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Eating disorders and subsequent risk of substance use disorders involving illicit drugs: a Danish nationwide register-based cohort study

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Abstract

Purpose

No study has investigated the ongoing risk of substance use disorders involving illicit drugs (ISUD) after first eating disorder (ED) and whether the pattern of risk differs according to types of ED and ISUD. Therefore, we aimed to longitudinally assess the risk of a subsequent diagnosis of any ISUD (pooled category) and specific ISUD after a first-time diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or unspecified ED (USED).

Methods

A retrospective cohort study using data from Danish nationwide registers identified 20,759 ED patients and 83,038 matched controls (1:4 ratio). Risk of any ISUD diagnosis after first ED diagnosis was estimated by generating hazard ratios (HR). Logistic regression was applied to assess associations between each ED and specific ISUD.

Results

Patients with AN, BN, and USED (without a prior ISUD diagnosis) exhibited an increased relative risk of a subsequent diagnosis of any ISUD compared with respective controls, and the elevated risk persisted over 10 years (AN, adjusted HRs ranging from 1.60 [99% CI 1.15–2.24] to 5.16 [3.14–8.47]; BN, 2.35 [1.46–3.79] to 14.24 [6.88–29.47]; USED, 2.86 [1.35–3.79] to 8.56 [3.31–29.47]). The highest estimates were observed during the first year of follow-up. Each ED type was associated with an increased likelihood of all types of ISUD. AN and USED were most strongly associated with sedatives/hypnotics, BN with other illegal substances (e.g., ecstasy and hallucinogens).

Conclusions

ED patients have a considerable risk for subsequent ISUD. Prevention efforts and treatment targeting ISUD are likely required to improve ED treatment prognosis.

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Availability of data and materials

Data will be made available upon request as long as Danish data regulation and legislation are complied with.

Code availability

Not applicable.

Notes

  1. The ICD-9 has never been implemented in Denmark.

  2. The ICD-11 will be implemented in Denmark in 2022.

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Acknowledgements

The authors would like to thank the Psychiatric Research Foundation for granting funding for this study.

Funding

This study was unconditionally funded by the Psychiatric Research Foundation, University of Southern Denmark, Region of Southern Denmark (Grant number: R67-A3037-B1261).

Author information

Authors and Affiliations

  1. Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark

    Lotte Skøt, Anna Mejldal, Maria Mercedes Guala, René Klinkby Støving & Angelina Isabella Mellentin

  2. Center for Eating Disorders, Odense University Hospital, Odense C, Denmark

    Maria Mercedes Guala & René Klinkby Støving

  3. Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark

    René Klinkby Støving

  4. Neuroplasticity Research Group, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Leonie Ascone

  5. Unit for Psychiatric Research, Children and Adults, Department of Regional Health Services Research, University of Southern Denmark, 6200, Aabenraa, Denmark

    Elsebeth Stenager

  6. Center for Telepsychiatry, Research Unit for Telepsychiatry and E-Mental Health, Region of Southern Denmark, Odense C, Denmark

    Mia Beck Lichtenstein & Angelina Isabella Mellentin

  7. Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense C, Denmark

    Angelina Isabella Mellentin

Authors
  1. Lotte Skøt
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  2. Anna Mejldal
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Contributions

MMG and AIM designed the study and got it funded. AM and AIM retrieved, managed, and analyzed the data. LS and AIM wrote the draft of the manuscript, and all the authors contributed to and approved the final manuscript.

Corresponding author

Correspondence to Lotte Skøt.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethics approval

The Danish Data Collection Agency approved this study. All data were anonymized prior to conducting the analyses. In Denmark, ethics committee review is not required for register-based studies and neither is informed patient consent.

Consent to participate

Not applicable.

Consent for publications

Not applicable.

Electronic supplementary material

Appendix 1

Appendix 1

ICD-10 psychiatric diagnoses and ICD-8 equivalents

F01–F09 Mental disorders to known physiological conditions

290.xx, 292.x9, 293.x9, 294.xx (excluding 294.30, 294.38, 294.39), 309.x9

F10–F19 Mental and behavioral disorders due to psychoactive substance use

291.x9, 294.30, 294.38, 294.39, 303.xx, 304.xx,

F20–F29 Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders

295.x9, 297.x9, 298.x9, 299.xx

F30–F39 Mood [affective] disorders

296.x9, 300.49, 300.59, 301.19, 301.69

F40–F49 Neurotic, stress-related and somatoform disorders

300.x9 (excluding 300.49, 300.59), 305.x9, 305.60, 305.68, 307.99

F60–F69 Disorders of adult personality and behavior

301.x9 (excluding 301.19, 301.69),301.80, 301.81,301.82, 301.83, 301.84

F70–F79 Intellectual disabilities

311.xx, 312.xx, 313.xx, 314.xx, 315.xx

F80–F89 Pervasive and developmental disorders

299.00,299.01, 299.02,299.03, 306.10, 306.11, 306.12

F90–98 Behavioral disorders

306.x 9 (excluding 306.59, 306.89), 306.18, 308.0x

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Skøt, L., Mejldal, A., Guala, M.M. et al. Eating disorders and subsequent risk of substance use disorders involving illicit drugs: a Danish nationwide register-based cohort study. Soc Psychiatry Psychiatr Epidemiol 57, 695–708 (2022). https://doi.org/10.1007/s00127-021-02201-x

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