ETD

• Anorexic-Bulimic Spectrum
• Bipolar Disorders
• Bipolar Spectrum
• Eating Disorders
• Mood Disorders
• Mood Spectrum
• Sleep
• Soft Bipolar Dimension

Background - Lifetime mood spectrum signs and symptoms might be present in patients with Anorexic-Bulimic Spectrum Disorders, with relevant impact on their course and response to treatments.
Aims - The aim of the study was to assess the lifetime occurrence of signs and symptoms belonging to the mood spectrum in patients with eating disorders and no full-blown comorbidity for bipolar or unipolar disorders. The second aim was to assess body-related issues, including body dissatisfaction and dysmorphic concerns. The third aim was to evaluate sleep characteristics of patients with full-blown eating disorders (EDs) comorbid with mood spectrum phenomenology.
Material and Methods
A sample of 179 female patients with Anorexia Nervosa restrictive subtype (AN-R), Anorexia Nervosa Binge-Purging subtype (AN-BP), and bulimia nervosa (BN) was assessed with the following questionnaires: MINI (for the diagnosis of Axis I of the DSM-IV), SCI-ABS (to assess anorexic-bulimic spectrum symptoms), MOODS-SR (to identify mood spectrum symptoms and sleep patterns), W-SAS (to quantify functional impairment), EAT-26 (for the assessment of typical eating behaviors).
Results - Mood spectrum manifestations were present in patients with EDs, with significant differences between AN-R/BP and BN. SCI-ABS revealed significantly higher scores in ‘body dissatisfaction’ and ‘secondary social phobia’ dimensions, in patients with BN vs. AN-R/BP. MOODS-SR assessment revealed a greater presence of soft bipolar spectrum signs and symptoms in patients with BN, with five depressive factors and six hypo/manic factors more represented in BN. Correlation analyses between MOODS-SR factors and SCI- ABS ‘body dissatisfaction’ and ‘secondary social phobia’ were highly significant. Patients with more severe functional impairment (58.2% of the sample) were identified by WSAS as having more relevant bipolar spectrum phenomena, regardless of ED diagnoses.
BN participants scored higher than AN-R/BP on Sleep Pattern 3 (MOODS-SR), reflecting greater bipolar-spectrum sleep features (p = .005). Logistic regression indicated that hypersomnia and seasonal or menstrual-related sleep changes (items 138, 142, 145, 148) were more prevalent in BN, while insomnia-related items showed no group differences.
Conclusions - Study results highlighted the clinical relevance of the sub-threshold mood spectrum assessment in patients’ EDs, even in the absence of an Axis I comorbidity. The presence of a ‘soft bipolar dimension’ characterized a specific phenotype of patients with EDs, in which the two dimensions ‘body dissatisfaction’ and ‘secondary social phobia’ were over- represented. Mood spectrum has been shown to interfere with the overall functioning and adaptation of EDs patients, regardless of categorical diagnoses.
Furthermore, our findings suggest that sleep disturbances may represent an early and dimensional marker of affective instability and subthreshold bipolar vulnerability. These results lend support to a dimensional model of affective psychopathology and point to important implications for the clinical assessment and therapeutic management of EDs.

Contesto - Questo studio parte dall’idea che le persone con disturbi alimentari, come anoressia e bulimia, possano presentare sintomi legati all’umore nel corso della vita, anche senza una diagnosi vera e propria di disturbo dell’umore. Questi sintomi possono influenzare l’andamento della malattia e la risposta ai trattamenti.
Obiettivi - L’obiettivo era capire quanto siano presenti questi sintomi, come si collegano al rapporto con il proprio corpo (ad esempio insoddisfazione corporea e preoccupazioni sull’aspetto) e se esistono caratteristiche particolari del sonno in questi pazienti.
Metodi - Sono state studiate 179 donne con diversi disturbi alimentari attraverso questionari clinici specifici.
Risultati - I risultati mostrano che i sintomi dello spettro dell’umore sono abbastanza comuni. In particolare, le persone con bulimia presentano più spesso caratteristiche simili a una forma lieve di bipolarità rispetto a quelle con anoressia. Nella bulimia si osservano anche livelli più alti di insoddisfazione corporea e ansia sociale, aspetti strettamente collegati ai sintomi dell’umore.
Inoltre, chi ha maggiori difficoltà nella vita quotidiana tende ad avere anche più sintomi dello spettro bipolare. Per quanto riguarda il sonno, le pazienti con bulimia mostrano più spesso alterazioni tipiche dello spettro bipolare, come dormire troppo o cambiamenti del sonno legati alle stagioni o al ciclo mestruale, mentre l’insonnia non varia molto tra i gruppi.
Conclusioni - Lo studio evidenzia che anche sintomi dell’umore non evidenti sono importanti nei disturbi alimentari. Esiste un gruppo di pazienti con una forma lieve di bipolarità, associata soprattutto a insoddisfazione corporea e ansia sociale. Questi aspetti influenzano il funzionamento quotidiano e suggeriscono che i disturbi alimentari vadano valutati in modo più flessibile, per migliorare la diagnosi e il trattamento.