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The Interplay of Mood Disorders and Eating Disorders

The Interplay of Mood Disorders and Eating Disorders

Lifetime prevalence of mood disorders in patients with eating disordersTABLE. Lifetime prevalence of mood disorders in patients with eating d...
SIGNIFICANCE FOR THE PRACTICING PSYCHIATRISTSignificance for the Practicing Psychiatrist

Disordered eating behaviors commonly co-occur with mood disorders, particularly in women. The following Case Vignette, in which an eating disorder diagnosis is established during treatment, is a common one in clinical practice. It raises many questions for the treating clinician about appropriate diagnosis and treatment, as well as how best to understand the etiology and interconnectedness of these difficulties.

CASE VIGNETTE

Becka is a 20-year-old college sophomore with a psychiatric history of “depression and anxiety,” who is referred for evaluation of persistent depressive symptoms with passive suicidal ideation. The initial evaluation reveals that over the past 7 months Becka has been restricting her caloric intake to barely 1200 calories a day, and she has started a stringent exercise regimen. These behaviors have led to a 15-lb weight loss. She admits she would like to lose more weight, despite her BMI of 17.8 kg/m2. She also reports several neurovegetative symptoms, including depressed mood, anhedonia, impaired sleep, low energy, and persistent thoughts of death.

 

Epidemiology and etiologic considerations

Data from epidemiologic research support the overlap between eating disorders (eg, anorexia nervosa, bulimia nervosa, binge eating disorder) and mood disorders. For example, approximately 5% of patients with MDD also have an eating disorder (all DSM-IV diagnoses)1; for female patients with MDD, this rate has been reported to be as high as 33%.2 Similarly, mood disorders are a common comorbidity among patients with eating disorders (Table).

Neurovegetative features (eg, decreased or increased appetite) are common in mood disorders such as MDD. The effects of mood and anxiety on appetite, as well as the epidemiology data that suggest high comorbidity between eating disorders and affective disorders, have led clinicians to ponder explanatory models. Although some lines of evidence suggest a shared etiology between the disorders (eg, serotonergic dysfunction), the manner and extent to which shared biological factors are at play is not clear. Overall, it is probably too simplistic to conceive of an eating disorder as simply a sequela of a mood or anxiety disorder—or a mood/anxiety problem as a sequela of an eating disorder. Most likely, these disparate conditions share some etiologic factors.

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