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19 May 2006
Obese women with binge-eating disorder (BED) are already at increased risk of suffering from comorbid psychopathology, including anxiety and depression, but smoking could increase this risk further, US investigators report.
"These patients may have a deficit in coping strategies, making them more prone to using substances and/or food to regulate emotion," Marney White and Carlos Grilo, from Yale University School of Medicine in New Haven, Connecticut, comment.
The researchers explored whether obese women with BED who had smoked at some point in their lifetime differed from their nonsmoking counterparts in lifetime rates of comorbid psychopathology.
A total of 103 obese treatment-seeking women with a current DSM-IV diagnosis of BED participated in the study and were asked to complete diagnostic interviews to assess all Axis I psychiatric disorders.
Fifty-two of the women had never smoked, 45 were former smokers, and six were current smokers.
For the group as a whole, 68.9% met the criteria for at least one additional lifetime psychiatric disorder, of which mood disorders (53.4%), anxiety disorders (36.9%), and substance use disorders (13.6%) were the most common.
Comparing daily smokers with never smokers, the researchers found that the presence of any Axis I psychiatric disorder was more common in daily smokers, at 81.4%, compared with 57.7% for non-smokers.
Specifically, smokers were significantly more likely than non-smokers to meet the criteria for co-occurring diagnoses of major depressive disorder (62.8% vs 40.4%), panic disorder (27.9% vs 7.7%), post-traumatic stress disorder (11.6% vs 1.9%), and substance abuse or dependence (16.3% vs 1.9%).
Recognizing that the presence of substance use dependence may have confounded the results, the team compared the groups after removing individuals with lifetime substance use dependence from the analysis.
"Although attenuated, the results showed a pattern of increased lifetime risk of anxiety disorders among lifetime smokers," White and Grilo report in the Journal of Clinical Psychiatry.
They conclude: "The results of this study indicate that women with BED and a history of smoking may be especially distressed, with higher rates of comorbid lifetime psychiatric diagnosis."
The researchers add: "There is a great need for treatments to address multiple impulse control behaviors as clinicians and patients struggle with important unanswered questions around treatment formulation and planning."
Source: J Clin Psychiatry 2006; 67: 594–599
©2006 Current Medicine Group Ltd
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