- How Common is The Dual Diagnosis of Bulimia
- What Causes Bulimia
- Effects of Having Comorbid Bulimia and Alcoholism
- Other Common Disorders or Issues Faced by Women with Bulimia and Alcoholism
What is Bulimia?Bulimia nervosa is an eating disorder characterized by a cycle of binge eating (consuming excessive amounts of food) that is followed self-induced compensatory behaviors like vomiting, fasting or purging.
Bulimia is one of the most common eating disorders in women and it often co-occurs with alcoholism.
How Common is The Dual Diagnosis of Bulimia & Alcoholism?
The co-occurrence of bulimia and alcoholism has important implications. Both bulimia and alcohol use disorders are associated with an increased risk of experiencing:
Depressive and anxiety symptoms.
Menstrual cycle disturbances.
Other stress-related symptoms.
The co-occurrence of both conditions poses challenges for treatment and may adversely impact treatment outcomes, like the rate of relapse and return to normative functioning.Therefore, it is very important to address this co-occurrence.
What Causes Bulimia & Alcoholism?
Various theories have been proposed to explain the co-occurrence of bulimia and alcoholism. It is possible that the two conditions share common causal factors or may even be the manifestation of a general underlying factor. These could include genetic factors, other biological factors, psychological factors, environmental factors, or a mix of these.
It has also been proposed that food deprivation increases the likelihood of alcohol use by altering the brain reward pathways. Alterations in common bodily systems such as opioid pathways can also underlie both bulimia and alcohol use disorders.
Shared personality factors, referred to as an addictive personality style, have been proposed to underlie the emergence of bulimia in conjunction with alcoholism. It has been proposed that impulsivity could be a common driving factor for bulimia and alcohol abuse.
It has also been suggested that the feelings of guilt and shame consequent to binging episodes could be followed by attempts at regulating emotions through use of alcohol. Similarly, a diagnosis of depression associated with either bulimia or alcohol use disorder would increase the likelihood the other disorder occurring.
Periods of intoxication following alcohol consumption also tend to lead to restriction or regulation of eating behavior and could lead to binging episodes. ‘Self-medication hypothesis’ and ‘tension reduction hypothesis’ are some other proposed mechanism to explain the co-occurrence of bulimia and alcohol use disorders.
- Self-medication refers to attempts at managing emotional distress through use of a psychoactive substance such as alcohol.
- The tension reduction hypothesis posits that psychoactive substances including alcohol are used to alleviate feelings of anxiety and tension resulting from the eating disorder itself or any other co-occurring anxiety disorder in these individuals.
Effects of Having Comorbid Bulimia and Alcoholism
Women with co-occurring bulimia and substance use disorders are more likely to experience psychiatric symptoms. This can manifest in the following ways:
Higher levels of anxiety and depression.
Higher likelihood of hospitalization for the psychiatric problems.
Higher likelihood of exhibiting suicidal behavior.
Impaired social, occupational and interpersonal functioning.
Presence of an alcohol use disorder among women with bulimia has been reported to be associated with relatively poorer treatment outcomes in certain studies. However, this has not been a consistent finding across the literature, with certain studies reporting no such impact.
Other Common Disorders or Issues Faced by Women with Bulimia and Alcoholism
Women diagnosed with bulimia and alcoholism are at an increased risk of having other psychiatric disorders including personality disorders.
In fact, it has been suggested that the association between bulimia and alcoholism could be due to the shared association of these two conditions with other psychiatric disorders such as depressive disorder and posttraumatic stress disorder.
These women are also more likely to be diagnosed with cluster B personality disorders, including Borderline Personality Disorder.
Women with bulimia are also likely to deteriorate faster from habitual drinking to alcohol dependence.
Women with co-occurring binge eating and binge drinking are more likely to experience problems at work or school, with friends or a dating partner.
Women with co-occurring bulimia and alcoholism can also experience medical complications as both these conditions affect different body systems and organs adversely.
- The co-occurrence of bulimia and alcoholism can lead to malnourishment, a condition that can exacerbate the effects of each and lead to other medical complications.
Dialectical Behavior Therapy (DBT) has also been proposed as an intervention that can address the issues relevant to both bulimia and alcoholism.
Problems or complications of treating these two conditions together:
One of the major challenges in the management of co-occurring bulimia and alcohol is the limited clinical research.
Management of this comorbidity needs more research support.
Also, the impact of these two conditions on long-term treatment outcomes remains unexplored.
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