Co-existence of clinical high-risk for psychosis and bipolar disorder: a multi-dimensional psychopathological analysis.

Eating disorders (EDs) are characterized by preoccupation with body weight and shape, and dysfunctional eating patterns [, ]. In Western countries, the prevalence has been estimated to about 2–3% in females and less than 1% in males []. Particularly, the transition from adolescence to adulthood is a vulnerable period for developing EDs [] and other mental health problems and disorders []. These include suicide attempts, self-harm and suicidal ideation [, ], and common mental disorders like anxiety and depressive disorders [], all major public health concerns serving as important markers of mental distress as well as predictors of future suicide []. Among individuals with anorexia nervosa (AN), medical complications are the leading cause of death, followed by suicide []. Self-harm and suicidal behaviours arise from interactions between predictors [], such as gender, psychological distress, socioeconomic status, physical health, early life neglect and abuse, bullying, loneliness and financial situation [, , , ]. One-quarter to one-third of adolescents and adult patients with AN, bulimia nervosa (BN), or binge eating disorder (BED) report suicidal ideation, and similar proportions of patients with AN or BN have attempted suicide []. Further, self-harm is associated with lower recovery rates in EDs []. Findings from a systematic review and meta-analysis indicate that ED populations have an increased prevalence of suicide attempts, self-harm and suicidal ideation compared to psychiatric controls (including major depressive disorder, personality disorder, bipolar disorder, and other non-psychotic disorders) []. A meta-analysis of 32 334 individuals with EDs confirmed that those with AN and BN reported the highest prevalence of self-harm []. Another large systematic review and meta-analysis, including 29 studies from 11 countries, found that about one in three ED patients reported life-time prevalence of self-harm []. Disordered Eating (DE) is common in young people and concerning from a public health perspective, highlighting the need to implement strategies for preventing EDs []. DE is seen as a part of a continuum and present an “at risk” status [, ], often used when symptoms of abnormal eating are present but not reaching the threshold of an ED diagnosis []. DE associates with mental distress [] and has been linked to later EDs [, ]. A Norwegian study on more than 7 000 adolescents found an association between suicidal ideation and DE, and especially in males [], while a UK study on students found a co-occurrence of DE and self-harm in 4.5–4.9% of the students [].