Eating disorders (EDs) are characterized by symptoms like food restriction, limited dietary variety, fear of gaining weight, fear of food, binge eating episodes, compensatory behaviors (laxatives, purging, exercise, etc.), and body image concerns. EDs are highly prevalent, with collective lifetime rates for Anorexia nervosa (AN), Bulimia nervosa (BN), Binge eating disorder (BED), Avoidant/restrictive food intake disorder (ARFID), and other-specified feeding/eating disorders such as Atypical anorexia nervosa (AAN) and Purging disorder (PD) ranging in studies from 1.93% to 10. They are chronic mental disorders associated with high treatment-dropouts, low remission, and high relapse rates.
EDs are often comorbid with a series of medical sequelae leading to increased mortality. Psychiatric conditions such as depression, OCD, substance use disorders (SUDs), PTSD, and personality disorders are also commonly found in patients suffering from EDs. Eating pathology and depression are found to be mutual risk factors and prevalence rates of depression are as high as 50%, especially in patients with BN. There is evidence for a bi-directional comorbidity between AN and obsessive-compulsive disorder (OCD) as well; OCD is found in 35-44% of patients with AN. The prevalence of SUDs in patients suffering with EDs has been reported to be between 25 and 50%, especially among the binge/purge clinical phenotypes. Similarly, PTSD prevalence rates may reach 50% in intensive ED treatment samples. Evidence from clinical samples with ARFID suggests high rates of anxiety, depression, and OCD, as well as developmental disabilities (e.g., autism spectrum disorder) and a range of chronic medical illnesses.
Comorbidity – both medical and psychiatric - has an impact on both the clinical presentation, as well as the course of treatment of EDs. For example, patients with EDs and comorbid SUDs show a more severe ED-associated psychopathology, higher rates of medical complications, and worse outcomes. Among individuals with EDs, those with co-occurring PTSD have also been found to have higher levels of ED psychopathology, depression, and anxiety, while treatment studies have shown that the presence of depression and personality disorders predict ED treatment non-completion. Hence, treatment of ED and comorbid conditions appears to be more challenging than treatment of each of the single conditions.
So far, no evidence-based and established treatments that address EDs and comorbid conditions exist. In clinical praxis, patients with EDs and comorbid conditions primarily receive treatment for their EDs, while aspects of treatment of the comorbid disorder may be addressed. More often, comorbid disorders are treated in subsequent treatments. The lack of integrative programs makes it difficult for professionals to refer patients to adequate treatment resources and may appear to patients as confusing and unsettling.
In this Research Topic we welcome papers dealing with the issue of both somatic and psychiatric comorbidity in patients with EDs and presenting the newest developments in the field of diagnostic assessments and/or treatment. With this Research Topic, we hope to add to the existing knowledge, provide stimuli to improve interventions, and reduce the burden of suffering in patients with EDs and comorbid conditions.
Eating disorders (EDs) are characterized by symptoms like food restriction, limited dietary variety, fear of gaining weight, fear of food, binge eating episodes, compensatory behaviors (laxatives, purging, exercise, etc.), and body image concerns. EDs are highly prevalent, with collective lifetime rates for Anorexia nervosa (AN), Bulimia nervosa (BN), Binge eating disorder (BED), Avoidant/restrictive food intake disorder (ARFID), and other-specified feeding/eating disorders such as Atypical anorexia nervosa (AAN) and Purging disorder (PD) ranging in studies from 1.93% to 10. They are chronic mental disorders associated with high treatment-dropouts, low remission, and high relapse rates.
EDs are often comorbid with a series of medical sequelae leading to increased mortality. Psychiatric conditions such as depression, OCD, substance use disorders (SUDs), PTSD, and personality disorders are also commonly found in patients suffering from EDs. Eating pathology and depression are found to be mutual risk factors and prevalence rates of depression are as high as 50%, especially in patients with BN. There is evidence for a bi-directional comorbidity between AN and obsessive-compulsive disorder (OCD) as well; OCD is found in 35-44% of patients with AN. The prevalence of SUDs in patients suffering with EDs has been reported to be between 25 and 50%, especially among the binge/purge clinical phenotypes. Similarly, PTSD prevalence rates may reach 50% in intensive ED treatment samples. Evidence from clinical samples with ARFID suggests high rates of anxiety, depression, and OCD, as well as developmental disabilities (e.g., autism spectrum disorder) and a range of chronic medical illnesses.
Comorbidity – both medical and psychiatric - has an impact on both the clinical presentation, as well as the course of treatment of EDs. For example, patients with EDs and comorbid SUDs show a more severe ED-associated psychopathology, higher rates of medical complications, and worse outcomes. Among individuals with EDs, those with co-occurring PTSD have also been found to have higher levels of ED psychopathology, depression, and anxiety, while treatment studies have shown that the presence of depression and personality disorders predict ED treatment non-completion. Hence, treatment of ED and comorbid conditions appears to be more challenging than treatment of each of the single conditions.
So far, no evidence-based and established treatments that address EDs and comorbid conditions exist. In clinical praxis, patients with EDs and comorbid conditions primarily receive treatment for their EDs, while aspects of treatment of the comorbid disorder may be addressed. More often, comorbid disorders are treated in subsequent treatments. The lack of integrative programs makes it difficult for professionals to refer patients to adequate treatment resources and may appear to patients as confusing and unsettling.
In this Research Topic we welcome papers dealing with the issue of both somatic and psychiatric comorbidity in patients with EDs and presenting the newest developments in the field of diagnostic assessments and/or treatment. With this Research Topic, we hope to add to the existing knowledge, provide stimuli to improve interventions, and reduce the burden of suffering in patients with EDs and comorbid conditions.
