The prevalence, odds and predictors of lifespan comorbid eating disorder among people with a primary diagnosis of bipolar disorders, and vice-versa: Systematic review and meta-analysis

Michele Fornaro, Federico Manuel Daray, Fernando Hunter, Annalisa Anastasia, Brendon Stubbs, Domenico De Berardis, Jae Il Shin, Muhammad Ishrat Husain, Elena Dragioti, Paolo Fusar-Poli, Marco Solmi, Michael Berk, Eduard Vieta, André Ferrer Carvalho

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)


Background: There are scarce and discrepant data about the prevalence and correlates of co-occurring eating disorders (EDs) among people with a primary diagnosis of bipolar disorder (BD), and vice-versa, compelling a systematic review and meta-analysis on the matter. Methods: MEDLINE/PsycINFO databases were systematically searched for original studies documenting BD⇌ED comorbidity across the lifespan, from inception up until April 20th, 2020. Random-effects meta-analysis and meta-regression analyses were conducted, accounting for multiple moderators. Results: Thirty-six studies involved 15,084 primary BD patients. Eleven studies encompassed 15,146 people with primary EDs. Binge eating disorder (BED) occurred in 12.5% (95%C.I.=9.4-16.6%, I2=93.48%) of BDs, while 9.1% (95%C.I.=3.3-22.6%) of BEDs endorsed BD. Bulimia Nervosa (BN) occurred in 7.4% (95%C.I.=6-10%) of people with BD, whereas 6.7% (95%C.I.=12-29.2%) of subjects with BN had a diagnosis of BD. Anorexia Nervosa (AN) occurred in 3.8% (95%C.I.=2-6%) of people with BDs; 2% (95%C.I.=1-2%) of BD patients had a diagnosis of AN. Overall, BD patients with EDs had higher odds of being female vs. non-ED controls. Several moderators yielded statistically significant differences both within- and between different types of BDs and EDs. Limitations: Scant longitudinal studies, especially across different EDs and pediatric samples. High heterogeneity despite subgroup comparisons. Limited discrimination of the quality of the evidence. Conclusions: The rates of BD⇌ED comorbidity vary across different diagnostic groups, more than they do according to the “direction” of BD⇌ED. Further primary studies should focus on the risks, chronology, clinical impact, and management of the onset of intertwined BD⇌ED across different ages, promoting a continuum approach.

Original languageEnglish
Pages (from-to)409-431
Number of pages23
JournalJournal of affective disorders
Publication statusPublished - 2021 Feb 1

Bibliographical note

Funding Information:
MF, FD, FH, AA, DDB, JIS, ED, MS, AFC have no conflict of interest to disclose in conjunction with the present rereport. BS is supported by a Clinical Lectureship (ICA-CL-2017-03-001) jointly funded by Health Education England (HEE) and the National Institute for Health Research (NIHR). BS is part-funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust. BS also holds active grants with the Medical Research Council and Guys and St Thomas Charity (GSTT). The views expressed are those of the author(s) and not necessarily those of the (partner organization), the NHS, the NIHR, the Department of Health and Social Care, the MRC, or GSTT. MIH is a PI for a trial sponsored by COMPASS Pathways Limited for which he receives salary support and has previously served as Member, Board of Trustees for the Pakistan Institute of Living and Learning. MIH reports grants from the Brain and Behavior Research Foundation, Physician's Services Incorporated Foundation, Stanley Medical Research Institute, and the University of Toronto. MB is supported by a NHMRC Senior Principal Research Fellowship (1156072). EV has received grants and served as consultant, advisor or CME speaker for the following entities: AB-Biotics, Abbott, Allergan, Angelini, AstraZeneca, Bristol-Myers Squibb, Dainippon Sumitomo Pharma, Farmindustria, Ferrer, Forest Research Institute, Galenica, Gedeon Richter, Glaxo-Smith-Kline, Janssen, Lundbeck, Otsuka, Pfizer, Roche, Sage, Sanofi-Aventis, Servier, Shire, Sunovion, Takeda, the Brain and Behaviour Foundation, the Generalitat de Catalunya (PERIS), the Spanish Ministry of Science, Innovation and Universities (CIBERSAM), EU Horizon 2020, and the Stanley Medical Research Institute. PFP has received honoraria or grant fees from Lundbeck, Angelini, Menarini, Boehringer Ingelheim outside the current work.

Publisher Copyright:
© 2020 Elsevier B.V.

All Science Journal Classification (ASJC) codes

  • Clinical Psychology
  • Psychiatry and Mental health


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