A longitudinal analysis of comorbid psychiatric illness in eating disorder patients

Abstract

Previous research has illustrated that anorexia nervosa (AN) and bulimia nervosa (BN) are associated with considerable amounts of psychiatric comorbidity. The purpose of this study was to examine the role of comorbid psychopathology in the manifestation and outcome of eating disorders. In addition, the development of psychiatric illness subsequent to eating disorder recovery was investigated. The participants for this study were comprised of 246 women (51 anorexics, 110 bulimics, and 85 purging anorexics) who have been involved in a prospective, naturalistic, longitudinal study over a median of 8.9 years. Over the period of observation, 125 participants (47.3%) reached full recovery and 220 (89%) achieved partial recovery. There were 11 deaths in the sample. During the course of the study, eating disorder severity was positively correlated to major depressive disorder (MDD) and drug abuse, but not alcohol abuse or suicidality. Duration of intake episode was positively correlated with an increased time to achieving full eating disorder recovery. Nearly two-thirds of the recovered group developed a major depressive episode after achieving full recovery from their eating disorder. For the majority of participants this episode constituted a relapse into MDD symptomatology after a period of remission from affective disturbance. The median time to the development of a major depressive episode was 96 weeks after full recovery. Duration of intake episode, history of MDD and older age at intake were found to be predictive of developing a major depressive episode after full recovery from an eating disorder. A moderate number of participants developed alcohol abuse, drug abuse and suicidality subsequent to eating disorder recovery. No differences were found between diagnostic subgroups in levels of psychosocial functioning after full recovery.;The findings of this study underscore the influential role of comorbid psychopathology in the course of eating disorders. In addition, this study is the first to reveal the vulnerability of developing a major depressive episode following eating disorder recovery.