Abstract
ObjectiveResearch suggests autoimmune processes to be involved in psychiatric disorders. We aimed to address the prevalence and incidence of autoimmune diseases in a large Finnish patient cohort with anorexia nervosa, bulimia nervosa, and binge eating disorder.MethodsPatients (N = 2342) treated at the Eating Disorder Unit of Helsinki University Central Hospital between 1995 and 2010 were compared with general population controls (N = 9368) matched for age, sex, and place of residence. Data of 30 autoimmune diseases from the Hospital Discharge Register from 1969 to 2010 were analyzed using conditional and Poisson regression models.ResultsOf patients, 8.9% vs. 5.4% of control individuals had been diagnosed with one or more autoimmune disease (OR 1.7, 95% CI 1.5–2.0, P<0.001). The increase in endocrinological diseases (OR 2.4, 95% CI 1.8–3.2, P<0.001) was explained by type 1 diabetes, whereas Crohn's disease contributed most to the risk of gastroenterological diseases (OR 1.8, 95% CI 1.4–2.5, P<0.001). Higher prevalence of autoimmune diseases among patients with eating disorders was not exclusively due to endocrinological and gastroenterological diseases; when the two categories were excluded, the increase in prevalence was seen in the patients both before the onset of the eating disorder treatment (OR 1.5, 95% CI 1.1–2.1, P = 0.02) and at the end of the follow-up (OR 1.4, 95% CI 1.1–1.8, P = 0.01).ConclusionsWe observed an association between eating disorders and several autoimmune diseases with different genetic backgrounds. Our findings support the link between immune-mediated mechanisms and development of eating disorders. Future studies are needed to further explore the risk of autoimmune diseases and immunological mechanisms in individuals with eating disorders and their family members.
Highlights
Eating disorders are relatively common multifactorial disorders, the etiology of which appears to be regulated by interplay of environmental and genetic factors
We explored the potential associations in three stages; period prevalence at the onset of the treatment of an eating disorders, accounting for both prevalent and new onset autoimmune disease cases for the time before the treatment; incidence after the treatment onset until the end of the study period to yield the information of new onset autoimmune diseases and to separate the potential improved effect of the treatment system to detect the autoimmune diseases among patients compared to controls; and lifetime prevalence including prevalent and new onset autoimmune disease cases any time before, during, or after the treatment until the end of the follow-up
We examined the incidence of new onset autoimmune diseases beginning at the day that the participants entered to the treatment for an eating disorder until the end of the study period (Table 3)
Summary
Eating disorders are relatively common multifactorial disorders, the etiology of which appears to be regulated by interplay of environmental and genetic factors. They are often associated with substantial somatic morbidity [1,2], since psychological stress combined with dysregulated eating behavior and subsequent nutritional disturbances have a potent effect on several organ systems. The risk of eating disorders has been shown to be increased in some somatic illnesses [3,4,5] Many of these illnesses, such as type 1 diabetes (T1D) and inflammatory bowel diseases present autoimmune or autoinflammatory etiology. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection (PANDAS) include anorexia nervosa (AN) [8]
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