(14) Comorbid Substance Use Disorders in Individuals with Diagnosed Eating Disorders

Background & Introduction: Eating disorders (EDs) are surging in the U.S. and worldwide. The prevalence of co-occurring mental health problems in youths with EDs are not well understood, even as under-treated mental health comorbidities are known to portend worse ED outcomes. Previous literature has indicated that screening and treatment for substance use disorder (SUD) should be offered to people receiving treatment for ED because co-occurrence of ED and SUD is relatively common. Additionally, research has identified specific patterns of co-occurring alcohol use and eating disorder behaviors to avoid weight gain from alcohol consumption. However, up-to-date, population-level data on the prevalence of comorbid SUD in people with ED are lacking. To address this critical gap in research, we used real-time electronic health records (EHRs) to estimate the rates of psychiatric comorbidity in young people with ED.

Methods: We conducted a retrospective cohort study using the TriNetX databases, a large deidentified federated multinational network of healthcare organizations with access to real-time EHR dataset. First, we compared psychiatric comorbidities in the 365 days preceding index events in two groups: patients diagnosed with EDs identified by International Classification of Diseases-10 Clinical Modification (F50), (n=14,524), and peers without EDs initiating antidepressants (n=110,051). We then curated a 1:1 propensity score matched cohort of people receiving index ED diagnoses (study cohort, n=13,707), and peers without EDs initiating antidepressants (control cohort, n=13,707) between 1/1/2022 and 12/31/2022. The propensity score was estimated on the basis of age, sex, and ethnoracial covariates. Our primary outcomes were 1-year risk of comorbidities related to substance use, represented by the odds of co-occurring substance use related diagnoses in the 365 days following index events. Adjusted odds ratio (aOR) and 95% confidence interval (CI) in the ED cohort, compared to controls, were estimated using multinomial logistic regression.

Results: Our sample encompassed 13,707 people with EDs (10,643 females, mean age 15.9 years; 68.1% White) and 13,707 matched controls. After propensity score matching, EDs were significantly associated with substance use disorder, aOR [95% CI], 1.25 [1.14, 1.37]; cannabis use disorders, 1.40 [1.23, 1.58]; alcohol use disorders, 1.61 [1.32, 1.98]. EDs were not significantly associated with opioid use disorder, 1.17 [0.79, 1.72]; nicotine use disorder, 1.11 [0.96, 1.27]; and other stimulant use disorders, 1.25 [0.84, 1.85].

Conclusion & Discussion: This large population-based analysis of real-world administrative claims suggests that co-occurring substance use related disorders are prevalent in people with EDs, with elevated risk compared to peers without EDs initiating antidepressants. These findings may indicate a treatment gap in this understudied population, and raises future questions for study regarding potential relationships between the development of eating disorders and substance use disorders. Results from this study may help inform more comprehensive interventions by clinicians and policy makers to better serve individuals with ED. The TriNetX database only allows us to analyze data from patients who are ill-enough or systemically-enfranchised enough to receive care, which may limit the generalizability of these findings to the potentially larger community of individuals living with ED.

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