Psychiatric Comorbidity Alcoholism Mood and Personality

Of particular concern to the gastroenterologist is the high comorbidity between eating disorders and substance abuse, especially alcoholism. The overall rate of all substance use disorders among eating disordered patients was 37% in one study, and rates of alcoholism among bulimics were > 40% (Braun et al, 1994). Patients abusing alcohol exhibit high rates of GI comorbidity, and women suffer adverse consequences, such as cirrhosis, from consumption of alcohol more quickly than do men. We recommend screening all eating disordered patients for alcohol abuse behaviors (Redgrave et al,2003).

Mood disorders are highly comorbid with eating disorders; between 40 to 80% of patients with eating disorders will have an affective disorder during their lifetime (Braun et al, 1994). The presence of major depressive disorder or bipolar disorder complicates the examination and management of the patient with AN or BN. Actively depressed patients may feel hopeless and be more likely to resist treatment. In addition, because starvation is associated with a syndrome of depression, symptoms of eating disorders may mimic depression yet reverse rapidly with refeeding.

There is a strong link between personality vulnerabilities and eating disorders. Methods of measuring personality vary widely, so comparing studies is somewhat problem atic, but it is clear that certain traits (eg, neuroticism) make recovery prolonged for patients, and that, in general, the greater the personality pathology the more complicated the management of the eating disorder (Wonderlich and Mitchell, 2001). As with eating disorders, the primary treatment of personality vulnerabilities is psychotherapy.

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