There’s a link between diabetes and eating disorders such as bulimia and binge eating, according to researchers who studied 52,000 patients in 19 different countries.

Depression and diabetes have long been connected, but now a study in the journal Diabetologia looks at possible associations of diabetes with 15 other mental disorders, as designated by the Diagnostic and Statistical Manual, 4th Edition.

Though all mental disorders have some association with the disease, researchers find especially significant links to depression, bulimia, binge eating, and intermittent explosive disorder, characterized by vitriolic talk and violent behavior.

The study (“Associations Between DSM-IV Mental Disorders and Diabetes Mellitus: A Role for Impulse Control Disorders and Depression”) says that the eating disorders-diabetes connection suggests that the mental health disorders could cause glucose dysregulation that might result in diabetes later in life.

Also, the researchers say the link might have to do with low levels of HDL-cholesterol and decreased serotonin functioning, “both of which have been associated with aggression and diabetes.”

Key point: These disorders are often evident long before the appearance of diabetes.

“As the literature has focused exclusively on depression, it remains possible for a person to develop an eating disorder, become depressed later on, and in the end develop diabetes mellitus,” the study states. “Targeting the eating disorder in this case will theoretically be a far more promising approach than focusing solely on depression.”

The survey participants were given standard psychiatric tests, such as the World Mental Health Surveys and the U.S. Health Interview Survey.

Participating countries include Colombia, Mexico, China, Germany, France, Italy, Poland, Spain, Portugal, Japan, New Zealand, and Belgium.

Impulse control disorders usually erupt at around age 20, the researchers say, earlier than the ages that most of the other mental disorders—including depression—manifest themselves.

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