Comorbidity is generally defined as the co-occurrence of two or more physical or mental health problems.
Psychiatric comorbidities, particularly, have recently emerged as significant clinical, public health and research issues, in part due to recent changes in psychiatric nomenclature, involving an increased focus upon elucidating any number of mental health problems with which an individual might present, rather than diagnosing one problem to the exclusion of others.
Psychiatric Comorbidity and Mortality
Psychiatric comorbidity in individuals with an eating disorder is common. Research demonstrates that 55-97% of individuals diagnosed with an eating disorder also receive a diagnosis for at least one more psychiatric diagnosis. The most common psychiatric comorbidities associated with eating disorders include mood disorders such as major depressive disorder, anxiety disorders - particularly OCD and social anxiety disorder - post-traumatic stress disorder (PTSD), substance use disorders, sexual dysfunction, and self-harm and suicide ideation.
Death by suicide is significantly more prevalent in eating disorders populations compared to the general population. Recent research has found that individuals with anorexia are 31 times more likely to commit suicide than individuals from the general population, and the suicide rate for individuals with bulimia is 7.5 times higher than that of the general population. To improve the treatment of eating disorders, it is important to understand the timelines and sequencing of the onset of psychiatric comorbidities, and to consider the potential impact these comorbidities have on the diagnosis, treatment and prognosis of the eating disorder.
Medical Comorbidity and Mortality
People with eating disorders also frequently present with medical comorbidities. Individuals with eating disorders can become very unwell and may require access to hospital treatment. Common reasons for hospitalisation include medical complications (rapid weight loss, a very low weight, cardiac irregularities, hypoglycaemia, electrolyte imbalance), extreme and disordered behaviour, for example several days of no nutrition intake, psychological complications such as suicidality or active self-harm and lack of response to outpatient treatment in very underweight patients. Eating disorders are one of the 12 leading causes of hospitalisation costs due to mental health, with 11% of these admissions being due to life-threatening complications. International research shows that hospitalisation for complications related to eating disorders are increasing due to both increases in first admissions as well as readmissions.
Recent research shows that individuals with anorexia nervosa have a mortality rate five times higher than the general population, and those with bulimia nervosa are 50% more likely to die prematurely than those in the general population.
If you suspect that you or someone you know is experiencing an eating disorder, it is important to seek help immediately. The earlier you seek help the closer you are to recovery. Contact your GP for a referral to a practitioner with specialised knowledge in eating disorders.
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Binge eating disorder
Binge eating disorder (BED) is defined by regular episodes of binge eating accompanied by feelings of loss of control, and in many cases, guilt, embarrassment and disgust.
Anorexia nervosa (AN) is defined by the persistent restriction of energy intake, intense fear of gaining weight and disturbance in self-perceived weight or shape.
Bulimia nervosa is defined by repeated episodes of binge eating followed by compensatory behaviours. People with bulimia nervosa often place an excessive emphasis on body shape or weight in their self-evaluation. This can lead to the person’s sense of self-esteem and self-worth being defined by the way they look.
Other specified feeding or eating disorders
Other Specified Feeding or Eating Disorder (OSFED) was formerly recognised as Eating Disorder Not Otherwise Specified (EDNOS) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Feeding and eating disorders are characterised by a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.