No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Why Do Women with Alcohol Problems Binge Eat?
Abstract
Questionnaires assessing heavy drinking and binge eating were administered to 58 women with alcohol problems. A sub-sample of
the binge-eaters then participated in qualitative interviews about their perceptions of the connections between their two problems. Seventy-one percent self-identified as binge-eaters with most reporting ‘severe’ binge eating. Binge-eaters were younger, more frequent drinkers and drank more often for emotional relief than non-binge-eaters. Binge
eating and heavy drinking appeared to serve similar functions in a given client (i.e. emotional relief or reward functions). We
discuss implications of the findings for the development of better
treatments for women struggling with both health issues.
... It taps two motives for binge eating: emotional relief and emotional reward. These two motivations for binge eating are separable but interconnected (see Stewart et al., 2006). ...
... The women who scored high on a drinking motives factor involving relief from distress were also those who reported binge eating to relieve emotional distress, and those women who scored high on a drinking motives factor involving emotional reward also reported binge eating for reasons related to emotional reward. Our results thus suggest that binge eating and heavy drinking serve similar functions in a given woman (Stewart et al., 2006). ...
... A review of the emerging literature on this issue makes it clear that there are high levels of co-occurrence of, and common underlying motivations for, binge eating and heavy substance use among women (Filstead et al., 1988; Stewart et al., 2003 Stewart et al., , 2006). To date, there appears to be little in the way of treatment within the Canadian health care system that effectively addresses the co-existence of these two issues for women. ...
Disordered eating and substance use problems are significant and often co-occurring mental and physical health issues facing women today (see Chapter 13 of this book). Some suggest that when these two conditions co-exist, it may reflect a more significant emotional struggle than when either problem occurs alone (Singer et al., 1993). Researchers are beginning to argue that such co-occurrence must be taken into consideration in the development of more helpful treatment strategies for women (Holderness et al., 1994). Current research, including our own (Stewart et al., 2006), has explored, and continues to explore, common triggers and underlying motivations for both issues. Findings on this topic could be helpful to identify at-risk women, and could also clarify some of the factors associated with co-prevalence, which would be useful in improving current treatments.
Through a brief overview of two key studies, as well as our own recent research, this chapter examines how an understanding of the mechanisms underlying the co-occurrence of disordered eating and substance use problems in women can improve women’s health programming, both in terms of modifying existing treatments and developing preventive measures and early interventions that can help avoid the emergence
of more extreme clinical problems.
For the past 25 years, the frequent co-prevalence of disordered eating and substance use problems among women has been widely documented. Connections between eating problems, particularly bulimic behavior, among women and the harmful use of alcohol and other drugs have now been strongly established (Krahn,
1991; Singer et al., 1993; see also Goldbloom, 1993; Holderness et al., 1994; Sinha & O’Malley, 2000; and Wilson, 1993, for reviews). Several recent studies, including our own (Stewart et al., 2006), have investigated the possibility that binge eating and problematic substance use may be so highly co-prevalent because they reflect a common mechanism or mechanisms involving emotional regulation: namely, providing emotional rewards (e.g., fulfilling needs and desires) and/or emotional relief from psychological distress (e.g., reducing anxiety or depression).
... Bland flickor med både alkohol-och narkotikadiagnoser var förekomsten av ätstörningar någon gång under livstiden 40 procent (Hodgins et al, 2007 ). Vidare har både män och kvinnor i behandling för missbruk rapporterat att mat ofta varit ett substitut för droger i syfte att reglera humör och negativ affekt, för att hantera tristess eller för att tillfredsställa sug (Cepik, Arikan, Boratav, & Isik, 1995; Cowan & Devine 2008; Stewart, et al, 2006). Såväl stort alkoholintag som stört ätbeteende, framför allt hetsätning, antas användas som " copingstrategi " och som självreglering av känslor, och beteendena kan fylla samma funktion för en person (Anderson et al, 2005; Stewart et al, 2006). ...
... Vidare har både män och kvinnor i behandling för missbruk rapporterat att mat ofta varit ett substitut för droger i syfte att reglera humör och negativ affekt, för att hantera tristess eller för att tillfredsställa sug (Cepik, Arikan, Boratav, & Isik, 1995; Cowan & Devine 2008; Stewart, et al, 2006). Såväl stort alkoholintag som stört ätbeteende, framför allt hetsätning, antas användas som " copingstrategi " och som självreglering av känslor, och beteendena kan fylla samma funktion för en person (Anderson et al, 2005; Stewart et al, 2006). Det kan vara svårt att identifiera ätstörning hos individer som missbrukar. ...
... En studie som gjorts på patienter med bulimi visade inte ett ökat alkoholintag efter 19 timmar utan mat (Bulik, & Brinded, 1993). Jämfört med sambandet mellan bulimi och missbruk, är sambandet mellan alkohol-/narkotikamissbruk och restriktiv anorexi inte lika tydligt, vilket innebär att det troligen även är andra biologiska faktorer som kan vara av betydelse (Stewart et al, 2006). Utvecklandet av både missbruk och ätstörningar kan med andra ord härledas, och delvis förklaras av, gemensamma biologiska faktorer. ...
... Willing and eligible women who were participating in the larger questionnaire-based study (Stewart et al., 2006) were scheduled for a later qualitative interview. Data was gathered on self-reported experiences of depression and co-existing alcohol use problems through in-depth semi-structured qualitative interviews of 18 women. ...
... Thematic analyses of women's descriptions of their reasons for drinking showed that alcohol was used by women to self-medicate for depression by relieving painful emotional experiences (reported by all 18 women) and by producing a sense of pleasure (reported by 15 of the 18 women) (Stewart et al., 2006). Drinking to relieve painful emotional experiences provided women with a means of escape, numbing them from overwhelmingly painful emotions that they often felt powerless to change. ...
... 3. The study reported here emerged within the context of a larger study on the relations of binge eating and heavy drinking in women receiving treatment for alcohol problems (see Stewart et al., 2006). Since the purpose of the larger study was to attempt to understand the mechanisms underlying the co-prevalence of binge eating and binge drinking among women problem drinkers, all of the women participating in the interviews had a co-existing problem of binge eating and heavy drinking. ...
Although epidemiological literature reports a significant overlap between depression and alcoholism among women, the dynamics of this relationship requires further exploration. The present paper documents significant lifetime histories of depression among women in treatment for alcohol problems, and presents findings on these women's experiences of the relationship between depression and alcohol use problems. In this community-based treatment sample, 18 out of 18 women participating in qualitative interviews reported histories of depression and almost 80% were currently using anti-depressant medication. The use of alcohol as an attempt to escape difficult emotions or alternatively to produce positive emotional experiences is discussed within the gendered context of the stories women tell about their depression and alcohol use.
... Alguns estudos concluíram que a IAC e o abuso de álcool estavam significativamente correlacionados e ambos teriam uma função de coping de evitamento, uma vez que as emoções e eventos de vida negativos e/ou stressantes eram relatados como precedentes (Anderson, Simmons, Martens, Ferrier & Sheehy, 2006) e, estes comportamentos, eram citados como uma forma de regulação emocional (Stewart, Brown, Devoulyte, Theakston & Larsen, 2006), podendo estas mulheres comer e/ou consumir para lidar com estes afetos, com o intuito de reduzir e/ou evitar o afeto negativo na ausência de estratégias de coping mais adequadas (Sherwood, Crowther, Wills & Ben-Porath, 2000). Segundo Folkman & Lazarus (1980) e Folkman (1984 as estratégias de coping, utilizadas pelos sujeitos para se adaptarem a circunstâncias adversas ou stressantes, são mecanismos de 12 defesa, a life-events, que passam por um conjunto de esforços, cognitivos e comportamentais, e visam responder a um stressor perante circunstâncias externas ou estados internos. ...
... As PCA e o consumo de substâncias, maioritariamente, iniciam-se na adolescência e persistem no tempo (APA, 2014; Kanbur & Harrison, 2016), pois esta faixa etária tem um enorme relevo: no desenvolvimento e consolidação da personalidade, das condições de saúde e das crenças (Tavolacci et al., 2015); na adoção de comportamentos de risco e/ou de promoção à saúde (Anderson, Martens & Cimini, 2005;Stewart et al., 2006); e na exploração e estabelecimento de hábitos e comportamentos (e.g., alimentares; consumos). Contudo, os anos de faculdade apresentam inúmeros desafios de saúde, tais como as elevadas taxas de consumo de álcool e o aumento de peso no primeiro ano (Ham & Hope, 2003). ...
An extensive literature has reported a co-occurrence between maladaptive eating behavior and consumption of substances (alcohol and/or drugs), such as impulsivity, in particular the negative urgency, has been referred to as a risk factor and a predictor for these behaviors. The present study aimed to verify the frequency of attitudes and behaviors characteristic of eating disorders and substance use; assess the differences between the sex of the participants; and to verify the existence of correlations and direct effects between the attitudes and behaviors of eating disorders, the body mass index, the substances consumption and the negative urgency among the university population of portuguese nationality. The results showed: higher frequências than national prevalences, both in attitudes and in certain maladaptive eating behaviors, as well as in substances consumption; that attitudes and the maladaptive eating behaviors and the negative urgency were more frequent in women, while the consumption of substances was more common in men; that there was not significant correlation between the atitudes, the eating behaviors and the consumptions of substances; however, the negative urgency emerged as a predictor of the attitudes of eating disorders, the binge eating disorder and the drug use.
... Illicit substances (amphetamines/stimulants/cannabis/ opiates) Amphetamines may be used as appetite suppressants in order to aid weight loss [15,16]. Psychoactive substances may also be used to help regulate painful affect [27]. In a review of the literature, Holderness et al. (2004) found that rates of amphetamine use were found to be higher in patients with AN compared with BN [17]. ...
... Questions should specifically explore the misuse of substances as weight loss mechanisms, for example, caffeine, tobacco, insulin, thyroid medications, stimulants or over the counter medications (laxatives, diuretics) used for metabolism restriction, caloric restriction, appetite suppression or purging [11,36,37]. Similarly, the role of alcohol or psychoactive substances in emotional regulation should be explored, for example, the use of alcohol, opiates or cannabis for the relief of anxiety, depression, guilt or shame, or for emotional reward [27]. Wolfe and Maisto (2000) highlight the importance of a behavioural assessment (including questionnaires, self-monitoring, role play and collection of collateral information) in order to explore the functional relationship between substance use patterns and ED behaviours. ...
Introduction
Research has shown that eating disorder (ED) patients who abuse substances demonstrate worse ED symptomatology and poorer outcomes than those with EDs alone, including increased general medical complications and psychopathology, longer recovery times, poorer functional outcomes and higher relapse rates. This article provides a broad overview of the prevalence, aetiology, assessment and management of co-morbid EDs and substance use disorders (SUDs).
Review
The co-occurrence of EDs and SUDs is high. The functional relationship between EDs and SUDs vary within and across ED subtypes, depends on the class of substance, and needs to be carefully assessed for each patient. Substances such as caffeine, tobacco, insulin, thyroid medications, stimulants or over the counter medications (laxatives, diuretics) may be used to aid weight loss and/or provide energy, and alcohol or psychoactive substances could be used for emotional regulation or as part of a pattern of impulsive behaviour. A key message conveyed in the current literature is the importance of screening and assessment for co-morbid SUDs and EDs in patients presenting with either disorder. There is a paucity of treatment studies on the management of co-occurring EDs and SUDs. Overall, the literature indicates that the ED and SUD should be addressed simultaneously using a multi-disciplinary approach. The need for medical stabilization, hospitalization or inpatient treatment needs to be assessed based on general medical and psychiatric considerations. Common features across therapeutic interventions include psycho-education about the aetiological commonalities, risks and sequelae of concurrent ED behaviours and substance abuse, dietary education and planning, cognitive challenging of eating disordered attitudes and beliefs, building of skills and coping mechanisms, addressing obstacles to improvement and the prevention of relapse. Emphasis should be placed on building a collaborative therapeutic relationship and avoiding power struggles. Cognitive behavioural therapy has been frequently used in the treatment of co-morbid EDs and SUDs, however there are no randomized controlled trials. More recently evidence has been found for the efficacy of dialectical behavioural therapy in reducing both ED and substance use behaviours.
Conclusion
Future research would benefit from a meta-analysis of the current research in order to better understand the relationships between these two commonly co-occurring disorders.
... As such, students higher in negative urgency may be at risk of both AUD and BED, as both alcohol and food may be used as a maladaptive method to cope with negative emotions (Fisher et al., 2004).Within student samples in the negative urgency is linked to both problem drinking and eating behaviors (Dir, Karyadi, & Cyders, 2013). As AUD and eating disorders show high rates of comorbidity (Khaylis et al., 2009;Mikheeva & Tragesser, 2016;Sinha et al., 1996;Stewart et al., 2006), negative urgency may be a common mechanism by which young adults increase risk for both disorders (Luce et al., 2007;von Ranson et al., 2002). ...
Identifying students at risk of developing binge-eating and alcohol use disorders is a priority in the United Kingdom (UK). Although relationships between negative urgency (impulsive behavior during times of negative emotion), risky drinking, and binge-eating have been established in students from other countries, these links have yet to be replicated in male and female UK students. UK students aged 18-30 (n=155) completed the: (1) the Urgency, Pre-meditation, Perseverance, Sensation Seeking (UPPS-P) negative urgency subscale; (2) Alcohol Use Disorders Identification Test (AUDIT); and (3) Binge-Eating Scale (BES). For categorical analysis, participants were assigned to one of four groups as a function of AUDIT and BES clinical cut-off scores: (1) no risk (28%); (2) risky drinkers (47%); (3) binge-eaters (6%); and (4) risky drinkers + binge-eaters (19%). For dimensional analysis, across students with non-zero AUDIT and BES scores (n=141), BES, AUDIT, gender, and their interactions were entered as predictors in the same block of a regression. UPPS-P negative urgency was the dependent variable. Categorical results indicated that binge-eaters with and without risky drinking endorsed significantly higher negative urgency than students with no risk. Dimensional results showed that although higher BES and AUDIT scores were positively linked to higher negative urgency, but only the BES was significantly associated. Furthermore, BES shared substantially more variance with negative urgency than the AUDIT, and the BES-negative urgency relationship was stronger in male students than female students. High risk students may benefit the most from interventions that help regulate negative emotion.
... Notably, unlike illicit drugs and nicotine, alcohol contains calories, which may contribute to higher body weight and influence eating behavior. The estimated comorbidity of alcohol abuse and disordered eating in a community sample falls between 30% to 50% (Dansky, Brewerton, and Kilpatrick, 2000), while 71% of women seeking treatment for problematic alcohol use report compulsive overeating (Stewart et al., 2006). Fifty-eight to sixty-eight percent of individuals who use tobacco endorse disordered eating (Anzengruber et al., 2006). ...
Rates of obesity and overweight have been rising steadily for nearly three decades, and the associated psychosocial and medical complications are creating a public health crisis. Although obesity rates have no doubt been impacted by a host of environmental, behavioral, and genetic variables, a very important contributor has been Binge Eating Disorder (BED). BED is associated with myriad mental and physical health problems, many of which can be both causes and consequences of disordered eating behavior, resulting in a complex interplay of etiologic and associated features. In particular, a lifetime history of BED is associated with obesity in its most severe form, and BED is also highly comorbid with other documented mortality risk factors (e.g., tobacco use and alcohol abuse). This chapter provides an overview of BED, with an emphasis on our current understanding of the disorder. First, historical changes in the conceptualization of BED are covered, including the changes to the BED diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Next, we review BED's psychosocial cofactors (e.g., sex, ethnicity, body image) and comorbid conditions. Finally, we conclude by drawing parallels between BED, binge eating (BE), and addictive behavior, suggesting related directions for future research.
... They include symptom substitution, family background, impulsivity, the cycle of restraint and capitulation to reward, and emotional relief. Several recent studies, including our own work (Stewart et al., 2006), have further investigated the possibility that binge eating and substance use problems may be so highly co-prevalent because they reflect a common mechanism or mechanisms involving emotional regulation: namely, that both behaviours might involve common mechanisms of providing emotional rewards (e.g., fulfilling needs and desires) and/or emotional relief from psychological distress (e.g., reduction of anxiety or depression). Studies are now beginning to emerge that explore the underlying mechanisms contributing to the co-prevalence of eating and drinking problems in women from a women-centred perspective. ...
Although the precise rates of substance use problems among people with disordered eating have varied across studies, one consistent finding is elevated rates of alcohol problems (Wilson, 1993). Up to 55 per cent of women presenting for treatment of bulimia nervosa have met the diagnostic criteria for alcohol abuse (Wilson, 1993). Although most research has focused on the co-prevalence of eating disorders and alcohol problems,women with eating disorders also appear to be at increased risk for abusing a variety of substances other than alcohol, including amphetamines, barbiturates, marijuana, tranquilizers and cocaine (Holderness et al., 1994). Across studies, about one-quarter of women with bulimia report a past or current history of using drugs other than alcohol (Frank et al., 1991;Weiss & Ebert, 1983). Typically, the greatest association between substance use problems and eating disorders has been found among women with bulimia nervosa or the binge-eating/purging subtype of anorexia nervosa, rather than women with the restricting subtype of anorexia (Garfinkel et al., 1980; Garner et al., 1985).
Not only have high rates of substance use problems been observed in samples of women with eating disorders, but the converse is also true: high rates of disordered eating have been reported among groups of women with substance use disorders(Holderness et al., 1994; Wilson, 1993). For example, Taylor et al. (1993) found that women with alcohol problems are more likely to experience eating disorders than women in the population at large. About 30 to 40 per cent of women being treated for an alcohol problem report a history of disordered eating. There are advantages to conceptualizing both drinking and eating problems as
part of a continuous—as opposed to categorical—framework. Drinking has been posited to lie on a continuum, with non-drinkers at one end and people with severe alcohol dependence at the other (Sobell & Sobell., 1993a, b). Similarly, Garner and his colleagues (1983) have characterized eating problems as occurring on a continuum, with anorexia and bulimia representing the extreme end of the spectrum of preoccupation with weight that is ubiquitous among women in our culture (see also Brown, 1993). Adopting this perspective acknowledges that most women who struggle with problem eating and alcohol use fall outside clinical definitions of these problems—and are therefore usually excluded from research on the topics. Their subsequent invisibility in co-prevalence research means that evidence-based health service planning does not respond to the needs of women at all levels of risk. Similarly, research would benefit
substantially by changing the focus from scrutinizing rates of co-occurring diagnoses to examining the mechanisms that account for the overlap of eating problems and substance use problems at all levels of severity.
... Piran and Robinson (2005) found the severity of substance use was positively correlated with the extent of disordered eating behavior. In a treatment program for women with problems due to alcohol use, 71 percent of these women also engaged in binge eating behaviors (Stewart, Brown, Devoulyte, Theakston, & Larsen, 2006). This is nearly double the percentage of similar women between the ages of 14 to 40 years in the general population who display binge-eating behavior (i.e., 36 percent). ...
... Mostly based on animal models, these data have clinical implications. Alcohol drinking and binge eating seem to have a similar role of emotional relief [21]. Also, the triggering capacity of small amounts of food into binge eating can be compared to the urge of drug taking after a small dose in people suffering from addiction [17]. ...
Abstract
Objective: To describe eating behaviors and body composition before, during and after substance abuse withdrawal, and to assess if these factors were related with withdrawal outcome.
Methods: This was a three month follow-up study examining eating behaviors (measured by validated questionnaires and interview), substance use (assessed with Addiction Severity Index) anthropometry (weight, height and bioimpedance for body composition), medical conditions and psycho-social environment (recorded from medical files and Addiction Severity Index) of 117 patients enrolling in a detoxification program at the University Hospitals, Geneva, Switzerland.
Characteristics at baseline and after one month were compared according to patients’ outcome. Variables showing a significant association with relapse were entered in a multivariate logistic regression
Results: Most patients were men (84, 71%), and detoxified from alcohol (95, 81%). Relapse rates were 27%
after 1 month and 45% after 3 months. Eating disorders were rare but 19% scored high on shape concern scale, 35% experienced nibbling, 20% compulsive night eating and 14% binge episodes, 24% displayed lower than normal fat-free mass and 40% had higher than normal fat mass. Bivariate analysis showed that low nutritional status (low BMI, or low fat mass or low fat free mass), was associated with a decreased risk of relapse. Withdrawal from drugs, higher tobacco consumption and higher severity index for legal area were associated with relapse. These determinants showed no effect on outcome in a multivariate analysis.
Conclusion: Problematic eating behaviors were common in this group, whereas eating disorders were rare.
Relapse rate was high. No variable was related with relapse at multivariate level. As in general population, overweight and high fat mass were common among persons abusing substances. BMI was a poor indicator of their nutritional status. Our study suggests attention should be given to patients’ eating behaviors, weight and shape preoccupation during substance withdrawal and follow-up.
Présente dans de nombreux troubles, la dysrégulation émotionnelle augmente la suicidalité. Difficile à cibler pharmacologiquement, elle se traite en psychothérapie, notamment en Thérapie Comportementale et Dialectique (TCD). Néanmoins, son caractère intensif la rend difficile à implanter. Pour faciliter cette implantation, le CHU de Strasbourg pratique des groupes TCD transdiagnostiques de 4 mois à destination des patients TPL, TDAH et bipolaires sans thérapie individuelle systématique. Mais ce format n’avait jamais été évalué. Notre étude est encourageante. Immédiatement après la thérapie, la régulation émotionnelle s’améliore significativement, ainsi que la pleine conscience, le fonctionnement social et la colère. Un an après, cette amélioration se poursuit sur plusieurs critères (régulation émotionnelle, suicidalité, addictions, consommation de soins...). Le format TCD réalisé à Strasbourg semble donc intéressant, mais nous devons faire d’autres études pour s’en assurer.
Objective
Comorbid eating disorders (EDs) and substance use disorders (SUDs) are common. Most research has explored substance use among individuals with an ED. Few studies describe the prevalence of EDs in samples of women with SUD who are attending treatment. This study is a systematic review and meta-analysis of the point and lifetime prevalence of comorbid ED among treatment-seeking female patients with SUD.
Method
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline, six databases were systematically searched to identify studies. Prevalence rates of EDs and/or ED behaviors and methodological factors were extracted from each eligible study. Risk of bias was assessed using the AXIS tool. Random-effects meta-analysis was used to pool prevalence estimates. The protocol is registered in PROSPERO.
Results
Full text reviews were conducted on 131 studies and 24 (N = 4767) met inclusion criteria. Point prevalence of disordered eating behaviors (DEBs) was 38.71% and lifetime prevalence 20.95%. The point prevalence of a diagnosed ED was 15.69% and lifetime prevalence was 15.67%. For any ED or disordered eating, the point prevalence was 29.99% and lifetime prevalence was 19.40%. Age was a significant negative moderator for point prevalence of AN which was 5.41%.
Conclusions
This review indicates that there is a high rate of women attending treatment for SUDs with comorbid EDs and/or DEBs. Implications for treatment approaches and suggestions for future research are provided.
Patients presenting for gastric bypass surgery often demonstrate binge eating behaviors. The present study sought to determine whether binge eating triggers are predictive of weight loss outcomes in bariatric surgery patients at 6 months postoperatively in the setting of a university hospital.
A total of 48 patients presenting for gastric bypass surgery at an academic medical center in the Southeastern United States and who had returned for the 6-month follow-up visit were included in the present study. The patients were mostly women (85%), white (71%), and middle-aged (mean age 47 years), with an average weight of 100.9 kg. The patients completed the Inventory of Binge Eating Situations at baseline, and weight loss outcomes were assessed at 6 months. Weight loss success was indexed using 2 methods: the percentage of excess weight lost (continuous variable) and whether the patient was on track with their weight loss as defined by a ≥ 50% excess weight loss (dichotomous variable).
A significant negative correlation (r = -.31, P = .03) was found between the preoperative Inventory of Binge Eating Situations scores and the percentage of excess weight loss at 6 months after gastric bypass surgery. Logistic regression analysis showed that "on track" status at 6 months was predicted by the Inventory of Binge Eating Situations score at baseline (Wald chi-square = 3.97, df = 1, P = .046).
Careful assessment of binge eating situations could serve as a potential predictor of poor weight loss outcomes in patients seeking gastric bypass surgery. These findings support the baseline assessment of binge eating triggers and future research to examine the effectiveness of interventions for coping with binge eating triggers for gastric bypass surgery patients.
The primary goal of this study was to evaluate whether women with alcohol problems report differences in their strength of endorsement of specific positive outcome expectancies as a function of alcoholic beverage type. Fifty-four participants completed the Beverage Expectancy Questionnaire (BEQ) that assessed five specific positive outcome expectancies across three different beverage types (i.e., wine, beer, hard liquor). Participants endorsed the strongest expectancies of Social/Sexual Enhancement, Global Positive Affect and Relaxation in the beer-specific context as compared to the wine-specific context. Levels of consumption were significantly higher overall for hard liquor than for wine in the sample as a whole. Quantity of wine drinking was predicted by wine-specific Arousal and Personality Transformation expectancies; quantity of beer drinking was predicted by beer-specific Arousal expectancies; quantity of hard liquor consumption was predicted by hard liquor-specific Personality Transformation, Relaxation, and Arousal expectancies. Clinical implications of the findings and future research directions are discussed.
Addiction and relationship violence are serious and undeniably prevalent societal problems with high costs to families and individuals, as well as concomitant costs to health care, school, and social systems. The co-occurence of addiction and abuse is a reality that has yet to be fully acknowledged and explored from either a theoretical or practical perspective. The Violence and Addiction Equation: Theoretical and Clinical Issues in Substance Abuse and Relationship Violence addresses the addiction-violence overlap by assembling state-of-the-art theory and research in these areas to document the connection and the problem while also exploring prevention and treatment. Chapters cover biological bases of addiction and abuse, personality factors in the equation, developmental, psychopathological and cognitive social-learning models, and numerous issues in clinical treatment. Also presented are perspectives on interpersonal violence and addiction across the lifespan: from adolescence and young adult through partnership, parenthood, and maturity. This book represents a primary effort to pull together separate fields and offer essential assistance to researchers and practitioners working to alleviate the combined impact of addiction and violence.
Anxiety sensitivity (AS) is the fear of anxiety sensations which arises from beliefs that these sensations have harmful somatic, social, or psychological consequences. Over the past decade, AS has attracted a great deal of attention from researchers and clinicians with more than 100 peer-reviewed journal articles published. In addition, AS has been the subject of numerous symposia, papers, and posters at professional conventions. Why this growing interest? Theory and research suggest that AS plays an important role in the etiology and maintenance of many forms of psychopathology, including anxiety disorders, depression, chronic pain, and substance abuse. Bringing together experts from a variety of different areas, this volume offers the first comprehensive state-of-the-art review of AS--its conceptual foundations, assessment, causes, consequences, and treatment--and points new directions for future work. It will prove to be an invaluable resource for clinicians, researchers, students, and trainees in all mental health professions.
Posttraumatic stress disorder (PTSD) and alcohol use disorders are frequently comorbid conditions (Stewart, 1996). Alcohol use may serve a “negatively-reinforcing” function among traumatized individuals with PTSD (Stewart, 1996; Stewart, Conrod, Pihl, & Dongier, 1999a; Stewart, Pihl, Conrod, & Dongier, 1998). As such, the heavy drinking behavior of those with PTSD should be relatively situation-specific (i.e., more frequent in “negative” discriminative contexts than in other types of contexts). To test this “situational-specificity” hypothesis, a lifetime measure of trauma exposure (Everstine & Everstine, 1993), the PTSD Symptom Self-Report Scale (Foa, Riggs, Dancu, & Rothbaum, 1993), and the 42-item Inventory of Drinking Situations (Annis, Graham, & Davis, 1987) were administered to a community-recruited sample of 294 adult women substance abusers. PTSD symptoms were significantly positively correlated with frequency of heavy drinking in negative situations, but unrelated to frequency of heavy drinking in positive and temptation situations. At the level of specific drinking situations, PTSD symptoms were significantly positively correlated with frequency of heavy drinking in the negative situations of Unpleasant Emotions, Physical Discomfort, and Conflict with Others. PTSD symptoms were unrelated to frequency of heavy drinking in the positive situations of Pleasant Times with Others and Social Pressure to Drink, or in the temptation situations of Testing Personal Control and Urges and Temptations. Additionally, PTSD symptoms were significantly negatively correlated with frequency of heavy drinking in positive situations involving Pleasant Emotions. Anxiety sensitivity (fear of anxiety-related sensations; Peterson & Reiss, 1992), but not Neuroticism (tendency to experience negative affect; Costa & McCrae, 1992), mediated the observed associations between PTSD symptoms and situation-specific heavy drinking in negative contexts in general, and Conflict with Others and Physical Discomfort situations in particular. Implications for designing potentially more effective interventions for women with comorbid PTSD-alcohol use disorders are discussed.
The cardinal feature of bulimia nervosa as well as an important feature in some cases of anorexia nervosa, binge eating is central to the proposed Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) scheme for classifying eating disorders. Despite its prevalence, no one volume has been devoted to synthesizing all that is known about binge eating and its treatment. Bridging a gap in the literature, this . . . text brings together significant, original contributions from leading experts from a wide variety of fields.
A valuable resource for all clinicians and researchers interested in eating problems and their treatment, "Binge Eating" also serves as a text for advanced courses on eating disorders, or as supplementary reading for students of psychopathology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Research on the cognitive patterns characteristic of women high in dietary restraint indicates an attentional bias favoring the early-stage selective processing of forbidden food words. The current study was conducted to determine whether highly restrained women also show a later stage memory bias for forbidden food words. Sixty-seven university females encoded a list of 30 words (15 forbidden food words, 15 animal control words) presented in an incidental learning task. Participants were then asked to freely recall as many words as they could remember. Scores on the Restraint Scale were used to classify participants as either high (N = 29) or low (N = 38) in dietary restraint. Contrary to prediction, high-restraint women did not remember more forbidden food words than low-restraint women. High-restraint women did, however, remember fewer animal control words than low-restraint women, suggesting a deficit in memory for material outside of the food-schema domain in restrained eaters relative to nonrestrained eaters. Consistent with hypothesis, only women in the high-restraint group remembered more forbidden food than animal control words, indicating a relative memory bias for forbidden food words only among restrained eaters. The results thus provide only partial support for Bemis-Vitousek and Hollon's theory that restrained eaters have cognitive structures (schema) which may support more elaborative encoding and/or greater memory accessibility of personally relevant (i.e., forbidden food) information and which may underlie self-reported food preoccupation among clinical and nonclinical restrained eaters.
The present study examined whether restrained eaters relative to nonrestrained eaters show greater preoccupation with forbidden foods than nonforbidden foods using a modified Stroop color-naming task. Fourteen restrained eaters and 14 nonrestrained eaters completed a computerized Stroop task, involving naming the ink color of forbidden food words, nonforbidden food words, and animal control words. Subjects also rated all food words on perceived forbiddenness (degree to which subjects were avoiding each food in efforts to control body weight). As hypothesized, Stroop interference for both types of food words was greater for restrained eaters than nonrestrained eaters. Contrary to hypothesis, restrained eaters did not demonstrate greater interference when color naming forbidden versus nonforbidden food words. However, restrained eaters rated only forbidden foods as more highly forbidden than nonrestrained eaters. The finding that dietary restraint was associated with the selective processing of both forbidden and nonforbidden food words may suggest that restrained eaters are more preoccupied with both types of foods than nonrestrained eaters. Alternatively, the Stroop may tap differences in the personal relevance of food cues between restrained eaters and nonrestrained eaters occurring early in the information processing chain, prior to restrained eaters' later classification of food words as bad versus good (forbidden vs. nonforbidden).
The authors seek to clarify, from both an epidemiologic and genetic perspective, the major risk factors for bulimia nervosa and to understand the relationship between narrowly defined bulimia and bulimia-like syndromes.
Personal structured psychiatric interviews were conducted with 2,163 female twins from a population-based register. Psychiatric disorders were assessed using DSM-III-R criteria.
Lifetime prevalence and risk for narrowly defined bulimia were 2.8% and 4.2%, respectively. Including bulimia-like syndromes increased these estimates to 5.7% and 8.0%, respectively. Risk factors for bulimia included 1) birth after 1960, 2) low paternal care, 3) a history of wide weight fluctuation, dieting, or frequent exercise, 4) a slim ideal body image, 5) low self-esteem, 6) an external locus of control, and 7) high levels of neuroticism. Significant comorbidity was found between bulimia and anorexia nervosa, alcoholism, panic disorder, generalized anxiety disorder, phobia, and major depression. Proband-wise concordance for narrowly defined bulimia was 22.9% in monozygotic and 8.7% in dizygotic twins. The best-fitting model indicated that familial aggregation was due solely to genetic factors with a heritability of liability of 55%. A multiple threshold model indicated that narrowly defined bulimia nervosa and bulimia-like syndromes represented different levels of severity on the same continuum of liability.
The liability to fully syndromal bulimia nervosa, which affects around one in 25 women at some point in their lives, is substantially influenced by both epidemiologic and genetic risk factors. The same factors that influence the risk for narrowly defined bulimia also influence the risk for less severe bulimia-like syndromes.
The charts of 100 nonpsychotic female patients in a psychiatric emergency room were reviewed to locate references to history of sexual molestation: 50 charts were selected at random from emergency room files, and 50 charts had been written by clinicians asked to query abuse history. A substantially higher rate of sexual abuse was found for patients who had been directly asked about sexual molestation (70%) than for the random sample (6%). Further analysis linked molestation history to suicidality, substance abuse, sexual difficulties, multiple psychiatric diagnoses, and axis II traits or disorders--especially borderline personality. Severe abuse and multiple abusers best predicted psychiatric sequelae.
This article argues that research efforts to understand the nature of the psychological processes underlying such psychological phenomena as formal thought disorder, delusions, and hallucinations will be more successful if the phenomena themselves are studied directly than if diagnostic categories (e.g., schizophrenia) are studied. This point is illustrated through references to the study of cognitive mechanisms underlying symptoms of schizophrenia. However, the advantages of the symptom approach are also applicable to the study of other types of psychopathology and other types of underlying mechanisms (e.g., physiological or biochemical mechanisms).
We first establish the association between binge eating and dieting and present sequence data indicating that dieting usually precedes binging, chronologically. We propose that dieting causes binging by promoting the adoption of a cognitively regulated eating style, which is necessary if the physiological defense of body weight is to be overcome. The defense of body weight entails various metabolic adjustments that assist energy conservation, but the behavioral reaction of binge eating is best understood in cognitive, not physiological, terms. By supplanting physiological regulatory controls with cognitive controls, dieting makes the dieter vulnerable to disinhibition and consequent overeating. Implications for therapy are discussed, as are the societal consequences of regarding dieting as a "solution" to the problem of binging.
In this article, the author critically reviews studies on the relationship between exposure to trauma, posttraumatic stress disorder (PTSD), and alcohol abuse. After establishing that strong relationships exist between exposure to traumatic events and alcohol problems, and particularly between the diagnoses of PTSD and alcoholism, the author discusses various factors, theories, and possible mechanisms to account for these associations. Moreover, she discusses applications of these findings to the assessment and treatment of people exposed to trauma who abuse alcohol. Finally, the author outlines novel methods for testing theoretical hypotheses and makes suggestions for methodological improvements in future research.
The present study examined relations between dietary restraint and self-reported patterns of alcohol use, including separate assessment of quantity and frequency of alcohol consumption. One hundred seventy-six female university undergraduates completed the Restraint Scale (RS) and measures of their usual quantity and frequency of alcohol consumption over the past year. Quantity and frequency self-reports were scored separately and were also used to calculate 3 additional drinking variables: a composite weekly alcohol consumption score (drinks per week), a binge drinking categorical variable (where participants were classified as either binge drinkers or non-binge drinkers), and a yearly excessive drinking score (number of times in the past year that each participant consumed at least 4 alcoholic beverages per drinking occasion). RS scores were significantly positively correlated with scores on 4 of the 5 drinking behavior measures (i.e., quantity, drinks per week, binge drinking, and yearly excessive drinking, but not frequency). Thus, chronic dieting appears to be related to a relatively heavy drinking pattern that can be characterized as potentially risky, due to its established associations with adverse health and social consequences.
This study explored the validity of classifying a community-recruited sample of substance-abusing women (N = 293) according to 4 personality risk factors for substance abuse (anxiety sensitivity, introversion-hopelessness, sensation seeking, and impulsivity). Cluster analyses reliably identified 5 subtypes of women who demonstrated differential lifetime risk for various addictive and nonaddictive disorders. An anxiety-sensitive subtype demonstrated greater lifetime risk for anxiolytic dependence, somatization disorder, and simple phobia, whereas an introverted-hopeless subtype evidenced a greater lifetime risk for opioid dependence, social phobia, and panic and depressive disorders. Sensation seeking was associated with exclusive alcohol dependence, and impulsivity was associated with higher rates of antisocial personality disorder and cocaine and alcohol dependence. Finally, a low personality risk subtype demonstrated lower lifetime rates of substance dependence and psychopathology.
Female substance abusers recruited from the community were randomly assigned to receive 1 of 3 brief interventions that differentially targeted their personality and reasons for drug use. The 90-min interventions were: (a) a motivation-matched intervention involving personality-specific motivational and coping skills training, (b) a motivational control intervention involving a motivational film and a supportive discussion with a therapist, and (c) a motivation-mismatched intervention targeting a theoretically different personality profile. Assessment 6 months later (N = 198) indicated that only the matched intervention proved to be more effective than the motivational control intervention in reducing frequency and severity of problematic alcohol and drug use and preventing use of multiple medical services. These findings indicate promise for a client-treatment matching strategy that focuses on personality-specific motives for substance abuse.
Ability to utilize ethanol calories to reduce rate of loss of body weight on restricted food intake was demonstrated in 6 inbred strains of mice. Preference for 10% ethanol (vis. water) during deprivation was related to differences in effective enzyme activity of liver alcohol dehydrogenase (ADH) as measured in vitro. Strain effects, accounting for approximately 90% of variance of effective ADH activity, were demonstrated in: (a) high correspondence between effective ADH activity and preference for ethanol under deprivation conditions, (b) increased preference for ethanol by highest preference strain and decreased preference by lowest preference strain following forced ethanol intake during deprivation, and (c) ability to maintain body weight on deprivation regardless of ethanol intake. (16 ref.)
Objective.
—To examine the extent of binge drinking by college students and the ensuing health and behavioral problems that binge drinkers create for themselves and others on their campus.Design.
—Self-administered survey mailed to a national representative sample of US 4-year college students.Setting.
—One hundred forty US 4-year colleges in 1993.Participants.
—A total of 17592 college students.Main Outcome Measures.
—Self-reports of drinking behavior, alcohol-related health problems, and other problems.Results.
—Almost half (44%) of college students responding to the survey were binge drinkers, including almost one fifth (19%) of the students who were frequent binge drinkers. Frequent binge drinkers are more likely to experience serious health and other consequences of their drinking behavior than other students. Almost half (47%) of the frequent binge drinkers experienced five or more different drinking-related problems, including injuries and engaging in unplanned sex, since the beginning of the school year. Most binge drinkers do not consider themselves to be problem drinkers and have not sought treatment for an alcohol problem. Binge drinkers create problems for classmates who are not binge drinkers. Students who are not binge drinkers at schools with higher binge rates were more likely than students at schools with lower binge rates to experience problems such as being pushed, hit, or assaulted or experiencing an unwanted sexual advance.Conclusions.
—Binge drinking is widespread on college campuses. Programs aimed at reducing this problem should focus on frequent binge drinkers, refer them to treatment or educational programs, and emphasize the harm they cause for students who are not binge drinkers.(JAMA. 1994;272:1672-1677)
Forty-two inpatient women with bulimia nervosa and 29 women with anorexia nervosa were surveyed regarding eating behavior, patterns of licit and illicit substance use, and relation between drug use and appetite. Substantial use of licit substances such as laxatives, diuretics, and emetics were reported in women with bulimia nervosa. In addition, alcohol and cigarette use were significantly more common in women with bulimia nervosa than anorexia nervosa. The majority of bulimic subjects reported that smoking decreased appetite, alcohol increased appetite, and laxatives had no effect on appetite. Analysis of temporal patterns of drug intake suggested that binging and purging as well as alcohol, cigarette, and laxative use were considerably more prevalent in the evening hours. We suggest that the high rates of drug use in women with bulimia nervosa may be related to effects of food deprivation associated with the disorder.
There were 158 female undergraduates categorized on the basis of scores on the Binge Scale and the presence or absence of vomiting in five groups: normals (n = 73), mild (n = 23), moderate (n =23), and severe (n = 14) bingers and binge vomiters (n = 18). These groups were examined on measures of eating-disorders, dietary restraint, negative self-image, psychopathology, and social desirability. A discriminant function analysis isolated three variables that predicted group membership: drive for thinness, restraint, and negative self-image. It was clear from the analysis that binge-vomiters were highly similar to severe binge eaters and both differed from moderate binge eaters, who in turn differed from mild binge eaters and normals. The latter two groups were almost identical. The results point to the importance of bingeing rather than vomiting in the etiology and treatment of bulimia.
Harm reduction is an increasingly recognized approach to the management of substance abuse and other behaviors that may pose serious health risks. Rather than defining drug use as a disease or a moral failing, harm reduction proponents stake out a humane and practical alternative—meeting clients "where they are at" to help them understand the risks involved in their behaviors and make appropriate decisions about their own treatment goals.
This volume explains the model's rationale and examines a range of applications in diverse communities. Following an overview of harm reduction principles and strategies, chapters show how education, behavioral training, and environmental modifications can help clients reduce the severity of consequences to themselves and their communities as they work toward decreased use or abstinence. Clinical applications are then surveyed for problems including heavy drinking, smoking, illicit drug use, and high-risk sexual behaviors. The book offers specific recommendations for policy and practice for front-line drug and alcohol treatment providers, AIDS educators, and community health activists. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
several phases of binge eating can be identified, each of which can be analyzed in terms of determining influences, including psychological influences / divide the binge episode into five phases / examine the impact of psychological mechanisms at each of these stages / evaluate the various models that have been proposed to explain binge eating in terms of how they recognize and explain the operation of these psychological mechanisms at each phase
addictions model / conditioning model / affective disorders/regulation model / escape model / dieting model / biopsychosocial models (PsycINFO Database Record (c) 2012 APA, all rights reserved)
methods for assessing binge eating can be grouped in four categories: (1) self-report questionnaires, (2) interview techniques, (3) self-monitoring, and (4) observational or laboratory-based behavioral strategies / summarizes the more commonly used assessment methods within these categories, and analyzes the relative advantages and disadvantages they offer the researcher and clinician (PsycINFO Database Record (c) 2012 APA, all rights reserved)
One hundred and sixty-seven female undergraduates completed a series of questionnaires assembled to assess indices of eating disorders relative to tobacco and alcohol use, self-control, and sex-role ideology. Data were subjected to correlational, factorial, regression and analysis of variance procedures. In general, results showed the eating disorder indices to be independent of smoking and drinking behaviour. Smoking status and alcohol consumption were significantly related in that nonsmokers consumed less alcohol and reported being drunk less often than either smokers or ex-smokers. Self-control scores showed the greatest association with a measure of social desirability, although there were weak links to eating disorder indices and level of alcohol use. Self-control also emerged as the sole predictor of eating disorder measures. Finally, sex-role ideology was found to be a weak moderator of alcohol consumption such that the more feminist the ideology, the lower the level of intake.
Twenty-eight adolescent bulimics were compared to 201 psychiatrically hospitalized non-eating disordered patients. Non-eating disordered patients were found to be reliably more aggressive, delinquent, and under-controlled than patients with bulimia nervosa. Sexual abuse was found to be less prevalent among bulimic adolescents than comparison adolescents. No significant between group differences were achieved on any measure of alcohol/drug abuse. The behavioral profiles of substance abusing bulimics were highly similar to those of non-eating disordered patients. Three months follow-up of bulimic patients found that they were less depressed, had less somatization, and were less overcontrolled; however, they showed no reliable improvements in eating attitudes/behaviours or drug/alcohol use.
The Restrained Drinking Scale (RDS) was designed to measure an individual's preoccupation with controlling alcohol intake. Cluster analyses indicated that the original RDS could be divided into four subscales. One of the subscales measured frequency and occasions for heavy drinking, and was therefore conceptually and statistically confounded with self-reported consumption. The remaining three subscales of the differentiated RDS outperformed two undifferentiated (with and without the confounding items) versions of the RDS in prediction of drinking behavior. Negative experiences interacted with drinking restraint and contributed in their own right to prediction of drinking. It was concluded that drinking restraint, as measured by the differentiated RDS, encompasses components that relate uniquely to drinking behavior.
The 42-item version of the Inventory of Drinking Situations (IDS-42) assesses relative frequency of drinking behavior across eight categories of drinking situations and was originally developed as a method for identifying high-risk situations in alcoholic samples. This study was designed to examine the psychometric properties of the IDS-42 in a sample of university students in order to assess its suitability as an assessment tool in the non-clinical population. Three hundred and ninety-six students (111 M, 283 F, 2 with missing gender data) completed the IDS-42 and a well established measure of drinking motives, the Drinking Motives Questionnaire (DMQ). Confirmatory factor analysis of the IDS-42 established a hierarchical factor structure with eight lower-order factors and three higher-order factors of negatively-reinforcing situations, positively-reinforcing situations, and temptation situations. The eight lower-order IDS-42 factors demonstrated moderate to high internal consistency and excellent concurrent validity with conceptually-similar DMQ subscale scores. Non-parametric analyses revealed that male students reported a higher drinking frequency overall as compared to female students, particularly in IDS-42 situations involving Social Pressure to Drink, Pleasant Times with Others, Testing Personal Control, and Urges and Temptations. Across the entire sample of university student drinkers, a higher drinking frequency was reported in positively-reinforcing situations as compared to negatively-reinforcing situations and temptation situations, as predicted. Results suggest the IDS-42 possesses good psychometric properties and support its utility as a tool in identifying situation-specific antecedents to drinking among university students.
Purpose:
We investigated the psychometric properties (factor structure, internal consistency reliability, concurrent validity) of the Short Form Inventory of Drinking Situations (IDS-42) in women substance abusers.
Methods:
A sample of 297 substance-abusing women was recruited from the community. The women completed the IDS-42 and the three-factor Drinking Motives Questionnaire (DMQ).
Results:
Confirmatory factor analyses of IDS-42 items suggested a hierarchical structure for the scale. Eight factors (corresponding to Marlatt and Gordon's eight heavy drinking situations) provided the best model fit at the lower-order level, and three factors (i.e., Negatively Reinforcing vs. Positively Reinforcing vs. Temptation Situations) provided the best model fit at the higher-order level. Lower- and higher-order IDS-42 subscales were shown to possess adequate-to-high levels of internal consistency. The eight lower-order IDS-42 factors demonstrated excellent concurrent validity with conceptually similar DMQ subscale scores. Across the entire sample of female substance abusers, a higher frequency of heavy drinking was reported in Positively Reinforcing Situations and Unpleasant Emotions Situations, as compared to other heavy drinking situations.
Implications:
Results support the IDS-42's good psychometric properties and demonstrate its utility as a tool in identifying situation-specific antecedents to heavy drinking among women substance abusers.
Assessed the effects of alcohol on the eating behavior of normally restrained and unrestrained eaters. The icecream consumption of 55 female college students was measured in a taste rating context following their consumption of alcohol or placebo, the label of which was systematically manipulated. In the absence of a disinhibitory label, alcohol served as a mood elevator (with consumption decreasing for restrained eaters and increasing for unrestrained eaters), replicating the authors' 1976 findings. Alcohol disinhibited the consumption of normally restrained eaters only when supplemented by a disinhibitory label. Results are interpreted as support for a cognitive/pharmacological interaction model of alcohol intoxication. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A 12-item version of the Eating Attitudes Test (EAT-12) was constructed and applied at 1-year intervals in a non-referred cohort of 1193 adolescents in Norway aged 13-18 years. Eight percent of the girls scored beyond the chosen cut-off point of 9/10 the first time and 9% the second time. Factor analysis demonstrated 3 factors--dieting, bulimia and food preoccupation and oral control. Both the total scores on the EAT-12 and the 3 different factor scores showed a significant relationship between eating behaviour and smoking, level of alcohol consumption, alcohol intoxication, psychopathology and parental bonding.
Initial interest in the relationship between eating disorders, which occur primarily in women, and substance abuse, which is much more frequent in men than women, stemmed from the observations of Crisp (1968) who noted that chronic anorexics who developed bulimic behavior often abused alcohol. More recently, cross-sectional studies of women with eating disorders have documented prevalences of alcohol and other substance abuse in these women that are much higher than those reported in the general female population. Conversely, women with substance abuse disorders report eating-disordered behavior more often than the general population. This article first presents a definition of eating disorders and then addresses (1) the rate of coprevalence of eating disorders and substance abuse; (2) the mechanism of the coprevalence of these disorders; (3) the clinical similarities of these disorders; and (4) future directions.
Research on the epidemiology of bulimia nervosa has focused largely on the prevalence of the disorder. As methods have improved, consensus has increased regarding the prevalence rate among adolescent and young adult women--about 1%. However, the accuracy of this figure and its clinical significance must be questioned. In this synthesis of the epidemiological work to date, the authors review the literature from a clinical and research perspective. They recommend a shift in emphasis away from studies of the distribution of the disorder toward studies of the determinants of the whole spectrum of the disturbance that exists in the community.
Self-reports of high-risk events, situations and experiences associated with substance abuse and binge-eating behaviors were examined in a sample of hospitalized patients being treated for both problems. The question being posed in the present study is: Are the high-risk situations for heavy drinking and binge eating similar or different? Results suggest some similarities in the intensity of specific high-risk situations as represented by questionnaire subscale scores, for both of the problem behaviors, but they point to interesting differences as well. The hierarchical importance of the high-risk situations for the two behaviors were markedly different.
The authors present data on 275 patients who met DSM-III criteria for bulimia. The mean age of the patients was 24.8 years, and the average duration of illness was approximately 7 years. These patients reported a variety of abnormal eating-related behaviors: binge eating (100%), self-induced vomiting (88.1%), laxative abuse (60.6%), diuretic abuse (33.1%), and chewing and spitting out food (64.5%). Over one-third reported a history of problems with alcohol or other drugs and most indicated substantial social impairment.
The authors report an abbreviated version of the Michigan Alcoholism Screening Test (MAST). They hypothesized, on the basis of previously published data, that scores based on ten of the questions of the MAST would be as effective in discriminating between alcoholics and nonalcoholics as scores based on all 25 questions. The responses of 60 alcoholic and 62 nonalcoholic psychiatric patients supported their hypothesis.
Bulimia is an eating disorder purported to comprise binge eating episodes with subsequent depressive moods and self-deprecating thoughts. This study reports the development and preliminary construct validation of a Binge Scale intended to provide more descriptive, quantifiable information about the behavioral and attitudinal parameters of bulimia. Over two-thirds of the females and nearly one-half of the males in the samples reported binge eating occurences. The severity of binge eating was associated with degree of dieting concern (“restraint”) and inversely related to self-image acceptance, particularly among females. Maintaining body weight below “set point” through restrained eating efforts may increase the susceptibility to periodic binge episodes.
The comorbidity of eating disorders and substance use and abuse has frequently been reported in the past 15 years. To date, however, no synthesis of this literature exists. Here, 51 studies reporting on these associations are reviewed. Studies of substance use and abuse in eating disordered women are considered, as are studies of eating disorders among women classified as substance abusers. The rates of substance abuse among eating disordered women are also examined. This review indicates that associations are stronger with bulimia, and "bulimic" behaviors, than with anorexia nervosa. Analogously, bulimic anorectics report more substance use and abuse than restricters. The prevalence of drug abuse was not found to differ between the relatives of bulimics and anorectics. Several mechanisms explaining the eating disorder-substance use/abuse link are considered, and suggestions for future research made.
To examine the extent of binge drinking by college students and the ensuing health and behavioral problems that binge drinkers create for themselves and others on their campus.
Self-administered survey mailed to a national representative sample of US 4-year college students.
One hundred forty US 4-year colleges in 1993.
A total of 17,592 college students.
Self-reports of drinking behavior, alcohol-related health problems, and other problems.
Almost half (44%) of college students responding to the survey were binge drinkers, including almost one fifth (19%) of the students who were frequent binge drinkers. Frequent binge drinkers are more likely to experience serious health and other consequences of their drinking behavior than other students. Almost half (47%) of the frequent binge drinkers experienced five or more different drinking-related problems, including injuries and engaging in unplanned sex, since the beginning of the school year. Most binge drinkers do not consider themselves to be problem drinkers and have not sought treatment for an alcohol problem. Binge drinkers create problems for classmates who are not binge drinkers. Students who are not binge drinkers at schools with higher binge rates were more likely than students at schools with lower binge rates to experience problems such as being pushed, hit, or assaulted or experiencing an unwanted sexual advance.
Binge drinking is widespread on college campuses. Programs aimed at reducing this problem should focus on frequent binge drinkers, refer them to treatment or educational programs, and emphasize the harm they cause for students who are not binge drinkers.
To evaluate the frequency of eating disorder features among women receiving treatment for an alcohol problem, 52 female attenders at an alcohol clinic were assessed using a standardized research clinical interview, and the findings compared with data on a general population sample. The results suggest that eating disorder features are overrepresented among women who present for treatment for an alcohol problem.
The results of past research suggest that bulimics are more likely than anorexics to engage in substance use, and that binge eating and/or purging may be an indicator of increased likelihood of substance use. We further investigated substance use among women with eating disorders.
We compared women with anorexia nervosa (n = 134) to women with bulimia nervosa (n = 320) with regard to history of substance use and investigated potential relationships between eating disorder symptom presentation and substance use.
Even after controlling for age and eating disorder symptom severity, women with bulimia nervosa were more likely than those with anorexia nervosa to have used alcohol, amphetamines, barbituates, marijuana, tranquilizers, and cocaine. Independent of diagnostic category, severity of caloric restriction was predictive of amphetamine use, severity of binge eating was predictive of tranquilizer use, and severity of purging was predictive of alcohol, cocaine, and cigarette use.
Results are discussed in relation to the results of past research and with an emphasis on the importance of considering eating disorder symptom presentation in addition to formal eating disorder diagnosis.
The results of past research suggest the possible existence of a distinct subgroup of bulimic individuals who display multiple behaviors indicative of impulsivity (e.g., stealing, self-injury, attempted suicide, drug abuse). We further investigated potential relationships between multi-impulsivity and other clinical variables.
We compared women with bulimia nervosa (purging type) who displayed "multi-impulsivity" (n = 40) to those who did not (n = 177) with regard to symptom history and presentation, eating-disordered attitudes, and sexual experience.
The two groups did not differ in mean age, body mass index, scores on scales of eating-disordered attitudes and traits, incidence of self-induced vomiting, sexual intercourse, or masturbation, and current frequency of binge eating and self-induced vomiting. However, relative to the comparison group, women in the multi-impulsive group reported earlier onset of binge eating and sexual intercourse, a greater incidence of laxative abuse, and use of a greater number of different substances. There were statistical trends (p < .10) toward the multi-impulsive group displaying earlier onset of self-induced vomiting, laxative abuse, and masturbation.
Results are discussed in relation to the results of past research and the implications for treatment of bulimic women.
Selective processing of appetitive cues was investigated among food-deprived subjects and restrained eaters using the modified Stroop.
Thirty-two university students (25 females, 7 males) were randomly assigned to a 6-hr food deprivation (FD) or a no food deprivation (NFD) condition. Subjects were also divided into three restrained eating groups-high (HR), moderate (MR), and low (LR)-according to Restraint Scale scores. Subjects color named sets of food, alcohol, and leisure control words. Stroop color-naming latencies were submitted to 2 x 3 (Food Deprivation Condition x Word Type) and 3 x 3 (Restrained Eating Group x Word Type) repeated measures analyses of variance (ANOVAs).
Food deprivation failed to produce longer latencies for food or alcohol words relative to control words. However, HR status was associated with significantly longer latencies for both food and alcohol, relative to control, words.
Chronic dietary restraint but not short-term food deprivation was associated with selective processing of appetitive cues. The results have implications for understanding food preoccupation and risk for alcohol abuse in restrained eaters.
Relationships between drinking motives (self-perceived reasons for drinking alcohol) and drinking restraint (preoccupation with controlling alcohol intake) were examined in a nonclinical young adult sample. Ninety-seven undergraduate university drinkers completed the Temptation and Restraint Inventory (Collins & Lapp, 1992), the Drinking Motives Questionnaire (Cooper, Russell, Skinner, & Windle, 1992), and measures of demographics (age and gender) and social desirability. Results indicated that after accounting for the influences of demographic and social desirability information, Coping Motives and Enhancement Motives scores from the Drinking Motives Questionnaire were significant predictors of Cognitive and Emotional Preoccupation scores on the Temptation and Restraint Inventory, and Coping Motives scores were a significant predictor of Cognitive and Behavioral Control scores on the Temptation and Restraint Inventory. Social Motives scores on the Drinking Motives Questionnaire did not significantly predict either Cognitive and Emotional Preoccupation or Cognitive and Behavioral Control scores. Further analyses suggested that actual behavioral attempts at alcohol restriction on the Temptation and Restraint Inventory were predicted by Enhancement Motives scores, whereas cognitive concerns about drinking were predicted by Coping Motives scores. Results are discussed in terms of implications for risk for excessive and problem drinking in enhancement and coping-motivated young adult drinkers.
This study was designed to compare risk situations for binge eating vs. heavy drinking among women who struggle with both problems. Participants were 41 women in treatment for an alcohol problem who also self-reported binge eating. Participants completed the Inventory of Binge Eating Situations (IBES; [Baker, J. M. (1998). Binge eating and binge drinking among university women. Unpublished master's thesis, Department of Psychology, Queen's University, Kingston, Ontario, Canada]) and the Inventory of Drinking Situations (IDS-42; [Annis, H. M., Graham, J. M., & Davis, C. S. (1987). Inventory of Drinking Situations (IDS) user's guide. Toronto, Canada: Addiction Research Foundation]) to measure frequency of binge eating and heavy drinking, respectively, in eight categories of situations. A 2 (substance) x8 (situation) repeated measures ANOVA revealed a significant substancexsituation interaction. Further exploration of this interaction indicated that heavy drinking is more likely than binge eating to occur in reward and interpersonal situations involving pleasant emotions, pleasant times with others, social pressure, and conflict with others. In contrast, binge eating and heavy drinking are equally likely to occur in relief situations involving unpleasant emotions, and physical discomfort, as well as in situations involving urges and temptations, and testing control. Implications of findings for the treatment of co-occurring binge eating and heavy drinking in women are discussed.
Inventory of Drinking Situations (IDS) user's guide
- H M Annis
- J M Graham
- C S Davis
Annis, H. M., Graham, J. M., & Davis, C. S. (1987).
Inventory of Drinking Situations (IDS) user's guide.
Toronto, Canada: Addiction Research Foundation.
Binge eating and binge drinking among university women
- J M Baker
Baker, J. M. (1998). Binge eating and binge drinking
among university women. Unpublished Master's
Thesis, Department of Psychology, Queen's
University, Kingston, Ontario, Canada.
Talking body talk: An analysis of feminist therapy epistemology. Unpublished doctoral dissertation
- C G Brown
Brown, C. G. (2001). Talking body talk: An analysis
of feminist therapy epistemology. Unpublished
doctoral dissertation, University of Toronto,
Toronto.
Screening for problematic drinking in women: Validity of the Michigan Alcoholism Screening Test (MAST)
- S L Scifres
Scifres, S. L. (2003). Screening for problematic
drinking in women: Validity of the Michigan
Alcoholism Screening Test (MAST) [Summary].