Young people with bipolar disorder are at high risk for eating disorders

Young people with bipolar disorder are at high risk for eating disorders

New research shows that young adults with bipolar disorder (BD) have a higher risk of developing eating disorders (EDs).

Researchers studied nearly 200 young adults with Behçet’s disease and found that more than 25% had lifelong erectile dysfunction, including anorexia nervosa (AN), bulimia (BN), and sexual dysfunction not specified (NOS).

People with GAD were more likely to be female and to have BD-II subtype. Their presentations were also more complex and included a history of suicide, additional psychiatric conditions, smoking, and a history of sexual abuse, as well as more severe depression and emotional instability.

“We think the take-home message is that in addition to other known comorbid psychiatric illnesses, young adults with Behçet’s disease are also at risk for developing ED. Thus, clinicians should routinely monitor eating, appetite, and body image disorders when working with this population, Lead author Diana Khubaeva, BSc, Hons, Research Analyst, Bipolar Youth Disorder Center, Center for Addiction and Mental Health, Toronto, Ontario, Canada, and senior author, Benjamin Goldstein, MD, PhD, director of the Bipolar Youth Center , Tell Medscape Medical News in a letter.

“Given the more complex clinical picture of young people with Behcet’s disease and concurrent EDs, this combination requires careful attention,” the researchers note.

The study was published online May 11 in Journal of Clinical Psychiatry.

lack of search

“From the current literature, we learned that ED disorders are not uncommon in individuals with Behçet’s disease, and that they are often associated with a more serious clinical profile,” the researchers say. “However, the majority of these studies have been limited to adult samples, and there has been a real dearth of studies examining this co-occurrence in young adults.”

This is “surprising” because ED often appears in adolescence, so the researchers decided to explore the problem in a “relatively large sample of young adults with Behçet’s disease.”

To investigate the problem, researchers studied 197 young adults (ages 13-20) with a diagnosis of BD (BD-I, BD-II, or BD-NOS) who were recruited between 2009 and 2017 (mean [SD] Age, 16.69 [1.50] Years; 67.5% female).

ED diagnoses included both current and life AN, BN, ED-NOS. The researchers used the Kiddie Schizophrenia and Affective Disorders Table for School-Age Children, Current and Lifelong Edition (K-SADS-PL) to determine a diagnosis of BD.

They also collected information about psychiatric disorders, as well as substance use and cigarette smoking disorders. The Life Problems Inventory (LPI) was used to determine borderline-dimensional personality traits.

Information about physical and sexual abuse, suicidal ideation, non-suicidal self-injury (NSSI), and affective regulation was obtained from other measurement tools. The participants’ height and weight were measured to calculate their body mass index.

Neurological and environmental factors

Of the total sample, 24.84% had received an ED diagnosis in their lifetime.

AN 3.6%
BN 8.1%
ED-NOS 16.8%

Furthermore, 28.9% had a lifetime history of overeating. Of these, 17.7% were also diagnosed as having ED.

Participants with BD-II were significantly more likely than those with BD-I to report both current and lifelong BN. There were no significant differences in the BD subtype in AN, ED-NOS, or binge eating.

The higher associations of clinical characteristics, psychiatric morbidity, treatment history, and dimensional traits in those with those without ED are detailed in the table below.

BD-II χ2 = 4.6 not corrected s = .03
Degrees of ‘severe’ lifelong depression R = 4.9 s <.001
NSSI’s lifelong history χ2 = 17.1 s <.001
suicidal ideation χ2 = 9.6 s = .006
suicide attempts χ2 = 10.5 s = .004
A history of sexual abuse χ2 = 7.2 s = .02
History of cigarette smoking χ2 = 13.8 s = .001
illness anxiety disorder χ2 = 10.4 s = .004
Post Traumatic Stress Disorder χ2 = 10.4 s = .004
substance use disorder χ2 = 9.6 s = .006
Family history of anxiety disorders χ2 = 9.8 s = .01
Individual treatment history χ2 = 8.4 s = .01
Self-reported ability scores R = 4.6 s <.001
Dozens of self-reported life problems R = 5.3 s <.001

The ED group scored significantly higher on all LPI scores, including impulsivity, emotional disorganization, identity confusion, and personal problems, compared to those without ED. They were also less likely to report lifelong lithium use (χ2 = 7.9, s = .01).

Multivariate analysis revealed that lifetime EDs were significantly associated with female sex, cigarette smoking history, individual treatment history, family history of anxiety, and overall LPI score and were negatively correlated with BD-I subtype.

Characteristic or (95% CI) P value.
female sex 4.61 (1.63 – 13.01) .004
History of cigarette smoking 2.78 (1.22 – 6.35) .02
Individual treatment history 3.92 (1.17 – 13.14) .03
Family history of anxiety disorders 2.86 (1.15 – 7.08) .02
Total LPI 1.01 (1.00 – 1.02) 009
BD-I . subtype .21 (.04 – .83) .03

“Comorbidity [between EDs and BD] They can be driven by both neurological and environmental factors,” Khubaeva and Goldstein note. EDs and BD are both diseases primarily associated with dysfunctions in reward systems—that is, there are dysfunctions in terms of seeking too much or too little reward. “

They added that individuals affected by these conditions have “ongoing challenges with emotional instability and the ability to manage emotions; eating too much or too little can be a manifestation of emotion coping.”

Additionally, medications commonly used to treat Behçet’s disease “are known to have side effects such as weight/appetite/metabolic changes, which can make it difficult to regulate eating, which can exacerbate pre-existing body image challenges.”

Researchers recommend applying trauma-informed care, assessing and treating suicide and self-harm, and prioritizing therapies that target emotional dysregulation, such as dialectical behavioral therapy.

“Clarion Call”

Comment on Medscape Medical NewsRoger McIntyre, MD, Professor of Psychiatry and Pharmacology, University of Toronto, Canada, and Head of the Mood Disorders Psychopharmacology Unit, said the study is “the first of its kind to comprehensively characterize the prevalence of ED in young adults with Behçet’s disease.”

“It can be hypothesized that EDs have overlapping domain disturbances of cognitive dysfunction, such as executive function and impulse control, as well as cognitive reward processes,” said McIntyre, chairman and CEO of Brain and Cognitive Discover, Toronto. and did not participate in the study.

“The data is a clear call for clinicians to routinely screen for ED in young men with Behçet’s disease and, when present, to be aware of the greater complexity, severity, and risk in this subpopulation of patients. The second is an additional reminder of the severity, disease, and complexity of BD-II, McIntyre said.

The study did not receive any direct funding. It was supported by charitable donations to the Center for Bipolar Disorder for Youth and the CAMH Discovery Fund. Goldstein Reports gives support from Brain Canada, the Canadian Institutes for Health Research, the Heart and Stroke Foundation, the National Institute of Mental Health, the Departments of Psychiatry at the University of Toronto, and the Sunnybrook Health Sciences Center. He also acknowledges his position as Chair of RBC Investments in Child Mental Health and Developmental Psychopathology at CAMH, a joint university chair of the University of Toronto, CAMH, and the CAMH Foundation. Khoubaeva does not state any related financial relationships. Other authors’ disclosures are listed in the original article. McIntyre received research grant support from CIHR/GACD/National Natural Science Foundation of China (NSFC); Speaker/consulting fees from Lundbeck, Janssen, Alkermes, Neumora Therapeutics, Mitsubishi Tanabe, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Axsome, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge, Pharma Abbvie, and Atai Life Sciences. Roger McIntyre is CEO of Braxia Scientific Corp.

J Clin Psychiatry. Published online May 11, 2022. Full text

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2022-06-06 20:49:14

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