ORIGINAL ARTICLE Mood spectrum comorbidity in patients with anorexia and bulimia nervosa Mario Miniati 1 • Antonella Benvenuti 1 • Elena Bologna 1 • Alessandra Maglio 1 • Biagio Cotugno 1 • Gabriele Massimetti 1 • Simona Calugi 2 • Mauro Mauri 1 • Liliana Dell’Osso 1 Received: 8 August 2016 / Accepted: 7 October 2016 Ó Springer International Publishing Switzerland 2016 Abstract Purpose To investigate the presence of mood spectrum signs and symptoms in patients with anorexia nervosa, restricting subtype (AN-R) or bulimia nervosa (BN). Method 55 consecutive female patients meeting DSM-IV criteria for eating disorders (EDs) not satisfying DSM-IV criteria for Axis I mood disorders were evaluated with the Lifetime Mood Spectrum Self-Report (MOODS-SR) and the Mini-International Neuropsychiatric Interview (MINI). The MOODS-SR explored the subthreshold comorbidity for mood spectrum symptoms in patients not reaching the threshold for a mood disorder Axis I diagnosis. MOODS- SR included 161 items. Separate factor analyses of MOODS-SR identified 6 ‘depressive factors’ and 9 ‘manic- hypomanic factors’. Results The mean total score of MOODS-SR was signifi- cantly higher in BN than in AN-R patients (97.5 ± 25.4 vs 61.1 ± 38.5, respectively; p = 0.0001). 63.6 % of the sample (n = 35) endorsed the threshold of C61 items, with a statis- tically significant difference between AN-R and BN (39.3 % vs 88.9 %; v 2 = 14.6; df = 1; p = 0.0001). Patients with BN scored significantly higher than AN-R patients on several MOODS-SR factors: (a) MOODS-SR depressive component: ‘depressive mood’ (11.2 ± 7.4 vs 16.0 ± 5.8; p \ 0.05), ‘psychomotor retardation’ (5.4 ± 5.6 vs 8.9 ± 3.8; p = 0.003), ‘psychotic features’ (2.0 ± 1.8 vs 4.1 ± 1.6; p = 0.001), ‘neurovegetative symptoms’ (5.0 ± 2.6 vs 7.7 ± 1.7; p = 0.001); (b) MOODS-SR manic/hypomanic component: ‘psychomotor activation’ (4.3 ± 3.6 vs 7.4 ± 3.1; p = 0.002), ‘mixed instability’ (1.0 ± 1.5 vs 2.0 ± 1.6; p \ 0.05), ‘mixed irritability’ (2.5 ± 1.8 vs 3.7 ± 1.6; p \ 0.05), ‘inflated self-esteem’ (1.1 ± 1.4 vs 2.1 ± 1.6; p \ 0.05), and ‘wastefulness/recklessness’ (1.0 ± 1.4 vs 2.0 ± 1.2; p = 0.009). Conclusions MOODS-SR identifies subthreshold mood signs/symptoms among patients with AN-R, and BN and with no Axis I comorbidity for mood disorders, and pro- vides a better definition of clinical phenotypes. Keywords Anorexia Á Bulimia Á Eating disorders Á Mood spectrum and comorbidity Introduction A number of clinical studies document how the comor- bidity between mood disorders and anorexia (AN) and bulimia nervosa (BN) are a frequent phenomenon. How- ever, the variability of comorbidity percentages across studies is impressive. The lifetime comorbidity for mood disorders ranges from 24 to 90 % in BN, and from 31 to 88 % in AN [1, 2]. Traditionally, the highest rates of lifetime comorbidity for the ‘unipolar side’ of mood dis- orders mainly refer to the AN ‘restricter’ subtype (AN-R). The comorbidity for the ‘bipolar side’ (Bipolar I–II Disorders, cyclothymia) is more frequently described in BN [1]. Mood disorder comorbidity complicates course and treatment response of AN, and BN [3, 4], and it is asso- ciated with a high risk of suicide attempts [5–7]. Similarly, a negative impact of AN, and BN on the course and treatment response of depressive episodes has been & Mario Miniati mario.miniati@med.unipi.it 1 Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy 2 Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, 40126 Bologna, Italy 123 Eat Weight Disord DOI 10.1007/s40519-016-0333-1