Clinical features of bipolar spectrum with binge eating behaviour

- Among 1114 patients with bipolar spectrum disorder, 30% had any current binge eating behavior (BE) and 27% had BE plus an eating disorder (ED) diagnosis.
- As compared to patients without BE, patients with BE were younger and more likely to be female; had higher degrees of suicidality, mood instability, and anxiety disorder comorbidity; had a higher mean BMI and a higher rate of obesity; and had higher degrees general medical comorbidity.
- Patients with BE but no ED diagnosis were more similar to patients without BE, but the positive predictive value and specificity of BE predicting an ED was 0.90 and 0.96, respectively.
- BP with BE may not be as clinically relevant a sub-phenotype as BP with an ED, but may be an adequate proxy for the latter.

ObjectiveTo determine whether bipolar spectrum disorder with binge eating behavior (BE) is an important clinical sub-phenotype.MethodsPrevalence rates and correlates of different levels of BE were assessed in 1114 bipolar spectrum patients participating in a genetic biobank. BE and eating disorders (EDs) were assessed with the Eating Disorder Diagnostic Scale (EDDS). Psychiatric illness burden was evaluated with measures of suicidality, psychosis, mood instability, anxiety disorder comorbidity, and substance abuse comorbidity. Medical illness burden was evaluated with body mass index (BMI) and the Cumulative Index Rating Scale (CIRS).ResultsThirty percent of patients had any BE and 27% had BE plus an ED diagnosis. Compared with bipolar spectrum patients without BE, bipolar spectrum patients with BE were younger and more likely to be female; had significantly higher levels of eating psychopathology, suicidality, mood instability, and anxiety disorder comorbidity; had a significantly higher mean BMI and a significantly higher rate of obesity; and had a significantly higher medical illness burden. Bipolar spectrum patients with BE but no ED diagnosis were more similar to bipolar spectrum patients without BE than to those with an ED. Nonetheless, the positive predictive value and specificity of BE predicting an ED was 0.90 and 0.96, respectively.LimitationsAs only two patients had co-occurring anorexia nervosa, these results may not generalize to bipolar spectrum patients with restricting EDs.ConclusionBipolar spectrum disorder with broadly-defined BE may not be as clinically relevant a sub-phenotype as bipolar spectrum disorder with an ED but may be an adequate proxy for the latter when phenotyping large samples of individuals.