Associations of the severity of depressive disorders in women with psychogenic low weight

Background: Depressive disorders are common in patients with anorexia nervosa (AN). Although depression with AN has been considered to be mainly secondary to the features of AN, other characteristics of such patients may also be causal, as personality disorders (PDs) often occur with AN and there are indications that PDs are causal factors for some depressive disorders. This study examined associations of the severity of depressive disorders in patients with low weight and a history of full or partial AN, to determine which characteristics of patients with AN are candidates as causal factors for depression in this context. Methods: 66 patients of a psychiatric ‘low-weight’ clinic completed self-report questionnaires. These patients presented with a mean body mass index (BMI) of 17.0 (S.D. 1.4) and their mean lowest BMI after the age of 16 had been 15.2 (S.D. 1.3). Results: Beck Depression Inventory (BDI) ratings were significantly associated with a range of eating disorder features (including age at presentation but not BMI) and with characteristics of a range of DSM-III-R PDs. Limitations: BDI ratings do not reflect clinical heterogeneity of depressive disorders, while self-report data for PD psychopathology can be subject to confounding variables. Conclusions: The results suggest that, first, features of AN (but not the degree of weight loss), and, second, psychopathology related to some features of all three DSM-III-R PD clusters may have causal roles in relation to depressive disorders in patients with AN and its variants. The findings indicate the need to consider a range of features of PDs in the management of patients with depression and AN.