Endocrine psychiatric comorbidity in metabolic disorders: Integrative mechanisms and traditional Chinese medicine

Table 1 Endocrine-psychiatric and behavioral comorbidity patterns across major metabolic-endocrine disorders

Index condition	Psychiatric and behavioral phenotypes (typical)	Evidence framing (psychiatric phenotype ascertainment)	Predominant comorbidity pattern1	Salient clinical burden (why it matters)
Type 2 diabetes/prediabetes	Depression; anxiety; sleep disturbance; cognitive dysfunction	Mixed	Bidirectional; disease-driven + behavior-driven[91]	Suboptimal metabolic control; reduced adherence/self-management; higher cardiometabolic risk (Figure 3)
Obesity/metabolic syndrome	Depression; anxiety; sleep disturbance (incl OSA-related); disordered eating	Mixed	Bidirectional; behavior-driven; treatment-emergent[92,93]	Weight trajectory reinforcement; impaired lifestyle persistence; increased cardiometabolic risk (Figure 3)
MAFLD/MASLD spectrum	Depression; anxiety; sleep disturbance; cognitive complaints	Mixed	Bidirectional; disease-driven + behavior-driven	Reduced quality of life; fatigue-related functional impairment; poorer lifestyle maintenance (Figure 3)
PCOS	Depression; anxiety; disordered eating; sleep disturbance	Mixed	Bidirectional; endocrine-metabolic-driven + psychosocial/behavior-driven[94]	Quality-of-life impairment; barriers to weight and symptom management; treatment non-persistence (Figure 3)
Thyroid dysfunction	Anxiety; depression; sleep disturbance; cognitive symptoms	Mixed	Primarily disease-driven; potential bidirectional feedback[95,96]	Functional impairment; symptom-related healthcare use; diagnostic misattribution risk (Figure 3)

¹Pattern terminology aligns with the bidirectional framework in (Figure 3): Disease-driven, behavior-driven, and treatment-emergent.

Evidence framing indicates whether the cited literature primarily defined psychiatric/behavioural phenotypes using DSM/ICD-based categorical diagnoses (“Diagnosis”), validated scale-based symptom thresholds or continuous scores (“Dimensional”), or a combination of both approaches (“Mixed”). OSA: Obstructive sleep apnea; MAFLD: Metabolic dysfunction-associated fatty liver disease; MASLD: Metabolic dysfunction-associated steatotic liver disease; PCOS: Polycystic ovary syndrome.