Research report The relationship of bulimia and anorexia nervosa with bipolar disorder and its temperamental foundations Anna V. Lunde a,b , Ole B. Fasmer c,d , Kareen K. Akiskal b , Hagop S. Akiskal b , Ketil J. Oedegaard b,c,d, ⁎ a Department of Clinical Psychiatry Risskov, Aarhus University Hospital, Denmark b International Mood Center, University of California, La Jolla, CA, USA c Division of Psychiatry, Haukeland University Hospital, Bergen, Norway d Institute of Clinical Medicine, University of Bergen, Norway Received 16 June 2008; received in revised form 30 September 2008; accepted 4 October 2008 Available online 12 November 2008 Abstract Background: Earlier studies have suggested a relationship between bipolar disorder (BP) and eating disorders (ED), more specifically, bulimia nervosa (BN) and bipolar II disorder (BP-II). In the present report we extend this relationship to broader definitions of bipolarity. Methods: Semi-structured interview of 201 patients with DSM-IV criteria for major affective disorders combined with Akiskal and Mallya criteria for Affective temperaments. To diagnose lifetime comorbid eating disorders DSM-IV criteria for eating disorders (Bulimia Nervosa, BN, Anorexia, AN) were used. Results: 33 patients had an eating disorder. When compared to patients without ED the patients with ED had a higher prevalence of bipolar disorders. Using strict DSM-IV criteria, this association was only significant for BN (OR) 4.5 (95% CI 1.1–17.6). When using a broader index of bipolarity including patients having affective temperaments, a significant relation was found for BN (OR) 9.1 (95% CI 1.1–73.6), and for patients with a lifetime history of both BN and AN (OR) 8.6 (95% CI 1.1–70.2).We also found patients with ED to have a significantly higher prevalence of affective temperaments, an earlier onset of major affective disorder and to have more depressive episodes. Limitations: Non-blind evaluation of diagnosis for mood, eating disorders and affective temperaments. Conclusion: In line with previous reports we describe an association between bulimia nervosa and bipolar disorder. Furthermore we report a relationship between lifetime bulimia and anorexia and cyclothymic and related affective temperaments. © 2008 Elsevier B.V. All rights reserved. Keywords: Bipolar disorder; Bipolar spectrum; Eating disorder; Affective temperaments 1. Introduction Eating disorders (ED) and major affective disorders are both disorders with major public health and clinical importance. It has been well documented earlier that there is a co-morbidity of these disorders (Hudson et al., 1987; Journal of Affective Disorders 115 (2009) 309 – 314 www.elsevier.com/locate/jad ⁎ Corresponding author. International Mood Center, University of California at La Jolla, San Diego, USA. E-mail addresses: koedegaar@ucsd.edu, keti@haukeland.no (K.J. Oedegaard). 0165-0327/$ - see front matter © 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2008.10.012