Research paperBinge Eating Disorder and Bipolar Spectrum disorders in obesity: Psychopathological and eating behaviors differences according to comorbidities
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.
Section snippets
Participants
From October 2014 until December 2015, all obese outpatients seeking treatment for weight loss at a department of internal medicine in Southern Italy were given the chance to participate in this study. The treatment foresaw the possibility of nutritional re-education, medical treatment and/or bariatric surgery in a stepwise model depending on the severity of obesity and medical and/or psychiatric comorbidities of each patient. One hundred sixty-two obese patients (58 males, 104 females) were
Results
The main characteristics of the sample and the distribution of the diagnosis within the BSD in Groups 1 and 3 are displayed in Table 1.
Sixty-two percent of participants received the diagnosis of BED, 49% had a diagnosis within the BSD and a total of 41% shared both diagnoses (Group 1). BED-BSD-Ob and BED-Ob diagnoses were more frequent among females, whilst Obesity was the most frequent diagnosis among males.
Age was similar across groups (F=.78; df=3; p=.68). Significant differences regarding
Discussion
The objective of the present research was to analyze the frequency of BED and BSD among obese patients who asked for weight reduction therapy, and to investigate distinctive eating behaviors and psychopathological differences associated with these comorbidities. Our results show a high frequency of either BED or BSD and a remarkable rate of double comorbidity, which is associated with increased psychopathology and specific altered eating behaviors.
Some limitations must be addressed before
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2018, European PsychiatryCitation Excerpt :In Mexico, the last National Survey demonstrated that the prevalence of obesity has augmented from 21.5% in 1993, to 33.3% in 2016 [1]. It has been established that obesity is associated with several psychiatric disorders [2,3], being binge eating disorder (BED) one of them [4]. One of these entities is BED which is characterized by recurrent-persistent episodes of uncontrolled binge eating with distress, in the absence of regular compensatory behaviors [5].
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2018, European PsychiatryCitation Excerpt :The SERT gene may also be associated with the pathophysiology of “binge eating”, but it is not clear how changes in 5-HT function could influence eating behaviours in obese patients [10]. On the other hand, personality and psychopathological traits seem to play an important role as risk factors in the development and maintenance of overweight and obesity [3,11–12], and recent studies have also described a pattern of impairment in the cognitive flexibility and decision-making domains [13,14] of obese patients with and without EDs. Previous cluster-analysis studies of EDs have yielded clinical subtypes for dietary restraint and negative affect dimensions; however, to our knowledge no studies have clarified the relationship between neurobiological and behavioural variables in obese patients [15,16].