Binge Eating Disorder and Bipolar Spectrum disorders in obesity: Psychopathological and eating behaviors differences according to comorbidities

Highlights

• We divided 119 obese according to BED or Bipolar Spectrum Disorder (BSD) comorbidity.

• We assessed altered eating behaviors and general psychopathology.

• Comorbidities were 41% BED-BSD, 21% BED and 8% BSD; only 29% had no comorbidity.

• The trend of symptoms severity was BED-BSD=BED>BSD>obese without comorbidity.

• Altered eating behaviors can be warning sign lights of comorbidities in obesity.

Abstract

Background

Obesity is not a mental disorder, yet DSM-5 recognizes a strong association between obesity and psychiatric syndromes. Disorders within the Bipolar Spectrum (BSD) and Binge Eating Disorder (BED) are the most frequent psychiatric disorders among obese patients. The aim of this research is to investigate the psychopathological differences and the distinctive eating behaviors that accompany these comorbidities in obese patients.

Methods

One hundred and nineteen obese patients (40 males; 79 females) underwent psychological evaluation and psychiatric interview, and a dietitian evaluated their eating habits. Patients were divided into four groups according to comorbidities, and comparisons were run accordingly.

Results

Forty-one percent of participants presented BED+BSD comorbidity (Group 1), 21% BED (Group 2) and 8% BSD (Group 3); only 29% obese participants had no comorbidity (Group 4). Female gender was overrepresented among Groups 1 and 2. BSD diagnosis varied according to comorbidities: Type II Bipolar Disorder and Other Specified and Related Bipolar Disorder (OSR BD) were more frequent in Group 1 and Type I Bipolar Disorder in Group 3. A trend of decreasing severity in eating behaviors and psychopathology was evident according to comorbidities (Group 1=Group2>Group3>Group 4).

Limitations

Limitations include the small sample size and the cross-sectional design of the study.

Conclusions

BED and BSD are frequent comorbidities in obesity. Type II Bipolar Disorder and OSR BD are more frequent in the group with double comorbidity. The double comorbidity seems associated to more severe eating behaviors and psychopathology. Distinctive pathological eating behaviors could be considered as warning signals, symptomatic of psychiatric comorbidities in Obesity.

Introduction

Obesity is endangering the health of a rapidly growing number of citizens in Western society (WHO, 2015). It is not a mental disorder (Marcus and Wildes, 2009), yet DSM-5 (APA, 2013) recognizes a strong association to psychiatric syndromes resulting in high social and economical burden (Amianto et al., 2011a).

Many studies have deepened this relation, from the psychiatric point of view, by taking into consideration the most important psychiatric diagnoses, for example, by investigating the frequency and causes of obesity among patients with Schizophrenia (Chouinard et al., 2016, Godin et al., 2015, Henderson et al., 2015, Manu et al., 2015, Ventriglio et al., 2015), Bipolar Spectrum Disorders (BSD) (McElroy, 2004; McElroy and Keck, 2012; McElroy et al., 2016a, 2016b; Shapiro et al., 2016; Soreca et al., 2008; Wildes et al., 2006) or Depression (Lilenfeld et al., 2008). Even if biological, psychological and social variables influence both the onset and the maintenance of obesity in psychiatric disorders (Wildes et al., 2006, Garner, 1993), most studies conclude that obesity can either be the consequence of the disorder or of treatment, and that it is associated with increased medical morbidity, weaker response to drug therapy and worse general psychiatric outcome (Ramacciotti et al., 2013, Amianto et al., 2015).

Less data exist considering the problem of this comorbidity from the other side of the coin, for example, regarding the frequency of Schizophrenia, BSD, Depression or Binge Eating Disorder (BED) among obese patients (Mather et al., 2009, Simon et al., 2006; Vázquez et al., 2008). Regardless of the etiology and the direction of these associations, it is clear that the association between obesity and BED is the most frequent.

BED is the most prevalent Eating Disorder (ED) and has only been classified as a separate diagnostic entity in the DSM-5 in recent years. Although specific psychological, behavioral and metabolic profiles distinguish patients with BED (Aloi et al., 2015, Succurro et al., 2015, Villarejo et al., 2014), it is often unrecognized (Montano et al., 2016) or misdiagnosed, and, thus, mistreated or left untreated, leading to severe dysfunction (Filipova and Stoffel, 2016). By the same token, the high comorbidity with other psychiatric disorders, especially mood disorders (Grilo et al., 2013, McElroy et al., 2011, Winham et al., 2014), make BED a challenging disorder for physicians. Recent research has focused on the comorbidity between BED and BSD. Although investigations of this kind, which explore the overlap of mood symptoms and eating behaviors, are scarce and non-systematic (McElroy et al., 2005), preliminary results indicate a positive correlation between BED and BSD (Amianto et al., 2011b; McElroy et al., 2013).

Given these considerations, the aim of the present research is to look for the psychopathological differences and the distinctive eating behaviors among obese patients with comorbid BED and/or BSD. We hypothesize that although BED and BSD are frequent comorbidities among obese subjects, the double comorbidity determines a greater psychopathological severity and more altered eating patterns than the single comorbidity, and, accordingly, distinctive eating patterns can be identified.