Co-occurring psychotic and eating disorders in England: findings from the 2014 Adult Psychiatric Morbidity Survey

Abstract

Background Psychotic disorders and eating disorders are complex mental illnesses associated with increased mortality and functional impairment. This study aimed to investigate the co-occurrence and relationships between eating disorders and psychotic disorders and assess the mediation effect of mood instability. Methods This study used data from the Adult Psychiatric Morbidity Survey (APMS) 2014, a general population-based survey in England. Participants (total N = 7546, female N = 4488, male N = 3058, mean age = 52.3 years) were categorised based on psychotic disorder status into the groups of probable psychosis, diagnosed psychosis, and healthy controls without psychosis. The dependent variable of this study was the presence or absence of an eating disorder, with mood instability as the mediator. Logistic regression and mediation analyses were conducted to assess the relationships between these variables. Results Both probable and diagnosed psychoses were significantly related to the presence of an eating disorder, and mood instability was found to be a mediating variable with moderate effect. Conclusion The present study demonstrates a significant relationship between eating disorders and psychotic disorders in the English general population, indicating higher levels of co-occurrence between these two groups of disorders than when compared with healthy controls. The findings also suggest the relationship between eating and psychotic disorders is mediated, to an extent, by the presence of mood instability traits. Future research could extend the present study’s findings through assessing whether specific eating disorders are more significantly related to psychotic disorders than others.

Kleine Levin Syndrome: Is it just a sleep disorder? A review of psychiatric features during symptomatic and asymptomatic periods

“…In particular, impaired sleep in the form of either insomnia or hypersomnia and sometimes both, are extremely common is psychosis indicating the presence of circadian rhythm alterations (15,16). Hypersexuality is frequently encountered in patients with mania and those with bipolar schizoaffective disorder while eating disorder, either anorexia or bulimia,are common in psychosis with emphasis on mood disorders (17) .…”

Body image as a mediator in the relationship between psychotic experiences and later disordered eating: A 12-month longitudinal study in high school adolescents

“…Findings from clinical studies showed a high prevalence of comorbidity between psychotic disorders and EDs (Khalil et al, 2011; Kouidrat et al, 2014). One of the largest population-based studies on the topic was conducted in England (i.e., the Adult Psychiatric Morbidity Survey) (Rodgers et al, 2022), and demonstrated that community adults (mean age = 52.3 years) categorized as either with probable or diagnosed psychoses reported significantly more EDs than healthy controls without psychosis. A recent systematic review encompassing 31 studies and 471,158 participants showed elevated rates of binge eating symptoms (8.9%–45%), food craving (16.1%–64%), food addiction (27%–77.4%), night eating (4%–30%), and disordered eating behaviors (10%–41.5%) among individuals with schizophrenia spectrum disorders ( N = 2,651) (Sankaranarayanan et al, 2021).…”

“…Possible shared pathophysiological pathways have also been hypothesized, including dopamine dysfunction, which is an established feature of psychotic disorders (Howes et al, 2012) and a previously described characteristic associated with EDs (Barry & Klawans, 1976; Frank et al, 2018). Other potential risk factors known to be implicated in both PEs and EDs have been proposed as mechanisms linking the two entities, such as cognitive impairments (e.g., deficits in visuospatial and global/local processing [Madsen et al, 2013; Watson, 2013]), mood instability (Rodgers et al, 2022), as well as reduced cognitive and emotional control (Hauser et al, 2011). In an attempt to explain in greater depth the relationship between EDs and psychosis, Seeman (2014) delineated seven hypotheses, including that body image distortions of EDs would represent delusional-like experiences related to psychotic disorders.…”

What kind of illness is anorexia nervosa? Revisited: some preliminary thoughts to finding a cure

“…Is it a misperception of body image as Bruch alluded to [ 17 ], or a psychotic illness? [ 18 ]. Is it a phobia of normal body weight as Crisp described?…”