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Occurrence of bipolar spectrum disorder and comorbidities in women with eating disorders

Rodolfo Nunes Campos12*, Junior Rodrigues Domingos dos Santos1, Táki Athanássios Cordás3, Jules Angst4 and Ricardo Alberto Moreno1

Author Affiliations

1 Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, School of Medicine, University of São Paulo (HC-FMUSP), Rua Ovidio Pires de Campos 785, São Paulo 05403-010, Brazil

2 Department of Psychiatry, Federal University of Goias, Goias 74690-900, Brazil

3 Eating Disorders Unit (AMBULIM), Department and Institute of Psychiatry, School of Medicine, University of São Paulo (HC-FMUSP), São Paulo 05403-010, Brazil

4 Psychiatric Hospital, Zurich University, Zurich, 8091, Switzerland

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International Journal of Bipolar Disorders 2013, 1:25  doi:10.1186/2194-7511-1-25

Published: 13 November 2013



Eating disorder (ED) patients often have comorbidities with other psychiatric disorders, especially with mood disorders. Although recent studies suggest an intimate relationship between ED and bipolar disorder (BD), the study on a broader bipolar spectrum definition has not been done in this population. We aimed to study the occurrence of bipolar spectrum (BS) and comorbidities in eating disorder patients of a tertiary service provider.


Sixty-nine female patients diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified were evaluated. The assessment comprised the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), clinical criteria for diagnosis of the Zurich bipolar spectrum. Mann–Whitney tests compared means of continuous variables. The association between categorical variables and the groups was described using contingency tables and analyzed using the chi-square or Fisher's exact test. The level of significance alpha was set at 5%.


The results showed that 68.1% of patients had comorbidity with bipolar spectrum, and this was associated with higher family income, proportion of married people, and comorbidity with substance use. The ED with BS group showed higher rates of substance use comorbidity (40.4%) than the ED without BS group (13.6%).


These results showed that the bipolar spectrum is a common comorbidity in patients with eating disorders and is associated with correlates of clinical importance, notably the comorbidity with substance use. Due to the pattern of similarity between the groups with and without comorbid bipolar spectrum in relation to various outcomes evaluated, the identification of comorbidity can be difficult. However, the precise diagnosis and careful identification of clinical correlates may contribute to future advances in treating these conditions. Further studies are necessary to evaluate the association of other clinical correlates and its possible causal association.

Bipolar disorder; Bipolar spectrum; Eating disorders; Comorbidity