Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder

S. L. McElroy, L. L. Altshuler, T. Suppes, Jr Keck, M. A. Frye, K. D. Denicoff, W. A. Nolen, R. W. Kupka, G. S. Leverich, J. R. Rochussen, A. J. Rush, R. M. Post

Research output: Contribution to journalArticlepeer-review

603 Scopus citations


Objective: Bipolar disorder often co-occurs with other axis I disorders, but little is known about the relationships between the clinical features of bipolar illness and these comorbid conditions. Therefore, the authors assessed comorbid lifetime and current axis I disorders in 288 patients with bipolar disorder and the relationships of these comorbid disorders to selected demographic and historical illness variables. Method: They evaluated 288 outpatients with bipolar I or II disorder, using structured diagnostic interviews and clinician-administered and self-rated questionnaires to determine the diagnosis of bipolar disorder, comorbid axis I disorder diagnoses, and demographic and historical illness characteristics. Results: One hundred eighty-seven (65%) of the patients with bipolar disorder also met DSM-IV criteria for at least one comorbid lifetime axis I disorder. More patients had comorbid anxiety disorders (N=78, 42%) and substance use disorders (N=78, 42%) than had eating disorders (N=9, 5%). There were no differences in comorbidity between patients with bipolar I and bipolar II disorder. Both lifetime axis I comorbidity and current axis I comorbidity were associated with earlier age at onset of affective symptoms and syndromal bipolar disorder. Current axis I comorbidity was associated with a history of development of both cycle acceleration and more severe episodes over time. Conclusions: Patients with bipolar disorder often have comorbid anxiety, substance use, and, to a lesser extent, eating disorders. Moreover, axis I comorbidity, especially current comorbidity, may be associated with an earlier age at onset and worsening course of bipolar illness. Further research into the prognostic and treatment response implications of axis I comorbidity in bipolar disorder is important and is in progress.

Original languageEnglish (US)
Pages (from-to)420-426
Number of pages7
JournalAmerican Journal of Psychiatry
Issue number3
StatePublished - 2001

ASJC Scopus subject areas

  • Psychiatry and Mental health


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