Defining comorbidity

My new friend Adam Lamparello posted the following on his Facebook page:

One thing that many people discuss when it comes to eating disorders is the issue of co-morbidity, that is, many people with anorexia, bulimia or any other eating disorder also struggle with depression, anxiety, obsessive compulsive disorder, etc. I agree with this, in part because I had the same problem and the research supports this fact. But now, research is showing that eating disorders, and factors such as low-self esteem and extreme sensitivity, may have biological roots. In other words, we may be pre-disposed to developing an eating disorder and be predisposed to having the factors that are common to causing the development of an eating disorder (although there are many other factors unique to the individual). There's one thing that I do disagree with, though, and that seems to be that ED experts separate the issues of eating disorders and depression, anxiety, OCD, etc. Hence the term co-morbidity. I would hypothesize that anorexia and bulimia can actually cause depression and anxiety disorders in an individual who would not necessarily be pre-disposed to these conditions. At the very least, eating disorders can make these conditions considerably worse in those individuals that are predisposed to mental health issues or would not necessarily develop such issues based on pre-disposition alone. In fact, I think they are intertwined, especially when we eventually know the extent of their biological roots.

Basically, right on.

A lot of the personality and eating disorders research seems to indicate that many sufferers have a cluster of different personality traits that seem to predispose them to EDs. The two general clusters tend to be over-controlled, anxious, and perfectionistic, and the other is impulsive, anxious, and novelty-seeking. Not surprisingly, these personality clusters also predispose people to co-occurring conditions like depression, OCD, and personality disorders.

I do think that some people truly have co-occurring conditions. I've had episodes of severe depression, anxiety, and OCD that were totally separate from my eating disorder. But the eating disorder also amplified my obsessive, anxious, perfectionistic temperament, and not in a good way. You can't tackle co-occurring conditions if you're not also tackling the eating disorder. As well, regular nutrition generally tends to improve co-occurring conditions. For some people, what looks like depression and anxiety and whatever else are actually side effects of starvation.

The truth is that no one really knows whether things like OCD and depression are part and parcel of an eating disorder or they exist alongside of it but totally separate. Another example would be red hair and green eyes--I am proud owner of both these traits. Although they do frequently appear together, plenty of people with red hair have blue or brown eyes, and my mom has green eyes and blonde hair.

As well, no one knows at exactly what level these temperament traits become pathological. At what point do they cease to become odd quirks and start to be something that needs treatment. So no one really knows.

It's a question I wish more psychologists and researchers took time to ask.


HikerRD said...

One of the presenter at the conference discussed the process of teasing this out a bit. (Don't ask me to recall who it was or the name of their session-- my note-taking skills are nothing compared to yours!). He described, appropriately, that many of these co morbidities will abate with renourishment, as we know. At that point, it makes sense to address the treatment of these other conditions (although I do recall they also acknowledged that if the coexisting anxiety is too great that it may need to be addressed at the start of treatment).
The point is that they did acknowledge that there could be secondary conditions which resolve with treatment, as we well know, or "free standing", so to speak, conditions that cluster with eating disorders.
Sorry for the long windedness of this response!

Thanks for summarizing these topics so well!

hm said...

My co-morbid conditions (being obsessive, anxious, depressed) came first. I think an ed just feels like a "perfect outlet" to a person with an itchy feeling need to have rigid internal structure- it scratches that itch. But then, of course, it ends up complicating things...

Anonymous said...

Agreed and I would also add that this can work the other way round as well, with 'comorbid' conditions coming first and playing a part in triggering the ED (depression causes loss of appetite in many after all). Of course they will also be exacerbated by the ED too which is helpful ;)

Anonymous said...

Hmm. Anxiety, bouts of depression and OCD pre-dated my AN and post-date it. Unfortunately, good nutrition doesn't help any of these co-morbidities that I have. But I do know that for some others, anxiety, depression and OCD are symptoms of an ED.

I would actually say that for me, AN was a symptom of pre-existing OCD, rather than being a separate disorder.

Unknown said...

So right!

Anonymous said...

I am interested in the co-morbidity. I have bipolar I and anorexia. Bipolar pre-dated the anorexia and that runs rampant in my family. I am also a recovered alcoholic, many years sober. I have heard that ED's have an addictive nature to them and that seems to be so for me. I had a perfectionistic personality in school but I think the fact I had my first manic episode half way through college, and I felt pretty worthless, gave me this distorted idea that I was only ok if I was thin. Because I was crazy. I do notice the two disorders feed into each other. When mood is out of control I want to control food and weight to cope. When I am not getting properly nourished because of ED it drives my mood into a state of cycling.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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