Psychiatric Comorbidity in Women With Binge Eating Disorder Prevalence Rates From a Non-Treatment-Seeking Sample Christy F. Telch Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Eric Stice Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine ABSTRACT This study provides estimates of comorbid psychiatric disorders in women with binge eating disorder (BED). Sixty-one BED and 60 control participants, who were recruited from the community, completed the Structured Clinical Interview for DSM—III—R Axis I and Axis II disorders and self-report measures of eating and general psychiatric symptomatology. Regarding psychiatric diagnoses, women with BED had higher lifetime prevalence rates for major depression, any Axis I disorder, and any Axis II disorder relative to controls. BED women also evidenced greater eating and psychiatric symptomatology than did controls. Results suggest that the prevalence of comorbid psychiatric disorders in BED may be lower than previously indicated by clinical studies. Eric Stice is now at the Department of Psychology, University of Texas at Austin. This research was supported in part by Grant MH50271 and a postdoctoral fellowship (MH19908) from the National Institute of Mental Health. We thank W. Stewart Agras for his comments on an earlier version of this article. Correspondence may be addressed to Christy F. Telch, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Room 1338, Stanford, California, 94305-5722. Electronic mail may be sent to [email protected] Received: July 7, 1997 Revised: December 17, 1997 Accepted: April 8, 1998 Research on binge eating disorder (BED) has mushroomed in the past decade, and a recent review concluded that BED is a significant clinical problem in U.S. society ( Castonguay, Eldredge, & Agras, 1995 ). Large community-based studies have reported prevalence rates for BED between 2% and 5% ( Bruce & Agras, 1992 ; Spitzer et al., 1992, 1993 ), and 20% to 40% of individuals in treatment for weight control meet criteria for BED ( Brody, Walsh, & Devlin, 1994 ; Gormally, Black, Daston, & Rardin, 1982 ; Marcus, Wing, & Lamparski, 1985 ; Spitzer et al., 1993 ). Moreover, research suggests that the severity of binge eating is associated with degree of overweight ( Bruce & Agras, 1992 ; Spitzer et al., 1993 ; Telch, Agras, & Rossiter 1988 ). Because BED is a proposed new diagnostic category based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM—IV ; American Psychiatric Association, 1994 ), researchers have attempted to elucidate the nature of BED, particularly with regard to comorbid Journal of Consulting and Clinical Psychology © 1998 by the American Psychological Association October 1998 Vol. 66, No. 5, 768-776 For personal use only--not for distribution. Page 1 of 1311/4/2000http://spider.apa.org/ftdocs/ccp/1998/october/ccp665768.htmlpsychopathology. Research using clinical samples has examined the relation of BED to eating pathology (e.g., overconcern with weight and shape) and psychiatric symptomatology (e.g., depressive and anxiety symptoms; Kolotkin, Revis, Kirkley, & Janick, 1987 ; Marcus et al., 1990 ; Schwalberg, Barlow, Alger, & Howard, 1992 ; Spitzer et al., 1993 ; Telch & Agras, 1994 ; Wilson, Nonas, & Rosenblum, 1993 ; Yanovski, Nelson, Dubbert, & Spitzer, 1993 ) as well as to the prevalence of psychiatric disorders ( Brody et al., 1994 ; Marcus et al., 1990 ; McCann, Rossiter, King, & Agras, 1991 ; Schwalberg et al., 1992 ; Yanovski et al., 1993 ). These studies have generally concluded that BED is associated with elevated eating and general psychiatric symptomatology, as well as with high rates of comorbid psychiatric disorders. However, estimates of comorbid psychiatric disorders in BED have been based primarily on studies using samples recruited for treatment trials. Within an obesity treatment trial, Marcus et al. (1990) found that a greater proportion of obese binge eaters met lifetime criteria for major depression relative to obese controls. McCann et al. (1991) , in a binge eating treatment study, found that women with bulimia nervosa and female obese binge eaters did not differ on lifetime prevalence of major depression (74% and 48%, respectively). Substantial lifetime prevalence rates of major depression or dysthymia (64%) and anxiety disorders (70%) based on the revised third edition of the DSM ( DSM—III—R ; American Psychiatric Association, 1987 ) were reported in 22 female obese binge eaters seeking treatment in an eating disorders clinic ( Schwalberg et al., 1992 ). Finally, Yanovski et al. (1993) reported on a sample of overweight men and women, one third of which was seeking treatment in a weight-loss study, and found that lifetime prevalence rates of major depression, panic disorder, bulimia nervosa, borderline personality disorder, and avoidant personality disorder were higher in participants meeting criteria for BED, compared with non-BED controls. It has been argued that findings from individuals seeking treatment may not be representative of persons with the disorder in the general population because these samples may overestimate comorbid pathology. This argument is based on a phenomenon called Berkson's bias, which states that persons with multiple diagnoses are more likely to seek treatment than persons with a single diagnosis ( Berkson, 1946 ). Moreover, most individuals with bulimia nervosa ( Fairburn & Cooper, 1982 ; Welch & Fairburn, 1994 ; Whitaker et al., 1990 ), and other psychiatric disorders ( Goodman et al., 1997 ; Robins, Locke, & Regier, 1991 ; Whitaker et al., 1990 ), do not seek treatment. For example, the Epidemiologic Catchment Area Study (ECA; Robins et al., 1991 ) suggested that only 13% of individuals with a single psychiatric disorder received treatment in the past year. Hence, data from individuals seeking treatment may not be representative of the population of persons with the disorder, potentially biasing estimates of comorbid disorders and general psychiatric symptomatology. Two additional methodological limitations of past studies should be noted. First, both Marcus et al. (1990) and Schwalberg et al. (1992) relied primarily on the self-report Binge Eating Scale (BES) to classify obese participants as binge eaters, and there is evidence that this scale may not
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