;159:562-565
The prevalence of eating disorders in recently admitted psychiatric in-patients.

Hay PJ, Hall A

Department of Psychological Medicine, Wellington School of Medicine, New Zealand.

Of 107 recently admitted psychiatric patients screened for eating-disorder symptoms by questionnaire, 17% met DSM-III-R criteria for eating disorders. Eight patients (one male) had bulimia nervosa. Ten patients had eating disorder not otherwise specified: seven (three male) bulimic type, and three (one male) anorexia nervosa type. The most common concurrent diagnoses were mood and personality disorders. As eating-disorder symptoms are relevant to the diagnosis and management of other psychiatric disorders they should be assessed routinely in all psychiatric patients.
J Nerv Ment Dis 1992 Nov;180(11):719-722
Bipolar II affective disorder in eating disorder inpatients.

Simpson SG, al-Mufti R, Andersen AE, DePaulo JR Jr

Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.

We examined the association between affective disorders and eating disorders in 22 eating disorder inpatients who were interviewed using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version. The first series of 11 were interviewed as part of an interrater reliability study; the second series, done as follow-up to the first, consisted of 11 consecutive admissions. Overall, there were 15 bulimics and seven anorexics. Nineteen patients had a major affective disorder, and 13 (59%) had bipolar II affective disorder. Bipolar II affective disorder appears to be a common finding in hospitalized patients with severe persistent eating disorders.
Acta Paedopsychiatr 1992;55(3):185-186
Defense style and adaptation in adolescents with depressions and eating disorders.

Smith C, Thienemann M, Steiner H

Division of Child Psychiatry and Child Development, Stanford University School of Medicine, Palo Alto, CA 94304.

Maturity of defense style has been associated with the level of adaptive functioning, but few studies have assessed defense style using self-report questionnaires which can provide ratings with great reliability and objectivity. We compared self-perception of defense style (using Bond’s Defense Style Questionnaire) with ratings of adaptation assessed retrospectively by two independent raters (using the DSM III-R Global Assessment of Functioning scale) in a population of 100 adolescent girls diagnosed as having either an eating disorder or depression. There was significant correlation between maturity of defense style and level of adaptation, with greater maturity of defense style being associated with higher levels of adaptive functioning. This effect was independent of diagnosis within this population.
Psychiatr Serv 1996 Apr;47(4):426-429
Comorbidity of DSM-III-R axis I and II disorders among female inpatients with eating disorders.

Grilo CM, Levy KN, Becker DF, Edell WS, McGlashan TH

Yale Psychiatric Institute, New Haven, Connecticut, USA.

Structured diagnostic interviews were used to determine DSM-III-R axis I and II diagnoses among 136 female psychiatric inpatients. To distinguish comorbidity of eating disorders with axis I and II disorders from simple diagnostic overlap, the frequency and distribution of diagnoses among the 31 patients with an eating disorder and the 105 without an eating disorder were compared. Social phobia, substance use disorders, borderline personality disorder, and avoidant personality disorder were diagnosed in a significantly larger proportion of the group with eating disorders. Future studies should focus on interpreting the meaning of the co-occurrence of these disorders in patients with eating disorders.
J Psychosom Res 1996 Jul;41(1):65-70
Pain sensitivity, alexithymia, and depression in patients with eating disorders: are they related?

de Zwaan M, Biener D, Bach M, Wiesnagrotzki S, Stacher G

Department of General Psychiatry, University Hospital of Psychiatry, University of Vienna, Austria. Martina.deZwaan@akh-wien.ac.at

A decreased sensitivity to painful stimuli and high scores for alexithymia and depression have been observed in patients with eating disorders. We investigated the relationship between these factors in 22 patients with anorexia nervosa, 18 patients with bulimia nervosa, and 32 healthy subjects. Alexithymia was assessed using the 20-item Toronto Alexithymia Scale and depression using the Beck Depression Inventory. Patients with bulimia exhibited significantly higher thresholds to mechanically induced pain than healthy subjects. Thresholds to thermally induced pain in patients with anorexia or bulimia were similar and significantly higher than in the healthy subjects. Alexithymia and depression scores were significantly higher in anorexic and bulimic patients than in the healthy subjects. Analyses of covariance revealed that the degree of alexithymia did not influence thresholds to thermally and mechanically induced pain, whereas the severity of depression affected to some extent the threshold to thermally induced pain.
Am J Psychiatry 1987 Mar;144(3):362-364
Short-term course of depressive symptoms in patients with eating disorders.

Wamboldt FS, Kaslow NJ, Swift WJ, Ritholz M

After inpatient treatment focused on aberrant eating behavior, six depressed normal-weight bulimic patients showed little improvement in depressive or eating symptoms. Four depressed anorexic patients with bulimic behavior improved in both areas, and five restricting anorexic patients had an intermediate response.
Biol Psychiatry 1988 Apr 1;23(7):719-725
Depression as a correlate of starvation in patients with eating disorders.

Laessle RG, Schweiger U, Pirke KM

Max-Planck-Institute of Psychiatry, Division of Psychoneuroendocrinology, Munich, F.R.G.

The relationship between depressive symptoms and starvation, reflected by body weight and biochemical parameters, was investigated in 64 patients fulfilling DSM-III criteria for anorexia nervosa or bulimia. Multiple regression analysis revealed significant effects of body weight and beta-hydroxybutyric acid, respectively, on such specific depressive symptoms as depressed or dysphoric mood when controlling for severity of psychopathology of the eating disorder.
Int J Eat Disord 1996 May;19(4):399-404
Discriminant function analysis of depressive symptoms in binge eating disorder, bulimia nervosa, and major depression.

Crow SJ, Zander KM, Crosby RD, Mitchell JE

Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.

OBJECTIVES: To examine the frequency and distribution of depressive symptoms among subjects with binge eating disorder (BED), bulimia nervosa (BN), and major depression. METHODS: This study examined depressive symptoms from the Hamilton Depression Scale in 122 BED, 142 BN, and 200 major depression subjects using discriminant function analysis. RESULTS: All three groups differed significantly on the Hamilton Depression Scale totals with major depressive disorder (MDD) subjects having the highest and BED subjects the lowest totals. Eighteen items differentiated MDD from the eating disorder groups. Three items-gastrointestinal (GI) somatic symptoms, paranoid symptoms, and obsessional symptoms-distinguished BED and BN. In each case these symptoms were more common in BN subjects. DISCUSSION: This study attempted to differentiate BN from BED on a basis other than eating behavior. The results provide limited support for the hypothesis that BN and BED can be distinguished on the basis of depressive symptoms.
Addict Behav 1987;12(4):357-361
Affective lability versus depression as determinants of bing eating.

Greenberg BR, Harvey PD

Department of Psychology, State University of New York at Binghamton 13901.

The relationships between dietary restraint, various affective disturbances, and binge eating were assessed in a sample of 73 college women unselected for bulimia. It was found, replicating earlier results, that the interaction of dietary restraint and depression was a significant predictor of binge eating. However, the interaction of dietary restraint and biphasic mood shifts was an even better predictor of the severity of binge eating and in fact accounted for all of the variance in the relationship of dietary restraint, depression, and binge eating. The results were discussed in terms of the possible role of affective liability in the development of binge eating.
Behav Res Ther 1990;28(3):205-215
The thin ideal, depression and eating disorders in women.

McCarthy M

Department of Psychology, University of Pennsylvania 19140.

It is proposed that a cultural ideal of thinness for women causes depression at a higher rate among women than among men. This model accounts for five currently unintegrated trends in the epidemiology of depression. It explains why: (1) twice as many women as men are likely to be depressed; (2) this sex difference emerges at puberty; (3) this sex difference is only found in western countries; (4) there is more depression today; (5) the average age of onset for depression is younger now than in the past. Four parallel trends in eating disorders can also be accounted for by the same factor.
J Clin Psychiatry 1988 Jul;49(7):267-270
Diuretic use as a marker for eating problems and affective disorders among women.

Mitchell JE, Pomeroy C, Seppala M, Huber M

Department of Psychiatry, University of Minnesota Medical School, Minneapolis 55455.

Fourteen female symptomatic volunteers between the ages of 18 and 40 who used diuretics on a regular basis for reasons that were not medically necessary were evaluated. Seven (50%) were diagnosed as having a current or past syndromal or subsyndromal eating disorder, and 9 (64%) were diagnosed as having a current or past affective disorder. The results of this pilot study suggest that chronic diuretic use in young women should signal to the clinician the possibility of an unrecognized eating problem and/or an affective disorder.
Int J Eat Disord 1996 Jan;19(1):45-52
Comorbidity of binge eating disorder and the partial binge eating syndrome with bipolar disorder.

Kruger S, Shugar G, Cooke RG

Westfalisches Zentrum fur Psychiatrie, University of Bochum, Germany.

OBJECTIVE: The authors examined the prevalence of binge eating disorder (BED), partial binge eating syndrome, and night binge eating syndrome in subjects with bipolar disorder (BD). METHOD: Sixty-one subjects in whom BD was established using DSM-III-R criteria received a semistructured clinical interview including a detailed description of binge eating behavior and of night binge eating. Frequencies were compared to prevalence estimates in community samples. RESULTS: Eight subjects (13%) met DSM-IV criteria for the diagnosis of BED. An additional 15 subjects (25%) exhibited a partial binge eating syndrome. These two otherwise identical groups of binge eaters were separated only by the DSM-IV frequency criterion. The rates found were higher than rates found in community samples. Ten subjects reported night binge eating in addition to their usual binge eating behavior. This occurred consistently between 2:00 and 4:00 a.m. CONCLUSIONS: Possible underlying mechanisms for the high frequency of binge eating among bipolar subjects are discussed including a model of serotonin-mediated self-modulation of mood. The finding of two groups of binge eaters separated only by the frequency criterion raises questions as to whether the frequency criterion as presently defined in DSM-IV is valid or should be modified.
Compr Psychiatry 1992 Mar;33(2):123-127
Psychiatric diagnoses in recovered and unrecovered anorectics 22 years after onset of illness: a pilot study.

Hsu LK, Crisp AH, Callender JS

University of Pittsburgh, School of Medicine, PA 15260.

Sixteen female anorectics, nine recovered and seven unrecovered, were interviewed 22 years after onset of illness. Concomitant psychiatric diagnoses were much more common among the unrecovered patients, but three recovered patients have had a major depressive episode occurring after recovery from their eating disorder. The findings point to a linkage between eating and affective disorders and the mechanisms of such a linkage are briefly discussed.

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