Comorbid Eating Disorders in a Sample of Youth With Bipolar Disorder: Elevated Burden of Dimensional and Categorical Psychopathology.

Objective: There is growing recognition of the importance of comorbid eating disorders (ED) among individuals with bipolar disorder (BD). However, most studies on this topic have focused on adult samples, and little is known regarding comorbid ED among youth with BD.Methods: The sample included 197 youth with DSM-IV BD (BD-I, BD-II, or BD-NOS [not otherwise specified]), aged 13-20 years and recruited from a subspecialized clinic within a tertiary academic health sciences center from 2009 to 2017. Univariate analyses examined demographic and clinical variables among participants with versus without lifetime DSM-IV ED. Variables significant at P < .10 were entered into a backward stepwise regression.Results: Fifty-six participants (28.4%) had lifetime DSM-IV ED (3.6% anorexia nervosa, 8.1% bulimia nervosa, 16.8% ED not otherwise specified). Significant correlates of lifetime ED were female sex (P < .001), BD-II subtype (P = .03), suicidal ideation (P = .006), suicide attempts (P = .004), non-suicidal self-injury (P < .001), sexual abuse (P = .02), cigarette smoking (P = .001), anxiety disorders (P = .004), posttraumatic stress disorder (P = .004), substance use disorders (P = .006), history of individual therapy (P = .01), and family history of anxiety (P = .01). Significant correlates of no lifetime ED were BD-I subtype (P < .001) and lifetime lithium use (P = .01). The ED group had significantly more severe lifetime depression (P < .001) and significantly more self-reported affective lability (P < .001) and borderline personality traits (P < .001). In multivariate analysis, the most robust predictors of lifetime ED were female sex (odds ratio [OR] = 4.61, P = .004), BD-I subtype (OR = 0.21, P = .03), cigarette smoking (OR = 2.78, P = .02), individual therapy (OR = 3.92, P = .03), family history of anxiety (OR = 2.86, P = .02), and borderline personality traits (OR = 1.01, P = .009).Conclusions: ED are common among youth with BD and associated with adverse clinical characteristics, many of which converge with prior adult literature. Future studies evaluating specific ED subtypes are warranted, as are treatment studies targeting comorbid ED in youth with BD.

Three Types of Adverse Childhood Experiences, and Alcohol and Drug Dependence Among Adults: An Investigation Using Population-Based Data.

BACKGROUND: There are several gaps in the literature on the link between adverse childhood experiences (ACEs) and substance use, including the impact of less direct forms of abuse, such as witnessing domestic violence, and the role of gender as a moderator of the relationship. OBJECTIVES: To estimate associations between three types of ACEs (sexual abuse, physical abuse, and exposure to parental domestic violence), when mutually adjusted, and two substance dependence outcomes (alcohol and drug dependence), while considering the potential moderating role of gender and the effects of a range of potential explanatory factors. METHODS: Secondary analysis of the nationally representative Canadian Community Health Survey-Mental Health (2012) using logistic regression (n = 21,554). A series of models were tested separately for each outcome, including ACEs, gender, race, and age. First, gender interactions were tested. Next, potential explanatory factors were entered into the models and the extent of attenuation was noted. These factors included: depression, anxiety, smoking, pain, insomnia, social support, and socioeconomic status RESULTS: All three ACEs are associated with significantly higher odds of alcohol and drug dependence, even when controlling for all factors simultaneously; however, no strong evidence for gender interactions was found. In the fully adjusted model, odds ratios for drug dependence vary from 2.52 (sexual abuse) to 1.34 (exposure to domestic violence). The comparable range for alcohol dependence is 2.13 (physical abuse) to 1.49 (exposure to domestic violence). CONCLUSIONS/IMPORTANCE: Three types of ACEs, including direct and indirect forms of violence, are independently related to lifetime drug and alcohol dependence among adult Canadians.