Background: The present study determined the psychiatric comorbidity of Axes I and II in a sample of subjects with eating disorders (EDs). The objective was to investigate associations between comorbidity and current and past treatment. Methods: In a sample of 248 women (77 anorexia nervosa, 137 bulimia nervosa, 34 eating disorders not otherwise specified), psychiatric comorbidity of Axes I and II was determined with the Structured Clinical Interview of DSM-IV. Current and past treatment since ED onset were also assessed. Results: High levels of psychiatric comorbidity were found in the total sample (71% Axis I and 68% Axis II). Only 17% of cases had no psychiatric comorbidity. Anxiety (52%) and affective disorders (50%) were the most common Axis I diagnoses. Personality disorders of Clusters C (52%) and B (23%) were most common for Axis II. Twenty-one percent of participants who were not in treatment at the time had a history of inpatient treatment, and an additional 59% had a history of outpatient treatment. Thirty-eight percent of participants currently in outpatient treatment had a history of inpatient treatment. Participants with multiple comorbidity (Axes I and II) had the highest proportion of cases who had been treated by health professionals. Higher levels of comorbidity were associated with experiences in more intense treatment settings (ranging from no treatment to inpatient treatment). Conclusions: ED subjects with greater comorbidity require more treatment encounters and more intense treatment settings. The association between comorbidity and treatment experiences may represent a bias in the assessment of comorbidity when samples with heterogeneous treatment history are recruited.

Keywords:
Eating disorders, Psychiatric comorbidity, Sample homogeneity, Anorexia nervosa, Bulimia nervosa
1.
Herzog DB, Nussbaum KM, Marmor AK: Comorbidity and outcome in eating disorders. Psychiatr Clin North Am 1996;19:843–859.
2.
Skodol AE, Gunderson JG, McGlashan TH, Dyck IR, Stout RL, Bender DS, Grilo CM, Shea MT, Zanarini MC, Morey LC, Sanislow CA, Oldham JM: Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. Am J Psychiatry 2002;159:276–283.
3.
Lowe B, Zipfel S, Buchholz C, Dupont Y, Reas DL, Herzog W: Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychol Med 2001;31:881–890.
4.
Zerbe KJ, Marsh SR, Coyne L: Comorbidity in an inpatient eating disordered population: Clinical characteristics and treatment implications. Psychiatr Hosp 1993;24:3–8.
5.
Braun DL, Sunday SR, Halmi KA: Psychiatric comorbidity in patients with eating disorders. Psychol Med 1994;24:859–867.
6.
Grilo CM, Levy KN, Becker DF, Edell WS, McGlashan TH: Comorbidity of DSM-III-R axis I and II disorders among female inpatients with eating disorders. Psychiatr Serv 1996;47:426–429.
7.
Rastam M, Gillberg IC, Gillberg C: Anorexia nervosa 6 years after onset. 2. Comorbid psychiatric problems. Compr Psychiatry 1995;36:70–76.
8.
Gillberg IC, Rastam M, Gillberg C: Anorexia nervosa 6 years after onset. 1. Personality disorders. Compr Psychiatry 1995;36:61–69.
9.
Godt K: Personality disorders and eating disorders: The prevalence of personality diosrders in 176 female outpatients with eating disorders. Eur Eat Disord Rev 2002;10:102–109.
10.
Andersen AE, Bowers WA, Watson T: A slimming program for eating disorders not otherwise specified. Reconceptualizing a confusing, residual diagnostic category. Psychiatr Clin North Am 2001;24:271–280.
11.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
12.
Fassino S, Abbate Daga G, Piero A, Rovera GG: Dropout from brief psychotherapy in anorexia nervosa. Psychother Psychosom 2002;71:200–206.
13.
Westen D, Harnden-Fischer J: Personality profiles in eating disorders: Rethinking the distinction between axis I and axis II. Am J Psychiatry 2001;158:547–562.
14.
Rosenvinge JH, Martinussen M, Ostensen E: The comorbidity of eating disorders and personality disorders: A meta-analytic review of studies published between 1983 and 1998. Eat Weight Disord 2000;5:52–61.
15.
Wittchen HU, Zaudig, M., Fydrich, T: SCID Strukturiertes Klinisches Interview für DSM-IV, Achse I und II. Göttingen, Hogrefe, 1997.
16.
COST Action B6: Psychotherapeutic Treatment of Eating Disorders. Final Evaluation Report. Luxembourg, Office for Publications of the European Communities, in press.
17.
Keller MB, Lavori PW, Friedman B, Nielsen E, Endicott J, McDonald-Scott P, Andreasen NC: The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Arch Gen Psychiatry 1987;44:540–548.
18.
Halmi KA, Eckert E, Marchi P, Sampugnaro V, Apple R, Cohen J: Comorbidity of psychiatric diagnoses in anorexia nervosa. Arch Gen Psychiatry 1991;48:712–718.
19.
Ricca V, Mannucci E, Mezzani B, Di Bernardo M, Zucchi T, Paionni A, Placidi GP, Rotella CM, Faravelli C: Psychopathological and clinical features of outpatients with an eating disorder not otherwise specified. Eat Weight Disord 2001;6:157–165.
20.
Noordenbos G: Eating disorders in primary care: Early identification and intervention by general practitioners; in Vandereycken W, Noordenbos G (eds): The Prevention of Eating Disorders. New York, New York University Press, 1998, pp 214–229.
21.
Keel PK, Dorer DJ, Eddy KT, Delinsky SS, Franko DL, Blais MA, Keller MB, Herzog DB: Predictors of treatment utilization among women with anorexia and bulimia nervosa. Am J Psychiatry 2002;159:140–142.
22.
Tantillo M: A relational approach to group therapy for women with bulimia nervosa: Moving from understanding to action. Int J Group Psychother 1998;48:477–498.
23.
Rathner G, Bonsch C, Maurer G, Walter MH, Sollner W: The impact of a ‘guided self-help group’ on bulimic women: A prospective 15-month study of attenders and non-attenders. J Psychosom Res 1993;37:389–396.
24.
Westen D, Arkowitz-Westen L: Limitations of axis II in diagnosing personality pathology in clinical practice. Am J Psychiatry 1998;155:1767–1771.
25.
Perry JC: Problems and considerations in the valid assessment of personality disorders. Am J Psychiatry 1992;149:1645–1653.
26.
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;31:284–289.
27.
Laessle RG, Wittchen HU, Fichter M, Pirke KM: The significance of subgroups of bulimia nervosa and anorexia nervosa: Lifetime frequency of psychiatric disorders. Int J Eat Disord 1989;8:569–574.
28.
White JH, Litovitz G: A comparison of inpatient and outpatient women with eating disorders. Arch Psychiatr Nurs 1998;12:181–194.
© 2003 S. Karger AG, Basel
2003
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.