Academic journal article Alcohol Research

Eating Disorders and Alcohol Use Disorders. (Research Update)

Academic journal article Alcohol Research

Eating Disorders and Alcohol Use Disorders. (Research Update)

Article excerpt

Alcoholism and eating disorders frequently co-occur and often co-occur in the presence of other psychiatric and personality disorders. Although this co-occurrence suggests the possibility of common or shared factors in the etiology of these two problems, research to date has not established such links. Regardless of the precise meaning of the association, the reality that eating disorders and alcohol use disorders frequently co-occur has important implications for assessment, treatment, and future research. KEY WORDS: eating disorder; personality disorder; AODD (alcohol and other drug dependence); comorbidity; anorexia nervosa; bulimia nervosa; gender differences; diet; coping skills; cognitive therapy; behavior therapy; psychosocial treatment method

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Numerous studies suggest that eating disorders (EDs) and alcohol and other drug use disorders (referred to throughout this paper as substance use disorders [SUDs]) frequently co-occur and often co-occur in the presence of other psychiatric and personality disorders. This review will consider the extent and nature of such co-occurrences and whether research supports the possibility of common or shared factors in the etiology or maintenance of EDs and SUDs. The reality that EDs and SUDs frequently co-occur has important implications for assessment, treatment, and future research. Although this review will offer implications for clinicians and researchers in both fields, the presentation bias will be toward providing a more detailed discussion of the ED literature for professionals in the alcoholism field.

EATING DISORDERS

The current classification system, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA] 1994) specifies three ED diagnoses. The formal diagnoses are anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). In addition, the DSM-IV includes a new ED category (binge eating disorder [BED]) as a research category. BED is a specific example of EDNOS. Brief descriptions of these EDs follow See Grilo (2002a) and Becker and colleagues (1999) for detailed discussions of the clinical features and assessment issues of these disorders.

Anorexia Nervosa is characterized by a refusal to maintain normal body weight (defined as 15 percent below normal weight for age and height), an intense fear of becoming fat, and (in females) skipped menstrual periods (i.e., amenorrhea) for at least 3 months. People with AN have a severely distorted body image. They see themselves as overweight despite being overly thin, and they tend to deny the seriousness of their low body weight. The DSM-IV specifies two subtypes of AN--a "restricting type," characterized by strict dieting or exercise without binge eating; and a "binge-eating/purging type," marked by episodes of binge eating and/or purging via self-induced vomiting or misusing laxatives, enemas, or diuretics. In severe cases, medical complications or death from starvation can occur. Roughly 50 percent of people with AN may eventually develop bulimia nervosa (described below). AN is a rare disorder; it occurs disproportionately in women, and is estimated to have a prevalence of roughly 1 percent in adolesc ent and young adult women (Hoek 1993).

Bulimia Nervosa is characterized by recurrent episodes of binge eating (defined as consuming unusually large amounts of food in a discrete period of time plus a subjective sense of lack of control over eating). BN is further characterized by regular use of extreme weight control methods (e.g., vomiting; abuse of laxatives, diet pills, or diuretics; severe dieting or fasting; vigorous exercise) and by dysfunctional attitudes about weight or shape that unduly influence self-evaluation. For a diagnosis of bulimia nervosa, the DSM-IV requires both the binge eating and inappropriate weight control methods to have occurred, on average, at least twice per week during the past 3 months. …

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