The most important comorbidities of anorexia

Anorexia has become a very common disorder over the past fifty years, particularly due to the imposition of the canon of female beauty, characterized by the model of extreme thinness in women.

As this eating disorder has increased, there have been more and more cases where the patient not only manifests this disorder but also suffers from some type of additional psychiatric problem.

Below we will see the main comorbidities of anorexia, As well as the treatment routes usually used for this type of combined disorders.

    Comorbidities of anorexia

    Anorexia nervosa is an eating disorder. In this disorder, the patient has a significantly lower body mass index (BMI) than expected in a person of the same height and age, usually less than 85% of the expected weight. This small body size is due to the intense fear of gaining weight, which is accompanied by rejection behaviors when eating..

    Co-morbidity is the presence of two or more psychiatric disorders or medical conditions, not necessarily related, occurring in the same patient. Knowing the comorbidity of two disorders, in this case anorexia and another, whether it is this anxiety disorder, mood disorder or personality, can explain the appearance of both in the same patient, in addition to provide information to professionals and to carry out evaluations and treatment decisions.

    1. Bipolar disorder

    The comorbidity between eating disorders and bipolar disorder has been studied. The reason psychiatric research is increasingly focusing on this line of study is that ADD is more common in the bipolar population, which requires the design of a specific treatment for patients with both diagnoses.

    It is important to adjust the treatment in such a way that no mistakes are made in trying to improve the prognosis of, for example, a case of bipolar disorder, as a side effect is detrimental to the course of the TCA.

    The emotional lability of anorexic patients can be confused with the symptoms of bipolar disorder. It should be noted that the main issue in patients who meet the criteria to be diagnosed with both disorders is the patient’s concern about one of the side effects of drugs for bipolar disorder, typically lithium and atypical antipsychotics, which can cause weight gain.

    This comorbidity is particularly striking in the case of patients with malnutrition and a depressive episode of bipolar disorder. Symptoms of depression can be confused with low energy and low libido in patients with anorexia. recently started in treatment.

      2. Depression

      One of the main challenges in treating depression in eating disorder patients, and in particular with anorexia nervosa, is making an accurate diagnosis. since patients with anorexia often present with malnutrition and lack of energyDepression may be disguised as a symptom of starvation. Many patients will recognize that their mood is not normal and describe them as “depressed,” but this does not necessarily have to be the case.

      This is why it is necessary to closely monitor the patient’s progress once she is on treatment in order to gain weight and have normal levels of nutrients in the blood. Malnutrition and depression share some very prominent symptoms such as loss of libido and sleep disturbances, which is why, once a person stops being undernourished, if these symptoms are still observed, it is possible to diagnose depression.

      Once the person with anorexia nervosa has been identified with a diagnosis of depression, psychotherapeutic and pharmacological treatment is usually done. In such cases, any antidepressant is acceptable except bupropion. The reason is that it can cause epileptic seizures in those who have epileptic seizures and subsequent purges. While these symptoms are typical of bulimia nervosa, it should be noted that switching from one ADD to another is relatively common.

      The dosage of antidepressants in patients with anorexia nervosa should be monitored because, as they are not of normal weight, there is a risk that when prescribing a normal dose, overdose will occur. In the case of fluoxetine, citalopram and paroxetine are usually started with 20 mg / day, while venlafaxine 75 mg / day and sertraline 100 mg / day.

      Regardless of the type of antidepressant prescribed, professionals make sure that the patient understands that if they do not gain weight, the benefit of the antidepressants will be limited. In people who have reached a healthy weight, consuming this type of medication should result in an improvement of about 25% in mood. However, professionals, to make sure this is not a false positive for depression, make sure they spend 6 weeks improving their eating habits before pharmacologically tackling depression.

      Do not forget about psychological therapy, especially cognitive behavioral therapiesMost treatments for ADD, especially anorexia and bulimia, involve working on the cognitive component behind the bodily distortions present in these disorders. However, it should be noted that in very low weight patients they are too malnourished for their participation in this type of therapy to be beneficial in the short term.

      3. Obsessive-compulsive disorder (OCD)

      There are two main factors to consider when it comes to obsessive-compulsive disorder (OCD) combined with ADD.

      First, rituals related to food, Which can interfere with the diagnosis and can be considered to be more related to anorexia than to OCD itself. Additionally, the person may engage in excessive exercise or obsessive behaviors such as heavy repetitive lifting.

      The second factor is the personality type common to patients with both disorders, with perfectionist traits, Personality aspects that persist even after normal weight has been reached. It should be noted that just having rigid and persistent personality traits, which remain beyond advanced therapy, does not clearly mean that you are dealing with a case of someone with OCD.

      Pharmacological treatment is usually started with antidepressants, such as fluoxetine, paroxetine or citalopram. As an additional strategy, it is necessary to incorporate small doses of antipsychotics, as some experts believe that this contributes to a greater and faster therapeutic response than if only antidepressants were given.

      4. Panic disorder

      The symptoms of panic disorder, with or without agoraphobia, are problematic both in a patient with ADD and in any other patient.

      The most common treatment of choice is a combination of antidepressantss with the already traditional cognitive therapy. Once treatment is started, the first symptoms of improvement are seen after six weeks.

      5. Specific phobias

      Specific phobias are not common in patients with ADD, leaving aside fears related to the disorder itself, such as a phobia of weight gain or the consumption of foods in particular, particularly high in fats and carbohydrates. These types of fears are treated with anorexia because they are symptoms of it. It makes no sense to deal with the patient’s body distortion or aversion to dishes like pizza or ice cream without considering their nutritional status or anorexia as a whole.

      It is for this reason that it is considered that apart from body and food phobias, specific phobias are also frequent in the population. anorexic than in the general population.

        6. Post-traumatic stress disorder (PTSD)

        PTSD has been considered to be a highly comorbid anxiety disorder with changes in eating behavior. We have seen that the more severe the ADD, the more likely it is that PTSD will occur and be more severe, Seeing-1 link between the two psychiatric conditions. In developed countries, where he has lived in peace for decades, most cases of PTSD were associated with physical and sexual abuse. It has been seen that about 50% of people with anorexia nervosa meet the diagnostic criteria for PTSD, the cause being mainly child abuse.

        However, there is a great deal of controversy between having experienced traumatic events and their effect on other co-morbid diagnoses. People who have experienced prolonged sexual abuse tend to have mood swings, unstable romantic / sexual relationships, and autolytic behaviors, the behaviors of which are symptoms associated with borderline personality disorder (BPD). This is where the possibility of a triple comorbidity arises: ADD, PTSD and BPD.

        The pharmacological route is complex for this type of comorbidity. It is common for the patient to experience severe mood swings, high intensity, and phobic behaviors., Which would suggest the use of an antidepressant and a benzodiazepine. The problem is that it has been seen that this is not a good option because, although the patient will see his anxiety reduced, there is a risk that he will end up overdosing, especially if the patient has obtained the drugs. from several professionals. This can have a negative effect on the crisis.

        In this case, it is necessary to explain to the patient that it will be difficult to treat anxiety completely pharmacologically, which allows a symptomatic but not total reduction of PTSD. It should be noted that some authors consider the use of atypical low dose antipsychotics rather than benzodiazepines to be more appropriate, as patients do not tend to adjust their dose.

          7. Substance abuse

          Substance abuse is a difficult area of ​​study in terms of co-morbidity with other disorders, as the symptoms can be mixed. It is estimated that about 17% of people with anorexia report alcohol abuse or dependence throughout their lifetime.. It should be noted that while there is sufficient data on alcoholism and ADD, it is not so clear what the rates of drug abuse, especially benzodiazepines, are in the anorexic population.

          Cases of anorexia combined with drug addiction are particularly delicate. When one of these is detected, it is necessary, before applying any pharmacological treatment, to put them in rehabilitation to try to overcome their addiction. Alcohol consumption in people with anorexia with a very low BMI complicates any pharmacological treatment.

          Bibliographical references:

          • Godoy-Sanchez, LI; Albrecht-Roman, WR and Mesquita-Ramírez, MN (2019) Psychiatric comorbidities of anorexia and bulimia nervosa in pediatrics. Tower. Nac. 11 (1), pages 17-26. ISSN 2072-8174. http://dx.doi.org/10.18004/rdn2019.0011.01.017-026.
          • Woodside, BD and Staab, R. (2006) Management of psychiatric comorbidity in CNS drugs for anorexia nervosa and bulimia nervosa 20: 655. Https://doi.org/10.2165/00023210-200620080-00004

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