Impulsivity, anxiety, and alcohol misuse in bipolar disorder comorbid with eating disorders

Andrew Jen, Erika Fh Saunders, Rollyn M Ornstein, Masoud Kamali, Melvin G McInnis, Andrew Jen, Erika Fh Saunders, Rollyn M Ornstein, Masoud Kamali, Melvin G McInnis

Abstract

Background: Eating disorders (ED) are noted to occur with bipolar disorder (BD), but relationships between additional comorbidities, clinical correlates, and personality factors common to both remain largely unknown.

Methods: Using data from the Prechter Longitudinal Study of Bipolar Disorder, we measured the prevalence and demographic factors of comorbid ED with BD, presence of additional comorbidity of anxiety and substance use disorders, psychosis, suicide attempts, mixed symptoms, childhood abuse, impact of NEO-Personality Inventory (NEO-PI) personality factors, and mood outcome in 354 patients with BD. We analyzed the prevalence of ED using both broad and narrow criteria.

Results and discussion: ED was more common in the Prechter BD sample than the general population, with the majority of those with ED being female. Anxiety disorders, alcohol abuse/dependence, and NEO-PI N5 impulsiveness were independently associated with ED in a multivariable linear regression analysis. BD age at onset was earlier in the ED group than that in the non-ED group and was earlier than the average onset of ED. Anxiety occurred before ED and alcohol use disorders after both BD and ED. Childhood trauma was associated with ED. Impulsivity and anxiety associated with BD may fuel ED and put patients at risk for other impulsivity-related disorders such as alcohol use disorders. ED was associated with more severe and variable moods and more frequent depression. Patients with BD should be regularly screened for ED, anxiety disorders, and alcohol use disorders, and comorbidity should be promptly addressed.

Keywords: Alcohol use disorders; Anxiety disorders; Bipolar disorder; Eating disorders; Impulsivity.

Figures

Figure 1
Figure 1
Age at onset of BD, EDs, anxiety disorders, and alcohol use disorder. Asterisk indicates that differences between those with and without ED are statistically significant.
Figure 2
Figure 2
Factors that are associated with ED in the PBD sample. By domain and unified analysis, controlled for age and sex. Asterisk indicates that variables were independently associated with an increased risk for ED in the unified analysis.

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