Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

Why is this research important? 

People experiencing eating disorders have high rates of co-occurring psychiatric or medical illnesses or conditions (known as comorbidities). This rapid review provides an overview of the scientific literature relating to the psychiatric and medical comorbidities associated with eating disorders and identifies areas where further research is needed.   

The most frequent psychiatric comorbidities identified by the review were anxiety, mood, substance use disorders, and post-traumatic stress disorders. Medical comorbidities and complications were observed across all body systems. Given the impact of comorbidities on eating disorder symptoms, behaviours, functioning, and treatment outcomes, the authors emphasise that identifying psychiatric and medical comorbidities is critical to treatment and recovery. Increased awareness of the prevalence and range of comorbid conditions may support early identification and management of comorbidities, and therefore contribute to improved outcomes in eating disorder treatment.  

The authors identify a need for more research into comorbidities for a broader range of eating disorder diagnoses (with most studies identified through the rapid review focused on anorexia nervosa), as well as a need for research into comorbidities among groups who are underrepresented within current research (for example, within culturally and linguistically diverse groups). The authors also highlight that future research into the nature of psychiatric and medical comorbidity for subthreshold and subclinical eating disorders will provide an opportunity for early identification and intervention. 

Authors: Ashlea Hambleton, Genevieve Pepin, Anvi Le, Danielle Maloney, National Eating Disorder Research Consortium, Stephen Touyz, Sarah Maguire 

Abstract/Summary: 
Background: Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders. 
Methods: This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised. 
Results: A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED. 
Conclusion: This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes. 

Access: Open 

Link: https://doi.org/10.1186/s40337-022-00654-2 

Citation: Hambleton, A., Pepin, G., Le, A., Maloney, D., National Eating Disorder Research Consortium, Touyz, S., & Maguire, S. (2022). Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. Journal of Eating Disorders, 10(1), 1-23.