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.
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.
Dr Uniacke is an upcoming Chief Resident in the department of psychiatry at the Columbia University Medical Center in New York City. Dr Broft is Assistant Professor of Psychiatry at the Columbia University Medical Center; she is also a psychiatrist in private practice in New York City. The authors report no conflicts of interest concerning the subject matter of this article.
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