Bulimia and Alcoholism

1. How Common is The Dual Diagnosis of Bulimia & Alcoholism?
2. What Causes Bulimia & Alcoholism?
3. Effects of Having Comorbid Bulimia and Alcoholism
4. 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?

• 
  Studies have demonstrated a significant association between bulimia and alcohol use, including alcohol use disorders. Individuals with bulimia have been found to have a higher prevalence of alcohol use as compared to those without an eating disorder.

  The prevalence of bulimia among treatment-seeking women with alcohol use disorders has been reported to vary between 30-50% across studies. Similarly, the prevalence of alcohol use disorder among women with bulimia has been found to vary between 20-25%.

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.

If you are struggling with bulimia and an addiction to alcohol, call 1-888-993-3112Who Answers? to learn about inpatient treatment options. Be sure to ask centers if they provide dual-diagnosis treatment for substance abuse and bulimia. 

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.

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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.
  

Treatment

• 
  Given the possibility of the co-occurrence of bulimia and alcoholism, it is advisable to screen women with either of the two conditions for the presence of the other condition. Various pharmacological and non-pharmacological interventions have been tried for the management of bulimia and alcohol addiction.

Medical treatment

• 
  One of the medications that have been used both in the management of bulimia as well as alcohol dependence is naltrexone. In spite of the methodological limitations of these studies there is some support for its effectiveness in at least a sub group of people with bulimia. Fluoxetine, a Selective Serotonin Reuptake Inhibitor (SSRI), has been found to be somewhat effective in the management of alcohol dependence as well as bulimia.

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Psychological treatment

• 
  Cognitive behavioral therapy (CBT), in conjunction with medical treatment, has been recommended for management of alcohol dependence as it reduces alcohol use and risk of relapse. CBT has also been found to be effective in the management of bulimia.

  CBT for bulimia and alcoholism share certain components. For example, CBT will focus on  identifying high-risk situations or triggers, use records to self-monitor one’s behavior, and teach coping skills to address feelings or social situations that may lead to loss of control. CBT might also help the person find an association between binging episodes and alcohol intake.

Dialectical Behavior Therapy (DBT) has also been proposed as an intervention that can address the issues relevant to both bulimia and alcoholism.

Sources

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2. Fouladi F, Mitchell JE, Crosby RD, et al. Prevalence of Alcohol and Other Substance Use in Patients with Eating Disorders. Eur Eat Disord Rev. 2015;23(6):531-536.

3. Bulik CM, Klump KL, Thornton L, et al. Alcohol use disorder comorbidity in eating disorders: a multicenter study. J Clin Psychiatry. 2004;65(7):1000-1006.

4. Dansky BS, Brewerton TD, Kilpatrick DG. Comorbidity of bulimia nervosa and alcohol use disorders: results from the National Women's Study. Int J Eat Disord. 2000;27(2):180-190.

5. Trace SE, Thornton LM, Baker JH, et al. A behavioral-genetic investigation of bulimia nervosa and its relationship with alcohol use disorder. Psychiatry Res. 2013;208(3):232-237.

6. Sinha R, O'Malley SS. Alcohol and eating disorders: implications for alcohol treatment and health services research. Alcohol Clin Exp Res. 2000;24(8):1312-1319.

7. Wolfe WL, Maisto SA. The relationship between eating disorders and substance use: moving beyond co-prevalence research. Clin Psychol Rev. 2000;20(5):617-631.

8. Lacey JH. Bulimia nervosa, binge eating, and psychogenic vomiting: a controlled treatment study and long term outcome. Br Med J (Clin Res Ed). 1983;286(6378):1609-1613.

9. Goldbloom DS. Alcohol misuse and eating disorders: aspects of an association. Alcohol Alcohol. 1993;28(4):375-381.

10. Grilo CM, Sinha R, O'Malley SS. Eating Disorders and Alcohol Use Disorders. 2002. http://pubs.niaaa.nih.gov/publications/arh26-2/151-160.htm?wvsessionid=wvce438d4a5a5e48b2bc7bf42645858ca7.

11. Grilo CM, Levy KN, Becker DF, Edell WS, McGlashan TH. Eating disorders in female inpatients with versus without substance use disorders. Addict Behav. 1995;20(2):255-260.

12. Sinha R. Alcohol, body weight and eating behavior-Part II. Weight Control Digest.9:820-825.