Abstract
ObjectiveTo evaluate inpatient outcomes and the prevalence of psychiatric and medical comorbidities in bulimia nervosa.MethodsWe used the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). We identified bulimia nervosa as the primary diagnosis and medical and psychiatric comorbidities using ICD9-CM codes. The differences in comorbidities were quantified using the Chi-square (χ2) test, and a multinomial logistic regression model was used to quantify associations among comorbidities (odds ratio (OR)).ResultsThe sample consisted of 3,319 inpatient admissions with bulimia nervosa between 2010–2014. Overall, 88% patients were younger than 40 years of age (p < 0.001). Bulimia nervosa was seen in a higher proportion of females (92.5%). The mean inpatient stay was 9.15 days and had a variable trend, whereas inpatient charges have been increasing (p < 0.001), averaging $34,398 (USD). The odds of having a longer hospitalization > 7 days (median) was seen in patients with comorbid fluid/electrolyte disorders (OR = 1.816; p < 0.001) and comorbid depression (OR = 1.745; p < 0.001). The most prevalent psychiatric comorbidities were psychosis (52.4%), followed by depression (23.5%). Females had three times higher odds of comorbid diabetes (OR = 3.374; p < 0.001), hypertension (OR = 2.548; p-value < 0.001), comorbid depression (OR = 1.670; p = 0.002), and drug abuse (OR = 2.008; p < 0.001).ConclusionOur study established psycho-socio-demographic characteristics, hospitalization outcomes, and comorbidities of bulimia nervosa patients. We believe that medical and psychiatric comorbidities of bulimia nervosa should be carefully investigated by clinicians as they can further complicate the management of bulimia nervosa and result in adverse inpatient outcomes.
Highlights
Bulimia nervosa is a potentially life-threatening eating disorder characterized by recurrent episodes of binge eating and inappropriate compensatory purging behaviors, such as self-induced vomiting, laxative abuse, enemas, and excessive exercise [1]
We believe that medical and psychiatric comorbidities of bulimia nervosa should be carefully investigated by clinicians as they can further complicate the management of bulimia nervosa and result in adverse inpatient outcomes
World Health Organization World Mental Health Surveys estimated that the lifetime prevalence of bulimia nervosa is 0.8% and the median age of onset is in the late teens to the early twenties [2]
Summary
Bulimia nervosa is a potentially life-threatening eating disorder characterized by recurrent episodes of binge eating and inappropriate compensatory purging behaviors, such as self-induced vomiting, laxative abuse, enemas, and excessive exercise [1]. World Health Organization World Mental Health Surveys estimated that the lifetime prevalence of bulimia nervosa is 0.8% and the median age of onset is in the late teens to the early twenties [2]. In the United States, the lifetime prevalence of bulimia nervosa in men and women was estimated to be 0.5% and 1.5%, respectively [3]. Bulimia nervosa has a significant impact on psychosocial functioning. In the United States, impaired psychosocial functioning was found among 78% of the patients; 44% reporting severe impairment. Patients with bulimia nervosa usually have a lifetime history of many psychiatric disorders that were shown to be associated with a poorer prognosis [4]. The most common psychiatric co-morbidities of bulimia nervosa are unipolar major depression (50%), specific phobia (50%), post-traumatic stress disorder (PTSD) (45%), attention-deficit/hyperactivity disorder (ADHD) (35%) and alcohol use disorder (34%) [3].
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