Alcohol abuse may follow onset of eating disorder

It's known that women with eating disorders often abuse alcohol, but new research shows that it's typically the eating disorder that arises first - and that women with certain personality traits may be prone to having both problems.

Researchers found that among 672 women who had ever suffered an eating disorder, 253 had abused alcohol at some point in their lives. Only one-third had developed their drinking problems prior to the eating disorder.

Understanding such "patterns of onset" is important in the treatment of eating disorders and alcohol abuse, according to lead study author Dr. Cynthia M. Bulik, of the University of North Carolina at Chapel Hill.

For example, she noted, eating disorder treatment programs may need to pay more attention to the risk of a patient having an alcohol problem.

The study, reported in the Journal of Clinical Psychiatry, also found that certain personality traits - including impulsivity and perfectionism - were associated with the odds of having both an eating disorder and an alcohol problem.

Past research has noted a high prevalence of alcohol abuse among women with bulimia, an eating disorder marked by bouts of binge eating followed by purging, fasting or excessive exercise. Likewise, Bulik and her colleagues found that women with bulimia or anorexia with bulimia-like bingeing were much more likely to abuse alcohol than were women with classic anorexia.

Overall, 46 percent of bulimics in the study had abused or been dependent on alcohol at some point in their lives. That figure was nearly 38 percent among women with anorexia marked by binge eating.

Using standard tests of personality, Bulik and her colleagues found that women who abused alcohol had a tendency toward impulsive behavior, but also perfectionism; they showed more concern over their mistakes, and perceived more criticism and higher expectations from their parents than women without alcohol problems did.

According to the study authors, these findings "mirror the clinical observation of both overcontrol and dyscontrol" often seen in patients with both eating disorders and drinking problems.]

Women who abused alcohol were also at greater risk of anxiety disorders and depression. Anxiety commonly goes hand-in-hand with eating disorders, and it's possible, according to Bulik's team, that for some women, alcohol provides an additional way - besides food restriction - to deal with that anxiety.

Bulik noted that the personality traits pinpointed in this study could prove useful in identifying eating disorder patients at risk of alcohol problems.

"When you see a patient who is particularly anxious or impulsive, your antennae should be on higher alert for the presence of alcohol use disorders," she said.

SOURCE: Journal of Clinical Psychiatry, July 2004.