Psychiatric and medical multimorbidity in anorexia nervosa, bulimia nervosa, and binge-eating disorder: An umbrella review of 61 meta-analyses and 213 meta-analytic associations.
Michele Fornaro, Chiara Di Lorenzo, Francesco Monaco et al.
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In 30 seconds
This umbrella review synthesized meta-analyses of observational studies on psychiatric and medical multimorbidity involving anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED). Across 61 meta-analyses, the authors assessed 213 estimates for credibility and methodological quality. Of 134 prevalence estimates, 91 (67.9%) met moderate-to-strong credibility criteria. Examples included personality disorders in AN and BN, non-suicidal self-injury in BN, and tobacco use disorder in BED. By contrast, no re-pooled risk-factor or outcome association reached convincing or highly suggestive credibility.
Key findings
- Of 134 prevalence estimates, 91 (67.9%) met moderate-to-strong credibility criteria.
- Any personality disorder prevalence was 49% (95% CI = 42-56%) in AN and 54% (47-61%) in BN.
- Non-suicidal self-injury prevalence in BN was 37% (31-43%); tobacco use disorder in BED was 47.7% (34.8-61.0%).
- No re-pooled risk-factor or outcome association reached convincing or highly suggestive credibility.
Why it matters
The review indicates that some comorbidity prevalence estimates are more credible than the evidence linking these disorders to risk factors or outcomes. This distinction can help frame comorbidity findings cautiously and underscores the value of assessing psychiatric and general medical conditions alongside eating disorders, while recognizing uncertainty in much of the association evidence.
What to keep in mind
The review covers only AN, BN, and BED, not the full spectrum of feeding and eating disorders. Evidence on risk factors and outcomes was substantially less certain than prevalence evidence.