How Eating Disorders Relate to Substance Abuse
Eating Disorders Tied to Drug Use, Drinking
Binge eating connected to obesity, purging linked to substance abuse.
By Nancy Walsh, MedPage Today
Medically Reviewed byZalman S Agus, MD
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MONDAY, July 16, 2012 (MedPage Today) —Adolescent girls with a variety of eating disorders — even conditions less severe than anorexia or bulimia — are at risk for obesity and alcohol and drug use, a prospective study found.
Among those who reported binge eating but not purging, the risk for becoming overweight or obese was doubled compared with healthy peers, according to Alison E. Field, ScD, of Harvard University in Boston, and colleagues.
Similarly, teenage girls who purged more than once each week even without binge eating were at risk for starting to use drugs or to overuse alcohol frequently, the researchers reported online ahead of print in the August issue ofPediatrics.
The true prevalence of eating disorders has been uncertain, since it has become increasingly apparent that many affected individuals do not meet the criteria specified in theDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition(DSM-IV).
The outcomes associated with these subthreshold eating disorders also have been unclear, so Field and colleagues recruited 8,594 girls whose mean age was 12 and who replied to serial questionnaires beginning in 1996 on eating habits and related concerns.
Approximately 4.1 percent reported binge eating more than once weekly, another 4.1 percent purged more than once weekly, and 1.5 percent were classified as having bulimia nervosa, characterized by both binge eating and purging at least once each week.
By 2007, 19.8 percent of the participants had become overweight or obese, 27.4 percent reported high levels of depressive symptoms, 36.3 percent were binge drinking, and 24.9 percent were using drugs other than marijuana.
Girls who reported binge eating more than once weekly were at risk for having high levels of depressive symptoms.
Those with bulimia nervosa were almost four times as likely to be using drugs compared with unaffected adolescent girls.
Even those classified as "eating disorder not otherwise specified," who overate weekly but did not sense "a loss of control," were at risk for drug use and binge drinking.
The researchers also analyzed outcomes when the disordered eating behaviors were reported as occurring monthly, rather than weekly, and again found high rates of adverse outcomes.
For example, those who reported bulimia nervosa on a monthly basis still were more than three times as likely to have started using drugs, while those who reported monthly binge eating were at risk for having high levels of depressive symptoms.
In addition, an increased risk for overweight or obesity was found for among girls who purged monthly and for those with monthly binge eating.
In discussing their findings, the researchers noted that the DSM-IV does not classify purging disorder or binge eating disorders as distinct diagnostic entities.
According to those current criteria, only 2 percent of adolescent girls and young women would be classified as having an eating disorder, which overlooks the sizable group who have subthreshold symptoms.
"The underestimation is even more striking if we include [eating disorder not otherwise specified], which increases the prevalence of eating disorders to 13 percent to 21 percent among adolescent and young adult females," observed Field and colleagues.
They also noted that the upcoming revision of the DSM is expected to include binge eating disorder, but not purging disorder, as a diagnostic classification.
Yet the risks of adverse physical and psychological outcomes were similar in this cohort for those who purged, they cautioned.
These conditions should be acknowledged as specific categories of disease, rather than being relegated to the "heterogeneous and often overlooked" group referred to as "eating disorder not otherwise specified," they argued.
"Primary care clinicians need to be made aware of these disorders so that adolescents in need of treatment will be identified," they concluded.
Limitations of the study included the predominantly white population and self-report of eating behaviors.
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