Mood spectrum comorbidity in patients with anorexia and bulimia nervosa

  • Mario Miniati
  • Antonella Benvenuti
  • Elena Bologna
  • Alessandra Maglio
  • Biagio Cotugno
  • Gabriele Massimetti
  • Simona Calugi
  • Mauro Mauri
  • Liliana Dell’Osso
Original Article



To investigate the presence of mood spectrum signs and symptoms in patients with anorexia nervosa, restricting subtype (AN-R) or bulimia nervosa (BN).


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’.


The mean total score of MOODS-SR was significantly 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 ≥61 items, with a statistically significant difference between AN-R and BN (39.3 % vs 88.9 %; χ 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).


MOODS-SR identifies subthreshold mood signs/symptoms among patients with AN-R, and BN and with no Axis I comorbidity for mood disorders, and provides a better definition of clinical phenotypes.


Anorexia Bulimia Eating disorders Mood spectrum and comorbidity 


Compliance with ethical standards

Ethical statement

The Ethics Committee of the University of Azienda Ospedaliero-Universitaria of Pisa approved all study procedures.

Informed consent

All patients signed a written informed consent after receiving a complete description of the study and having the opportunity to ask questions.

Conflict of interest

The authors declare that they have no conflict of interest.

Data sharing statement

No basic research and clinical research studies that require a data-sharing statement were performed for this paper.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • 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
  1. 1.Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
  2. 2.Alma Mater StudiorumUniversity of BolognaBolognaItaly

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