Disordered eating and substance use - Eating Disorders - Brief Article

Research has shown that patients with eating disorders (ED) exhibit alcohol and drug problems at rates above normal controls or population base rates. Substance abuse or dependence has been reported in up to 55 percent of bulimics and 23 percent of anorexics. Observations regarding the frequent comorbidity of EDs and substance use (SU)/substance use disorders (SUD) have led to a number of hypotheses regarding possible shared causation.

A first step in examining this causation is to evaluate the strength of association of eating problems and SU in a commune, sample. A recent investigation set out to address the following questions: l) How strong are associations between disordered eating (DE)/ED and SU/SUD?2) Are associations between DE/ED and SU/SUD stronger in those with bulimic rather than with restricting symptoms? 3) Are associations of DE/ED consistent across different classes of psychoactive substances?

Data was used from the Minnesota Twin Family Study (MTFS) and the sample for the current study, included 672 adolescent girls and 718 women. All subjects completed the Eating Disorder Questionnaire (EDQ). Information on eating attitudes and behaviors was gathered with the MTFS revision of the Eating Disorders Inventory (EDI). Substance misuse groups were defined by the presence or absence of the following diagnoses: Definite nicotine dependence for both cohorts; definite alcohol abuse, or probable or definite dependence in the adolescent group, or definite alcohol dependence alone in the adult group; and definite illicit drug abuse or dependence for both groups. Nicotine use was also assessed among the sample.

The criteria for restricting ED was met by 27 adolescents and 28 for Bulimic ED. Of the adolescent cohort 380 had used tobacco, 6 had been drunk, and 163 had used an illicit drug. Among the adolescents, 93 had definite nicotine dependence, 85 had definite alcohol abuse or probable or definite alcohol dependence, and 44 had definite chug abuse or probable or definite drug dependence. Eating attitudes and disorders were modestly associated with nicotine, alcohol, and drug use, and with nicotine dependence in adolescent girls. Alcohol use and misuse were related to eating attitudes and pathology in women. SU/SUDs were associated with restricting and bulimic behaviors and no major differences in associations were observed between substance classes.

The strongest finding to emerge from this study, consistent with previous research, was that eating attitudes and disorders were associated modestly with nicotine, alcohol and drug use, and nicotine dependence in adolescent girls. The present findings are inconsistent with the addiction model that posits a specific relationship between bulimia and substance abuse. Further research is needed that examines the causal nature of these relationships, such as studying longitudinal patterns of association, including temporal patterns.

Kristin M. von Ranson, William G. Iacono, and Matt McGue, "Disordered Eating and Substance Use in an Epidemiological Sample: I. Associations Within Individuals, "Int J Eat Disord 31: 389-403 (May 2002) Correspondence: Kristin M. von Ranson, Ph.D., Department of Psychology, University of Calgary, 2500 University, Drive NW, Calgary; Alberta T2N 1N4, Canada Email: kvonrans@ucalgary.ca

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