Psychiatric Comorbidity in Eating Disorders

This chapter addresses common psychiatric morbidity in people with eating disorders. Mood-spectrum disorder but also addictive behavior, obsessive-compulsive disorder, neurodevelopmental disorders, anxiety disorders (generalized anxiety disorder and social anxiety), cluster B personality disorder, and post-traumatic stress disorder are frequently comorbid, also raising treatment questions around parallel versus consecutive treatment. Additionally, comorbidities raise questions of pathogenesis that may elucidate common pathways, including neurobiological traits and states. The existing literature has not fully embraced new categorizations of the American Psychiatric Association’s DSM-5 nor diverse cultural populations. Knowledge of psychiatric comorbidity provides fertile soil for treatment modifications, with existing treatments imperfectly fitting common comorbidities, such as autism spectrum disorder, cluster B personality disorder, and post-traumatic stress disorder. Treatments can fail these patients, yet patients with common comorbidities can instead be construed as failing in treatment. The purpose of the chapter is to highlight more common, empirically based comorbidity, but acknowledging other chapters with important overlap, including autistic spectrum, trauma, genetics, and personality vulnerability.