Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature
Authors: Hambleton Ashlea , Pepin Genevieve , Le Anvi , Maloney Danielle ,   National Eating Disorder Research Consortium, Aouad Phillip , Barakat Sarah , Boakes Robert , Brennan Leah , Bryant Emma , Byrne Susan , Caldwell Belinda , Calvert Shannon , Carroll Bronny , Castle David , Caterson Ian , Chelius Belinda , Chiem Lyn , Clarke Simon , Conti Janet , Crouch Lexi , Dammery Genevieve , Dzajkovski Natasha , Fardouly Jasmine , Felicia Carmen , Feneley John , Firriolo Amber-Marie , Foroughi Nasim , Fuller-Tyszkiewicz Mathew , Fursland Anthea , Gonzalez-Arce Veronica , Gouldthorp Bethanie , Griffin Kelly , Griffiths Scott , Hambleton Ashlea , Hannigan Amy , Hart Mel , Hart Susan , Hay Phillipa , Hickie Ian , Kay-Lambkin Francis , King Ross , Kohn Michael , Koreshe Eyza , Krug Isabel , Le Anvi , Linardon Jake , Long Randall , Long Amanda , Madden Sloane , Maguire Sarah , Maloney Danielle , Marks Peta , McLean Sian , Meddick Thy , Miskovic-Wheatley Jane , Mitchison Deborah , O’Kearney Richard , Ong Shu Hwa , Paterson Roger , Paxton Susan , Pehlivan Melissa , Pepin Genevieve , Phillipou Andrea , Piccone Judith , Pinkus Rebecca , Raykos Bronwyn , Rhodes Paul , Rieger Elizabeth , Rodan Sarah , Rockett Karen , Russell Janice , Russell Haley , Salter Fiona , Sawyer Susan , Shelton Beth , Singh Urvashnee , Smith Sophie , Smith Evelyn , Spielman Karen , Squire Sarah , Thomson Juliette , Tiggemann Marika , Touyz Stephen , Utpala Ranjani , Vartanian Lenny , Wallis Andrew , Ward Warren , Wells Sarah , Wertheim Eleanor , Wilksch Simon , Williams Michelle , Touyz Stephen , Maguire Sarah 
Published: September 2022

Background

Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders.

Methods

This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised.

Results

A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED.

Conclusions

This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.