Psychiatric Comorbidity in Subgroups of Eating-Disordered Inpatients

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Abstract
A variety of comorbid psychiatric conditions complicate eating disorders. Typically, emphasis has been on “dual diagnoses,” yet the impression of many clinicians is that such a focus is too narrow and that patients with eating disorders (EDs) often have multiple psychiatric diagnoses. To examine this possibility and to determine differences in the codiagnoses found within different ED subtypes, the Schedule for Affective Disorders and Schizophrenia, Lifetime version (SADS-L) was administered to 20 consecutive inpatients admitted to an eating disorder unit. The mean number of psychiatric codiagnoses was 3.15. The subgroup of food-restricting nonbulimic anorectics had significantly fewer codiagnoses than the group of anorectics with bulimic behavior (2.3 vs. 3.8); the only patients with no comorbid diagnoses were in the former subgroup. The group of normal weight bulimics had an intermediate number of codiagnoses (3.2). The proportion of patients meeting criteria for any affective disorder was high (85%). AU patients who had bipolar disorders also had bulimic symptoms. These results suggest that successful treatment of patients with ED wiU be enhanced by 1) thorough assessment for complicating comorbid conditions from Axes I and I I; 2) coordinated treatment of the ED in conjunction with the comorbid disorders; and 3) pragmatic recognition that EDs serious enough for inpatient treatment usually occur with a variety of other psychiatric conditions. Prognosis may ultimately depend more on comorbid complications than on the ED itself.

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