title: Impulsivity, anxiety, and alcohol misuse in bipolar disorder comorbid with eating disorders.
abstract: BACKGROUND
  Eating disorders (ED) are noted to occur with bipolar disorder (BD), but relationships between additional comorbidities, clinical correlates, and personality factors common to both remain largely unknown.
  
  
  METHODS
  Using data from the Prechter Longitudinal Study of Bipolar Disorder, we measured the prevalence and demographic factors of comorbid ED with BD, presence of additional comorbidity of anxiety and substance use disorders, psychosis, suicide attempts, mixed symptoms, childhood abuse, impact of NEO-Personality Inventory (NEO-PI) personality factors, and mood outcome in 354 patients with BD. We analyzed the prevalence of ED using both broad and narrow criteria.
  
  
  CONCLUSIONS
  ED was more common in the Prechter BD sample than the general population, with the majority of those with ED being female. Anxiety disorders, alcohol abuse/dependence, and NEO-PI N5 impulsiveness were independently associated with ED in a multivariable linear regression analysis. BD age at onset was earlier in the ED group than that in the non-ED group and was earlier than the average onset of ED. Anxiety occurred before ED and alcohol use disorders after both BD and ED. Childhood trauma was associated with ED. Impulsivity and anxiety associated with BD may fuel ED and put patients at risk for other impulsivity-related disorders such as alcohol use disorders. ED was associated with more severe and variable moods and more frequent depression. Patients with BD should be regularly screened for ED, anxiety disorders, and alcohol use disorders, and comorbidity should be promptly addressed.
authors.affiliation: Department of Psychiatry, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, P.O. Box 850, Mail Code HO73, Hershey, PA 17033-0850 USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jen
authors.affiliation: Department of Psychiatry, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, P.O. Box 850, Mail Code HO73, Hershey, PA 17033-0850 USA ; University of Michigan Department of Psychiatry, Ann Arbor, MI 48109-5740 USA ; University of Michigan Depression Center, Ann Arbor, MI 48105, USA.
authors.forename: Erika Fh
authors.initials: EF
authors.lastname: Saunders
authors.affiliation: Department of Psychiatry, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, P.O. Box 850, Mail Code HO73, Hershey, PA 17033-0850 USA.
authors.forename: Rollyn M
authors.initials: RM
authors.lastname: Ornstein
authors.affiliation: University of Michigan Department of Psychiatry, Ann Arbor, MI 48109-5740 USA ; University of Michigan Depression Center, Ann Arbor, MI 48105, USA.
authors.forename: Masoud
authors.initials: M
authors.lastname: Kamali
authors.affiliation: University of Michigan Department of Psychiatry, Ann Arbor, MI 48109-5740 USA ; University of Michigan Depression Center, Ann Arbor, MI 48105, USA.
authors.forename: Melvin G
authors.initials: MG
authors.lastname: McInnis
keywords: Alcohol use disorders; Anxiety disorders; Bipolar disorder; Eating disorders; Impulsivity