Psychiatric comorbidity as a risk factor for the mortality of people with bulimia nervosa

Hubertus Himmerich,Robert Stewart,Chin-Kuo Chang,Hitesh Shetty,Matthew Hotopf,Ulrike Schmidt,Richard D Hayes,Janet Treasure

doi:10.1007/s00127-019-01667-0

Abstract

BackgroundBulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality.MethodsWe investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from January 2007 to March 2016 for 1501 people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score.ResultsA total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49–3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05–10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates.ConclusionsThese results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN.

Highlights

Bulimia nervosaBulimia nervosa (BN) is an eating disorder (ED) that was included in the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 [1] after its description by Gerald Russell the year before [2]
Diagnostic criteria for BN according to ICD-10, are similar to DSM-5 criteria and include recurrent episodes of overeating in which large amounts of food are consumed in short periods of time, a persistent preoccupation with eating and a strong desire to eat, attempts to counteract the fattening effects of food and a self-perception of being too fat [4]
The recorded causes of death among the 18 people with BN who have died in the observation window were: lethal intoxication from drugs or alcohol (n = 4), suicide (n = 3), circulatory or heart failure (n = 3), respiratory failure (n = 3) and cancer (n = 2)

Summary

Introduction

Bulimia nervosaBulimia nervosa (BN) is an eating disorder (ED) that was included in the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 [1] after its description by Gerald Russell the year before [2]. BN occurs in 1–2% of women with a sex ratio of men to women of about 1:10 [5, 6] It is often associated with affective disorders (AD) [7], substance use disorders (SUD) [8,9,10,11] and personality disorders (PD) [12,13,14]. It has been hypothesized that these comorbidities— SUD and PD—develop on the basis of an increased impulsivity and affective instability in patients with BN [15,16,17,18]. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality.

Methods

Results

Conclusion