title: Occurrence of bipolar spectrum disorder and comorbidities in women with eating disorders.
abstract: BACKGROUND
  Eating disorder (ED) patients often have comorbidities with other psychiatric disorders, especially with mood disorders. Although recent studies suggest an intimate relationship between ED and bipolar disorder (BD), the study on a broader bipolar spectrum definition has not been done in this population. We aimed to study the occurrence of bipolar spectrum (BS) and comorbidities in eating disorder patients of a tertiary service provider.
  
  
  METHODS
  Sixty-nine female patients diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified were evaluated. The assessment comprised the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), clinical criteria for diagnosis of the Zurich bipolar spectrum. Mann-Whitney tests compared means of continuous variables. The association between categorical variables and the groups was described using contingency tables and analyzed using the chi-square or Fisher's exact test. The level of significance alpha was set at 5%.
  
  
  RESULTS
  The results showed that 68.1% of patients had comorbidity with bipolar spectrum, and this was associated with higher family income, proportion of married people, and comorbidity with substance use. The ED with BS group showed higher rates of substance use comorbidity (40.4%) than the ED without BS group (13.6%).
  
  
  CONCLUSIONS
  These results showed that the bipolar spectrum is a common comorbidity in patients with eating disorders and is associated with correlates of clinical importance, notably the comorbidity with substance use. Due to the pattern of similarity between the groups with and without comorbid bipolar spectrum in relation to various outcomes evaluated, the identification of comorbidity can be difficult. However, the precise diagnosis and careful identification of clinical correlates may contribute to future advances in treating these conditions. Further studies are necessary to evaluate the association of other clinical correlates and its possible causal association.
authors.affiliation: Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, School of Medicine, University of São Paulo (HC-FMUSP), Rua Ovidio Pires de Campos 785, São Paulo, 05403-010 Brazil ; Department of Psychiatry, Federal University of Goias, Goias, 74690-900 Brazil.
authors.forename: Rodolfo Nunes
authors.initials: RN
authors.lastname: Campos
authors.affiliation: Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, School of Medicine, University of São Paulo (HC-FMUSP), Rua Ovidio Pires de Campos 785, São Paulo, 05403-010 Brazil.
authors.forename: Domingos Junior Rodrigues
authors.initials: DJ
authors.lastname: Dos Santos
authors.affiliation: Eating Disorders Unit (AMBULIM), Department and Institute of Psychiatry, School of Medicine, University of São Paulo (HC-FMUSP), São Paulo, 05403-010 Brazil.
authors.forename: Táki Athanássios
authors.initials: TA
authors.lastname: Cordás
authors.affiliation: Psychiatric Hospital, Zurich University, Zurich, 8091 Switzerland.
authors.forename: Jules
authors.initials: J
authors.lastname: Angst
authors.affiliation: Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, School of Medicine, University of São Paulo (HC-FMUSP), Rua Ovidio Pires de Campos 785, São Paulo, 05403-010 Brazil.
authors.forename: Ricardo Alberto
authors.initials: RA
authors.lastname: Moreno
keywords: Bipolar disorder; Bipolar spectrum; Comorbidity; Eating disorders