AN Patients: A Symptom That Might Be Overlooked

Physicians treating patients with anorexia nervosa (AN) face a wall of symptoms, many of which are serious and even life-threatening. AN produces one of the highest mortality rates among psychiatric conditions, but potential predictors of mortality, such as comorbid psychiatric illnesses, remain unclear. A recent study turned up what might be an unexpected source of illness tied to mortality among a group of anorexic women participating in a prospective longitudinal study (Arch Gen Psych 2003;60:179).

Pamela Keel, MD and colleagues at Harvard University found a high rate of alcoholism among a group of women with either DSM-IV anorexia nervosa (136) or bulimia nervosa (110) followed between January 1, 1987, and December 31, 1991. In fact, one of the predictors of mortality among anorexics in the study was severe undiagnosed alcoholism.

The authors suggest that physicians treating patients with anorexia nervosa carefully assess patterns of alcohol use during the course of care. One-third of the women in their study who had alcoholism and died had no history of alcohol use at intake.