Review
Comorbidity studies of eating disorders and mood disorders. Critical review of the literature

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Abstract

Objective

We conducted a critical literature review of studies assessing the prevalence of mood disorders (MD) in subjects with eating disorders (ED; anorexia nervosa and bulimia nervosa). In the first part of this article, we discuss methodological issues relevant to comorbidity studies between ED and MD. In the second part, we summarize the findings of these studies in light of the methodological considerations raised.

Method

A manual computerised search (Medline) was performed for all published studies on comorbidity between ED and MD. In order to have sufficiently homogeneous diagnostic criteria for both categories of disorders, this search was limited to articles published between 1985 and 2006.

Results

Too few studies include control groups, few studies compared diagnostic subgroups of ED subjects, and results are scarce or conflicting.

Discussion

The results are discussed in the light of the methodological problems observed. The implications when reviewing the results of published studies and planning future research are set out.

Section snippets

Methods

We performed a computerized search (Medline) for all published studies on comorbidity between ED and mood disorders, limiting our search to the 1980–2006 period, in order to maintain sufficiently homogeneous diagnostic criteria for both categories of disorders. In addition, a manual search was performed from the bibliography of papers identified.

The search identified 55 studies published after 1980 that explored the prevalence of one or several mood disorders in subjects with a lifetime

Population sources

Studies on referred patients, follow-up samples, and community samples should be considered separately for several reasons. First, patients in clinical settings may not be representative of all those with the disorder because of the «Berkson Bias» (Berkson, 1946; for further detail, see Godart et al., 2002). Second, follow-up studies of ED patients evaluate subjects with a lifetime diagnostic of ED, either past or current; as a consequence, they differ from those with a current ED on many

What is the convincing evidence that mood disorders are more frequent among women with an ED than among women from the community?

We will first present the range of the estimated prevalence (lifetime and current when mentioned) across studies for all specific mood disorders in subjects with ED, shown in Table 1, Table 2, Table 3, Table 4; separate consideration is given to studies in referred samples of subjects currently suffering from an ED (Table 1 for AN, Table 3 for BN), outcome studies (Table 2 for AN and BN), and community studies (Table 4 for AN and BN). Then, the comparative studies between ED and control groups

Discussion

Our literature review highlights the heterogeneity of samples and methods in numerous studies on comorbidity between ED and MD, and calls for caution in the interpretation of results. We do not aim to underestimate the value of findings from previous studies, but to reconsider the literature from the past 25 years in view of the advances that have occurred in terms of methodology and clinical knowledge of ED. Published research has provided valuable information in the field, but should now be

Conclusion

Our review highlights the need for further studies, which should address several requirements: studies on comorbidity should be designed with this specific goal in mind, rather than as a secondary aim within other types of studies (such as treatment studies, follow-up studies, etc…). New studies should include control subjects, matched (at least) for gender and age with ED subjects. Studies should evaluate prevalence of all types of MD in order to yield comparable estimates for MD in general.

Acknowledgements

Thanks to Angéla Verdier for her indispensable help in translating this article from French to English and to Lydia Evangelista for her secretarial support.

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