Bipolar disorders in severe anorexia nervosa: prevalence and relationships

Background The comorbidity between anorexia nervosa (AN) and bipolar disorders (BD) among subjects with AN is a matter of some debate, regarding its existence, its impact on the clinical manifestations of AN and the nature of the relationship between these disorders. Our aims were: (1) to evaluate the prevalence of BD among patients with severe AN; and (2) to determine whether people with a history of BD present particular clinical AN characteristics in comparison to people with a comorbid major depressive disorder or with any mood disorder comorbidity. Methods 177 AN subjects were surveyed to assess their nutritional state, dietary symptomatology, psychiatric comorbidities, treatments received and associated response. The diagnosis of BD relied on DSM-5 criteria, using the short-CIDI. The discriminant features of patients with AN and suspected BD were identified, comparing them to the characteristics of AN patients without any mood disorder and AN patients suffering from major depressive disorder. Results Among AN subjects, 11.3% were suspected to have BD. In comparison with the two other groups, these patients had more severe clinical profiles in terms of duration of AN (6.7 years, p = 0.020), nutritional state ( p max = 0.031), levels of anxious, depressive and dietary symptoms, lifetime comorbidity with anxious disorders, quality-of-life ( p = 0.001) and treatment (antidepressant and mood stabilizers, ( p = 0.029)). Limitations The participants were hospitalized in a tertiary center with severe AN. The diagnosis of BD requires evaluation using a more precise diagnostic instrument Conclusion These results underline the importance of systematic early detection of BD and mood disorders among individuals with severe AN, to provide optimum treatment. Level of evidence III: Evidence obtained from a cross-sectional study