Substance Use Disorders in Women with Anorexia Nervosa

Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
International Journal of Eating Disorders (Impact Factor: 3.13). 01/2009; 43(1):14-21. DOI: 10.1002/eat.20670
Source: PubMed


We examined prevalence of substance use disorders (SUD) in women with: (1) anorexia nervosa (AN) restricting type (RAN); (2) AN with purging only (PAN); (3) AN with binge eating only (BAN); and (4) lifetime AN and bulimia nervosa (ANBN). Secondary analyses examined SUD related to lifetime purging behavior and lifetime binge eating.
Participants (N = 731) were drawn from the International Price Foundation Genetic Studies.
The prevalence of SUD differed across AN subtypes, with more in the ANBN group reporting SUD than those in the RAN and PAN groups. Individuals who purged were more likely to report substance use than those who did not purge. Prevalence of SUD differed across lifetime binge eating status.
SUD are common in AN and are associated with bulimic symptomatology. Results underscore the heterogeneity in AN, highlighting the importance of screening for SUD across AN subtypes.

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    • "For example, a recent population-based study indicated that approximately 22% of women with AN have a lifetime history of AUD (Baker, et al., 2010). Although the association between AUD and AN is strongest with AN binge-purge type, the prevalence of AUD in women with AN restricting-type is greater than that found in the general population (Root, Pinheiro, et al., 2010). However, to date, the temporal sequence of comorbid AN and AUD has not been thoroughly examined. "
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    ABSTRACT: Women with eating disorders have a significantly higher prevalence of substance use disorders than the general population. The goal of the current study was to assess the temporal pattern of comorbid anorexia nervosa (AN) and alcohol use disorder (AUD) and the impact this ordering has on symptomatology and associated features. Women were placed into one of three groups based on the presence or absence of comorbid AUD and the order of AN and AUD onset in those with both disorders: (1) AN Only, (2) AN First, and (3) AUD First. The groups were compared on psychological symptoms and personality characteristics often associated with AN, AUD, or both using general linear models. Twenty-one percent of women (n=161) with AN reported a history of AUD with 115 reporting AN onset first and 35 reporting AUD onset first. Women with binge-eating and/or purging type AN were significantly more likely to have AUD. In general, differences were found only between women with AN Only and women with AN and AUD regardless of order of emergence. Women with AN and AUD had higher impulsivity scores and higher prevalence of depression and borderline personality disorder than women with AN Only. Women with AN First scored higher on traits commonly associated with AN, whereas women with comorbid AN and AUD displayed elevations in traits more commonly associated with AUD. Results do not indicate a distinct pattern of symptomatology in comorbid AN and AUD based on the temporal sequence of the disorders.
    Full-text · Article · Oct 2012 · Addictive behaviors
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    • "Although a different measure of impulsivity was used, results from this larger sample mirror those ofFavaro et al. (2005) who found that purging behavior, but not binge eating, was significantly associated with the presence of impulsive behaviors in a sample of individuals with AN and BN. Behaviors indicative of impulsivity such as substance abuse/dependence, self-injury, and suicide attempts have also been associated with the presence of purging behavior specifically in AN rather than the larger AN-BP subtype (Favaro & Santonastaso, 1996; Root, Pinheiro, et al., 2010). In the present study, we also found purging, but not binge eating behavior, to be significantly associated with novelty seeking, a personality trait that has been associated previously with impulsive behavior in individuals with AN and BN (Favaro, et al., 2005). "
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    ABSTRACT: To further refine our understanding of impulsivity, obsessions, and compulsions in anorexia nervosa (AN) by isolating which behaviours--binge eating, purging, or both--are associated with these features. We conducted regression analyses with binge eating, purging, and the interaction of binge eating with purging as individual predictors of scores for impulsivity, obsessions, and compulsions in two samples of women with AN (n = 1373). Purging, but not binge eating, was associated with higher scores on impulsivity, obsessions, and compulsions. Purging was also associated with worst eating rituals and with worst eating preoccupations. Our results suggest that purging, compared with binge eating, may be a stronger correlate of impulsivity, obsessions, and compulsions in AN.
    Full-text · Article · May 2012 · European Eating Disorders Review
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    • "In this sample of women with RAN, PAN, and AN-B, neither infant feeding, childhood picky eating, nor infant gastrointestinal problems were significantly associated with later AN subtype. An extensive literature has identified factors that distinguish across individuals presenting with different AN subtypes including temperament, comorbidity patterns, and outcomes (Garner, Garner, & Rosen, 1993; Halmi, Brodland, & Loney, 1973; Herzog, Schellberg, & Deter, 1997; Jordan, et al., 2008; Klump, et al., 2000; Pryor, Wiederman, & McGilley, 1996; Root, et al., 2010). Additionally, depression, substance abuse, higher levels of parental criticism, and low self-directedness have been associated with the emergence of bulimic symptomatology in individuals with RAN (Castellini, et al., 2011; Nishimura, et al., 2008; Tozzi, et al., 2005). "
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    ABSTRACT: This exploratory study assessed whether maternal recall of childhood feeding and eating practices differed across anorexia nervosa (AN) subtypes. Participants were 325 women from the Genetics of Anorexia Nervosa study whose mothers completed a childhood feeding and eating questionnaire. Multinomial logistic regression analyses were used to predict AN subtype from measures related to childhood eating: (i) infant feeding (breastfed, feeding schedule, age of solid food introduction), (ii) childhood picky eating (picky eating before age 1 year and between ages one and five) and (iii) infant gastrointestinal problems (vomiting and colic). Results revealed no significant differences in retrospective maternal report of childhood feeding and eating practices among AN subtypes.
    Full-text · Article · Mar 2012 · European Eating Disorders Review
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