Eating disorders, bipolar disorders and other mood disorders: complex and under-researched relationships

Claire McAulay; Phillipa Hay; Jonathan Mond; Stephen Touyz

摘要

BackgroundEating disorders are understood to no longer be the remit of lean adolescent girls alone [1], whatever pop culture offerings such as Netflix’s To The Bone might continue to present. Rather, people with eating disorders are much more diverse, often undiagnosed and often suffering in silence. One patient population with a unique but poorly understood vulnerability to eating disorders, as well as obesity and poor physical health, is people with bipolar disorder.Bipolar disorder is a complex, serious mental illness that confers significant functional impairment, primarily due to time spent in manic, depressed, or mixed state episodes, difficulty eliminating subthreshold depressive symptoms, and the financial, social and emotional sequelae of illness episodes. One significant contributor to disability is physical ill health, with the average life expectancy of someone with bipolar disorder notably reduced due to cardiometabolic illnesses like heart disease and type two diabetes mellitus. Furthermore, poorer physical health is associated with poorer mental health in this group, such as higher risk of depressive relapse [2, 3].The past two decades has seen increased focus on preserving and improving the physical health of people with bipolar disorder, who are often prescribed long-term medication known to be conducive to weight gain [4]. Trials of a number of interventions have attempted to implement lifestyle interventions to promote healthy eating, physical activity, and social connectedness, in order to prevent or reduce the adverse impact of obesity and improve physical health and psycho-social functioning [5]. These have been of limited long-term effectiveness, though early intervention post-first episode psychosis appears to be more promising [6].The role of disordered eating in contributing to physical and mental health outcomes among individuals with bipolar disorder has rarely been considered, despite the fact that approximately one in three people with bipolar disorder also meet criteria for binge eating disorder, bulimia nervosa, or variants of these disorders [7, 8]. Alongside studies questioning the impact of medication on weight gain in bipolar disorder [9], identifying the role of weight-cycling in higher cardiovascular risk [10], and showing that obesity risk pre-dates medication [11], are reports of a link between eating disorders and high Body Mass Index (BMI, kg/m2) [12] and evidence that baseline binge eating predicts medication-associated weight gain [13].With these recent developments in mind, the authors were curious about what novel interventions for eating disorders and weight disorder in bipolar disorder exist, and conducted a systematic review about their effectiveness.Footnote 1 In this search no treatments targeting eating disorders specifically were found to exist [14], despite the movement of this area into the spotlight over 10 years ago [15]. Most treatments of people with a high BMI in bipolar disorder neglect psychological factors with the exception of [16], and people with bipolar disorder are often though not always; see [17] excluded from eating disorder treatment trials e.g. [18, 19]. Hence, the effectiveness of Cognitive Behaviour Therapy (CBT) or other common treatments for eating disorders have not been evaluated among individuals with this comorbidity.One reason for the lack of treatment protocols is our poor understanding of the detail of eating disorders in bipolar disorder. This includes: whether eating disorders in bipolar disorder resemble eating disorders in those without bipolar disorder; what modifiable factors predict eating disorder risk; which temperamental factors or psychological mechanisms, such as impulsivity and emotion regulation, may be at play, and to what extent,; when eating disorder and bipolar disorder features first present and subsequently interact across the lifespan; and whether antipsychotic use remains relevant to obesity risk to when controlling for other factors. While one theory argues that impulsivity is probably the shared factor between mania and binge eating [20], other studies have suggested that higher impulsivity in this group is not unique enough to this subgroup, being elevated in bipolar-only patients, and is likely subsumed by other variables such as eating-disordered cognitions [21].To answer these questions, the authors (CM, JM and ST) have undertaken a series of studies, in Australia and the Netherlands, addressing these and other aspects of the association between bipolar disorder and eating disorders, using a comprehensive assessment of eating disorder features so as to avoid the loss of information inherent in categorical assessment. Preliminary findings have been instructive with our team able to isolate weight and shape overvaluation, dietary restriction and binge eating as particularly common, and unique contributors to poorer quality of life, among people with bipolar disorder [22]. Furthermore, data from bot

机译：背景紊乱被理解为单独的瘦粉青少年的缺点[1]，无论诸如Netflix的流行文化产品是否可能会继续存在。相反，患有饮食障碍的人更多样化，往往是未经核查的，并且经常陷入沉默。一种患者人口，具有独特但不善的脆弱性疾病，以及肥胖和身体健康状况不佳，是双相情感障碍的人。宝波障碍是一种复杂的，严重的精神疾病，赋予了显着的功能障碍，主要是由于所花费的时间狂躁，抑郁或混合状态集，难以消除亚阈值抑郁症状，以及疾病发作的金融，社会和情感后遗症。残疾的一位重要贡献者是身体健康的健康，由于心脏病等心脏病疾病和两种糖尿病患者，具有双相障碍的人的平均预期寿命。此外，较差的身体健康与该组的较差的心理健康有关，例如抑郁复发的风险较高[2,3]。过去二十年来，较高的是对保存和改善具有双相情感障碍的人的身体健康的重点通常是规定的长期药物，已知有利于体重增加[4]。许多干预措施的试验试图实施生活方式干预措施，以促进健康的饮食，身体活动和社会关联，以防止或减少肥胖的不利影响，并改善身体健康和心理社会功能[5]。这些具有有限的长期效果，尽管首次发作后的早期干预似乎是更有希望的[6]。饮食中的作用很少被认为是具有双相情感障碍的个体的身心健康成果，很少被考虑，尽管具有双相情感障碍的三个人中大约一个人也符合狂犬病的标准，但这些疾病的贪婪性贪婪症或变异性[7,8]。除了研究中，提出药物对双极性障碍的重量增益的影响[9]，鉴定重量循环在更高的心血管风险中的作用[10]，并显示肥胖风险预期药物[11]是链接的报道饮食障碍和高体重指数（BMI，kg / m2）[12]和基线狂犬病的证据预测药物相关的重量增益[13]。与这些最新的发展中，作者对哪些新的干预措施感到好奇存在于双相障碍中的饮食障碍和体重障碍，并进行了对其有效性的系统审查。在该搜索中，除了本领域的靶向饮食障碍的治疗情况下没有治疗，尽管该区域在10年内流入聚光灯以前[15]。除了[16]之外，双相情感障碍忽视心理因素的大多数人的治疗方法忽视了心理因素，而且虽然并非总是虽然具有双相情感障碍的人。见[17]除了吃障碍治疗试验之外的[17]。 [18,19]。因此，在具有这种合并的个体中，尚未评估认知行为治疗（CBT）或其他常见治疗侵蚀性疾病的常见治疗的有效性。缺乏治疗方案的原因是我们对双相情感障碍饮食疾病细节的理解差。这包括：在没有双相情感障碍的那些中，双相情感障碍是否在患者中进食障碍;什么可修改的因素预测饮食障碍风险;哪些气质因素或心理机制，如冲动和情绪调节，可能在比赛，在多大程度上;进食障碍和双相情感障碍的特征首先存在，随后在寿命周围互动;在控制其他因素时，抗精神病症是否与肥胖风险相关。虽然一个理论认为，冲动可能是躁狂症和狂犬病之间的共同因素[20]，但其他研究表明，该组的冲动较高，对于该亚组不足，在双极性患者中升高，并且可能归入通过其他变量，如饮食失调的认知[21]。要回答这些问题，作者（CM，JM和St）已经在澳大利亚和荷兰进行了一系列研究，解决了双极之间的关联和其他方面的研究紊乱和饮食障碍，利用综合评估进食障碍功能，以避免损失分类评估中固有的信息。我们的团队能够孤立体重和形状过高，饮食限制和狂暴，以及与双极性障碍的人们特别普遍，饮食限制和狂欢，以及独特的贡献者的初步调查结果是有益的此外，来自Bot的数据

Eating disorders, bipolar disorders and other mood disorders: complex and under-researched relationships

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