Psychiatric comorbidities of female inpatients with eating disorders

Objective: We analyze 27 point-prevalent DSM-IV Axis I comorbidities for eating disorder inpatients. Methods: The sample included 2436 female inpatients treated between January 1, 1995, and December 31, 2000, for primary DSM-IV diagnoses of anorexia, bulimia, and eating disorder not otherwise specified. Analyses were multivariate analysis of variance and multinomial logistic regression; sociodemographics and severity-of-illness measures were controlled. Results: Ninety-seven percent of patients evidenced >= 1 comorbid diagnoses; 94% evidenced comorbid mood disorders, largely unipolar depression, with no differences across eating disorders; 56% evidenced anxiety disorders, with no differences across eating disorders; and 22% evidenced substance use disorders, with significant differences across eating disorders (p <.0001). Five specific diagnoses differed across eating disorders. Alcohol abuse/dependence was twice as likely with bulimia (p <.0001); polysubstance abuse/dependence three times as likely with bulimia (p <.0001); obsessive-compulsive disorder twice as likely with restricting and binge/purge anorexia (P <.01); posttraumatic stress disorder twice as likely with binge-purge anorexia (p <.05); schizophrenia/other psychoses three times more likely with restricting anorexia (p <.05) and two times with binge-purge anorexia (p <.05). Conclusions: New findings emerged: extremely high comorbidity regardless of eating disorder, ubiquitous depression across all eating disorders, no difference in overall rate of anxiety disorders across eating disorders, greater posttraumatic stress disorder in binge-purge anorexia, more psychotic diagnoses in anorexia. Certain previous findings were confirmed: more obsessive-compulsive disorder in anorexia; more substance use in bulimia; and a replicated comorbidity rank-ordering for eating disorder patients: mood, anxiety, and substance use disorders, respectively.