Serving Substance Abuse Professionals Since 1993

Last Update: 11.03.09

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Eating Disorders

75 citations. January 2003 to present

Prepared: March 2009

Ackard DM; Eisenberg ME; Neumark-Sztainer D. Long-term impact of adolescent dating violence on the behavioral and psychological health of male and female youth. Journal of Pediatrics 151(5): 476-481, 2007. (29 refs.)

Objective: To evaluate the long-term impact of adolescent dating violence (ADV) on behavioral and psychological health. Study design: From a diverse sample of older adolescents who completed Project EAT in 1999 (wave 1) and 2004 (wave 2: mean age 20.4). 23 male and 102 female adolescents reporting ADV were compared with 671 male and 720 female adolescents reporting no ADV. Results: ADV was positively associated with cigarette smoking and suicide attempts for both sexes, binge-eating and suicidal ideation in male adolescents, and smoking marijuana and high depressive symptoms in female adolescents in analyses unadjusted for wave 1 outcomes. In analyses adjusted for wave 1, in female adolescents, ADV was significantly associated with smoking cigarettes, marijuana use, and high depressive symptoms and marginally associated with suicide attempts, in male adolescents, ADV was significantly associated with smoking cigarettes and marginally associated with binge-eating and suicidal ideation. ADV was significantly associated with an overall high-risk profile for both sexes; results remained significant in female adolescents after adjusting for wave 1. Conclusions ADV associated with greater likelihood of problematic health factors and increases nonspecific risk toward behavioral and psychological impairment in youth, particularly female adolescents.

Adams TB; Araas TE. Purging and alcohol-related effects in college women. International Journal of Eating Disorders 39(3): 240-244, 2006. (13 refs.)

Objective: Previous research indicates that college students who purge are more likely to consume alcohol in an unhealthy manner. The current study replicates and extends a previous study but employs a much larger, national sample. This study addresses 2 questions: (a) Are 18-24-year-old college women who purge more likely to engage in high-risk alcohol behavior? (b) Are 18-24-year-old alcohol-drinking college women who purge more likely to report greater negative consequences of alcohol use. Method: 47,202 U.S. students completed the National College Health Assessment during Spring 2004. Alcohol consumption and negative alcohol-related consequences were compared in purging and non-purging groups. Results: Respondents who purged reported heavier alcohol use and more negative consequences. Conclusion: The current study expands previous research regarding the association between purging behaviors and consequences of alcohol use. Further research is necessary to elucidate the most effective prevention and treatment programs.

Annus AM; Smith GT; Masters K. Manipulation of thinness and restricting expectancies: Further evidence for a causal role of thinness and restricting expectancies in the etiology of eating disorders. Psychology of Addictive Behaviors 22(2): 278-287, 2008. (35 refs.)

To test the eating disorder expectancy theory contention that expectancies for reinforcement from thinness play a causal role in body dissatisfaction and eating disorder symptoms, the authors manipulated expectancies in 2 studies. Participants were exposed to either a psychoeducational intervention or an experimental manipulation of thinness and restricting expectancies. Study I participants were symptomatic college women who attended 3 experimental sessions and I follow-up session, each I week apart. Study 2 participants were high school girls who received the 3 experimental sessions clustered into 2 meetings; they completed symptom measures at baseline and at follow-up. In both samples, the thinness expectancy manipulation produced greater declines in thinness expectancies and body dissatisfaction than did the psychoeducational intervention. For high school girls, the thinness expectancy manipulation also produced a greater decline in overall eating-disordered attitudes. These results provide further support for the role of expectancies in the etiology of eating-disordered behaviors.

Askenazy FL; Sorci K; Benoit M; Lestideau K; Myquel M; Lecrubier Y. Anxiety and impulsivity levels identify relevant subtypes in adolescents with at-risk behavior. Journal of Affective Disorders 74(3): 219-227, 2003. (41 refs.)

Background: Impulsivity (I) and anxiety (A) were hypothesized to be crucial clinical features in adolescents with at-risk behavior. We therefore classified them into sub-groups according to these two major dimensions. The study examined the relevance of these groups by describing their major diagnoses and behavioral characteristics. Methods: During a 1-year period, all in-patients consecutively admitted for at-risk behavior, except those with a previous psychotropic treatment and/or schizophrenic disorders, were rated for anxiety and impulsivity, and categorized into four groups: impulsive and anxious (IA), impulsive and non-anxious (Ia), non-impulsive and anxious (iA), non-impulsive and non-anxious (ia). We assessed the main behavioral disturbances (suicide attempt, carving, violence, delinquency, substance abuse, and eating disorder) and the main current axis I disorder in each sub-group. Results: A total of 69 patients were included. In the IA group 62% exhibited hypomanic episodes and 87% recurrent suicide attempts. In the la group all exhibited conduct disorders, 93% were males, 80% delinquents, and 100% violent with others. Both groups reported a high percentage of cannabis use (67%). The iA group exhibited anorexia nervosa (73%) with a major depressive episode. The ia patients were mainly non-violent, first suicide attempts with low risk. Limitations: Long-term data are needed to assess the stability of these groups. Conclusions: We found that sub-typing adolescents with at-risk behavior into four groups according to their level of anxiety and impulsivity was highly predictive of being suicidal with mood disorders (AI), delinquent with conduct disorder (Ia), anorectic or depressed (Ai), and with substance abuse associated only to impulsivity. It is likely that this sub-typing of patients may be useful for prevention and therapeutics. The impulsive-anxious group (IA) appears closely related to the soft bipolar spectrum. A replication and follow-up data are now needed.

Avena NM. Examining the addictive-like properties of binge eating using an animal model of sugar dependence. (review). Experimental and Clinical Psychopharmacology 15(5): 481-491, 2007. (132 refs.)

The increase in the incidence of obesity and eating disorders has encouraged research efforts aimed at understanding the etiology of abnormal eating behaviors. Clinical reports have led to the suggestion that some individuals may develop addictive-like behaviors when consuming palatable foods. Binge eating is a behavioral component of bulimia and obesity and has also become increasingly common in nonclinical populations in our society. This review summarizes the behavioral and neurochemical similarities between binge eating of palatable foods and the administration of drugs of abuse. An animal model of bingeing on sugar is used to illustrate behaviors found with some drugs of abuse, such as opiate-like withdrawal signs, enhanced intake following abstinence, and cross-sensitization. Related neurochemical changes commonly observed with drugs of abuse, including changes in dopamine and acetylcholine release in the nucleus accumbens, can also be found with bingeing on sugar. These neurochemical alterations are exacerbated when animals binge on sugar while at a low body weight or when the food they ingest is purged. Drawing on other animal models and the clinical literature, parallels between drug abuse and binge-eating behavior are discussed.

Baker JH; Mazzecii SE; Kendler KS. Association between broadly defined bulimia nervosa and drug use disorders: Common genetic and environmental influences. International Journal of Eating Disorders 40(8): 673-678, 2007. (36 refs.)

Objective: Previous research has shown an association between bulimia (BN) and drug use disorders (DUD). The purpose of the present study was to investigate possible influences on the comorbidity between BN and DUD. Method: Participants included 490 monozygotic and 354 dizygotic female twins and 930 females from opposite sex pairs. Multiple logistic regression analyses were used to test shared correlates and mediators. Bivariate twin analyses were used to investigate the contribution of genes and environment to the correlation between BN and DUD. Results: Depression, neuroticism, and childhood sexual abuse (CSA) mediated the association between BN and DUD regardless of which disorder was used as the dependent variable. Analyses also indicated genetic and nonshared environmental overlap between BN and DUD. Conclusion: The association between BN and DUD is due mostly to overlapping genetic influences with a smaller contribution from nonshared environment. Depression, neuroticism, and CSA are likely important shared correlates.

Beato-Fernandez L; Rodriguez-Cano T; Pelayo-Delgado E; Calaf M. Are there gender-specific pathways from early adolescence psychological distress symptoms toward the development of substance use and abnormal eating behavior? Child Psychiatry & Human Development 37(3): 193-203, 2007. (35 refs.)

The aim of the present longitudinal community study was to test whether psychological distress at 13 years of age predicted reported substance use problems in boys and abnormal eating behavior in girls 2 years later. The sample consisted of 500 male and 576 female students. The use of substances was evaluated using a semi-structured interview, psychological distress with the General Health Questionnaire (GHQ) and eating psychopathology with the Eating Attitudes Test (EAT-40), and the Bulimic Investigatory Test Edinburgh (BITE). Controlling the effect of initial substance use problems, psychological distress predicted later reported substance use problems in males. Girls with an initial score above the cut-off point on the GHQ were two times more likely to be at risk of having an eating disorder 2 years later. Therefore, psychological distress might take different developmental pathways in males and females, leading toward eating problems in the latter versus substance use in the former.

Becker AE; Keel P; Anderson-Fye EP; Thomas JJ. Genes and/or jeans?: Genetic and socio-cultural contributions to risk for eating disorders. (review). Journal of Addictive Diseases 23(3): 81-103, 2004. (105 refs.)

Eating disorders are prevalent among young adult females and pose serious psychological and medical risks. Notwithstanding important advances, efforts to develop effective means of preventing and treating eating disorders have been limited by an incomplete understanding of their multifactorial etiology. Whereas epidemiologic data strongly suggest the influence of socio-cultural context in moderating risk, many hypotheses about how these effects are exerted have remained empirically unevaluated. Specifically, experimental and observational data suggest that social transition (e.g., transnational migration, urbanization, modernization), Western media exposure, and certain peer environments (involving social comparison and teasing) may all contribute to risk. With respect to genetic influences on etiology, family and twin studies have supported a genetic diathesis to eating disorders. Whereas, molecular genetic studies have generated interesting leads-with the most promising findings emerging for genes related to the function of serotonin-they have yet to identify well-replicated susceptibility loci. This paper reviews the data supporting both socio-cultural and genetic contributions for eating disorders and suggests productive future strategies for continuing to unravel their likely multiple and complex interactions.

Birch CD; Stewart SH; Brown CG. Exploring differential patterns of situational risk for binge eating and heavy drinking. Addictive Behaviors 32(3): 433-448, 2007. (61 refs.)

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) x 8 (situation) repeated measures ANOVA revealed a significant substance x situation 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.

Bonfa F; Cabrini S; Aanzi M; Bettinardi O; Spotti R; Uber E. Treatment dropout in drug-addicted women: Are eating disorders implicated? Eating and Weight Disorders 13(2): 81-86, 2008. (24 refs.)

A high prevalence of eating disorders among drug-addicted female patients has been noted, and it could be associated to psychopathological underlying factors. Our aim was to assess eating disorder traits in women approaching a residential program for drug addiction. We hypothesized that these traits would correlate to more general psychopathological factors, and would influence treatment relapse. A sample of 204 substance dependent women attending a residential treatment was screened for psychopathological indices, and follow-up data were obtained at the end of the treatment. Clients had a high risk for eating disorders (15%), and lifetime prevalence was even higher (20%). Disordered eating was associated to psychopathological distress, in particular harm avoidance resulted significantly lower, (p=0.005), evoking higher unresponsiveness to danger. Drug addiction treatment outcome is associated to completion of defined programs, and eating disorder was a key covariable in determining treatment relapse or success (p=0.03). Clinicians should be aware of this potential co-morbidity, and concurrent treatments should be attempted, in order to prevent symptomatic shifting.

Bulik CM; Klump KL; Thornton L; Kaplan AS; Devlin B; Fichter MM et al. Alcohol use disorder comorbidity in eating disorders: A multicenter study. Journal of Clinical Psychiatry 65(7): 1000-1006, 2004. (41 refs.)

Background: Eating disorders and alcohol use disorders (AUDs) commonly co-occur, although the patterns of comorbidity differ by eating disorder subtype. Our aim was to explore the nature of the co-morbid relation between AUDs and eating disorders in a large and phenotypically well-characterized group of individuals. Method. We compared diagnostic and personality profiles of 97 women with lifetime anorexia nervosa only, 282 women with lifetime bulimia nervosa only, and 293 women with a lifetime history of both anorexia nervosa and bulimia nervosa or anorexia nervosa with binge eating (ANBN) (DSM, IV criteria). All individuals were participants in a multicenter study of the genetics' of anorexia nervosa and bulimia nervosa. We explored pattern of onset, Axis I and 11 comorbidity, and personality characteristics of individuals with and without AUDs by eating disorder subtype. Personality characteristics were assessed with the Multidimensional Perfectionism Scale, the Temperament and Character Inventory, and the Barratt Impulsivity Scale. Results: Alcohol use disorders were significantly more prevalent in women with ANBN and bulimia nervosa than in women with anorexia nervosa (p = .0001). The majority of individuals reported primary onset of the eating disorder, with only one third reporting the onset of the AUD first. After eating disorder subtype was controlled for, AUDs were associated with the presence of major depressive disorder, a range of anxiety disorders, and cluster B personality disorder symptoms. In addition, individuals with AUDs presented with personality profiles, marked by impulsivity and perfectionism. Conclusions: Individuals with eating disorders and AUDs exhibit phenotypic profiles characterized by both anxious, perfectionistic traits and impulsive, dramatic dispositions. These traits mirror the pattern of control and dyscontrol seen in individuals with this comorbid profile and suggest that anxiety modulation may be related to alcohol use in this group.

Cassin SE; von Ranson KM. Is binge eating experienced as an addiction? Appetite 49(3): 687-690, 2007. (19 refs.)

To ascertain to what degree binge eating is experienced as an addiction, this study examined the proportion of women with binge-eating disorder (BED) whose symptoms met criteria for an addiction. Women (N = 79) with current BED completed a structured telephone interview to assess for symptoms of a modified version of DSM-IV substance dependence and Goodman's [(1990). Addiction: Definition and implications. British Journal of Addiction, 85, 1403-1408] proposed diagnosis of 'addictive disorder'. Most binge eaters (92.4%,) met modified DSM-IV criteria for Substance dependence, whereas many fewer (40.5%) met Goodman's more restrictive criteria for addictive disorder. Women meeting criteria for addictive disorder had more frequent eating binges than those who did not. Despite certain observed similarities between binge eating and addictions, we argue that BED should remain classified as an eating disorder.

Cassin SE; von Ranson KM; Heng K; Brar J; Wojtowicz AE. Adapted motivational interviewing for women with binge eating disorder: A randomized controlled trial. Psychology of Addictive Behaviors 22(3): 417-425, 2008. (35 refs.)

In this randomized controlled trial, 108 women with binge-eating disorder (BED) recruited from the community were assigned to either an adapted motivational interviewing (AMI) group (1 individual AMI session + self-help handbook) or control group (handbook only). They were phoned 4, 8, and 16 weeks following the initial session to assess binge eating and associated symptoms (depression, self-esteem, quality of life). Postintervention, the AMI group participants were more confident than those in the control group in their ability to change binge eating. Although both groups reported improved binge eating, mood, self-esteem, and general quality of life 16 weeks following the intervention, the AMI group improved to a greater extent. A greater proportion of women in the AMI group abstained from binge eating (27.8% vs. 11.1%) and no longer met the binge frequency criterion of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) for BED (87.0% vs. 57.4%). AMI may constitute a brief, effective intervention for BED and associated symptoms.

Chanoine P; Spector ND. Hyperlipidemia, eating disorders, and smoking cessation. (review). Current Opinion in Pediatrics 20(6): 734-739, 2008. (19 refs.)

Purpose of review: The present article is intended to review the recent literature on three topics that are very important in pediatric office practice: hyperlipidemia, eating disorders, and smoking cessation. Review of the current literature will help pediatricians understand current data on the pathophysiology, diagnosis, and treatment of hyperlipidemia in childhood and adolescence. This article also provides practitioners with a summary of the most current literature on identifying the characteristics and risk factors of pediatric patients with eating disorders. The article concludes with a summary of recent literature on smoking prevention and cessation methods. Recent findings: The current literature shows that practitioners must be more aggressive in screening patients for hyperlipidemia. Education regarding the prevention of hyperlipidemia is also essential. Recent work has further identified the characteristics and risk factors of patients with eating disorders. Further, recent literature has studied innovative tools that can be employed by patients interested in smoking cessation. Summary: Hyperlipidemia, eating disorders, and smoking are three extremely important problems that negatively impact the lives of children and adolescents. Pediatricians should regularly screen their patients for hyperlipidemia and eating disorders. Practitioners should assist their pediatric patients with the process of smoking cessation.

Christo G; Jones SL; Haylett S; Stephenson GM; Lefever RMH; Lefever R. The Shorter PROMIS Questionnaire - Further validation of a tool for simultaneous assessment of multiple addictive behaviours. Addictive Behaviors 28(2): 225-248, 2003. (43 refs.)

There is both a theoretical and clinical need to develop a questionnaire that assesses a range of addictive behaviours. The Shorter PROMIS Questionnaire (SPQ) is a 16-scale self-report instrument assessing the use of nicotine, recreational drugs, prescription drugs, gambling, sex, caffeine, food bingeing, food starving, exercise, shopping, work, relationships dominant and submissive, and compulsive helping dominant and submissive. Clinical cut-off scores using the 90th percentile were derived from a normative group of 508 individuals. These cut-offs correctly identified 78-100% of cases within clinical criterion groups of specific disorders. The clinical sample also completed other validated scales assessing gambling, eating, alcohol, and drug use. Correlations were typically .7 with relevant SPQ scales. The SPQ food, drug, and alcohol scales were at least equivalent to validated comparison scales in the strength of their relationship to relevant clinical criterion groups. Internal consistency was high for all scales, and test-retest reliability was generally good. This clinically useful instrument provides a broad assessment of addictive problems, thereby benefiting both the treatment provider and the client.

Corcos M; Jeammet P. A psychosomatic approach of food addict behaviors. Sciences des Aliments 24(1): 71-83, 2004. (13 refs.)

Our personal experience is based on a population of severe anorexics and bulimics with major symptoms, usually evolving over several years. The treatment and follow-up for some of them is spread over several years, and can be superior to ten years in a few cases.This practice which combines a large number of cases and long-term, personalised individual treatments, has enabled the emergence of a certain amount of data from which have sprung a number of questions concerning the mental functioning of these patients.These observations have led us to believe that the essential difficulty of these adolescents lies within their personalities and their capacity to deal with conflict.Numerous authors suggest that narcissistic anxieties lie behind the addictive impass in eating disorders. This may therefore be conceptualised as a narcissistic structure defending against disruptive anxieties. When this defence is ineffective, severe depressive reactions are seen. We seem to see most often a proximity to, but not a continuity with, episodes of melancholy.Most usually, this defence successfully contains breakdowns, with varying degrees of effect, and what we see clinically is more of the order of despair and defence against depression, rather than established symptomatic depression.It is this dynamic, this avoidance of despair lianed to a compensatory juxtaposed narcissistic schema that, we feel must be appreciated in order to understand the developing risks in these behaviours: psychotic breakdowns, abnormal development, conduct disorders and psychpathic tendencies and psychosomatic reactions.

Curtis CE; Jason LA; Olson BD; Ferrari JR. Disordered eating, trauma, and sense of community: Examining women in substance abuse recovery homes. Women & Health 41(4): 87-100, 2005. (47 refs.)

Women with substance-related disorders are likely to suffer from disordered eating and, past traumatic experience, Issues that might inhibit the recovery process. The present study determined the prevalence of co-morbidity of disordered eating, trauma, and substance-related disorders among 60 women living in one of 15 Mutual help substance abuse recovery homes that establish new social networks for residents. Psychological sense of community was also examined to determine whether residents were able to obtain support that may have previously been absent. Results indicated that women with co-existing disordered eating and substance-related disorders, as well as women who have experienced trauma benefit from democratic, independent-living environments. Implications for treatment and future research are discussed.

Dawe S; Loxton NJ. The role of impulsivity in the development of substance use and eating disorders. (review). Neuroscience and Biobehavioral Reviews 28(3): 343-351, 2004. (77 refs.)

Impulsivity is now widely viewed as a multidimensional construct consisting of a number of related dimensions. Although many measures of impulsivity are correlated, most recent factor analyses support at least a two-factor model. In the current paper, these two factors have been labelled reward sensitivity, reflecting one of the primary dimensions of Gray's personality theory, and rash-spontaneous impulsiveness. The evidence supporting the existence of two dimensions of impulsivity is reviewed in relation to substance misuse and binge eating.

Donovan DM; Marlatt GA, eds. Assessment of Addictive Behaviors, 2nd edition. New York: Guilford Press, 2005. (Chapter refs.)

This edited volume, with 13 chapters and 33 contributors, examines the assessment issues related to addictive disorders and compulsive behaviors. Interestingly it begins with consideration of relapse prevention and assessment issues to accomplish this. The following chapter deals with assessive of addictive disorders in racial and ethnic groups. The next six chapters focus upon assessment for those involved with a specific drug -- alcohol, nicotine, cocaine, amphetamines, opiodis, marijuana -- followed by one dealing with hallucinogens, inhalants and steroid use. The concluding four chapters deal with assesment, not of psychoactive drugs, but with compulsive behaviors -- gambling, disordered eating and obesity, sexual offender relapse, and high risk sexual behavior. Incorporated within the discussion is consideration of screening and assessment tools, as well as assessment of comorbid psychiatric disorders and other related medical co-occurring conditions.

Duncan AD; Neuman RJ; Kramer JRF; Kuperman S; Hesselbrock VM; Bucholz KK. Lifetime psychiatric comorbidity of alcohol dependence and bulimia nervosa in women. Drug and Alcohol Dependence 84(1): 122-132, 2006. (47 refs.)

Previous work from our group revealed two groups of women with bulimia nervosa (BN), one with, and one without alcohol dependence (AD). The current study sought to determine whether women with lifetime BN and AD (BN+AD+) were more similar to women with BN and no AD (BN+AD_) or to women with AD and no BN (BN_AD+) in terms of lifetime psychiatric comorbidity and psychological functioning. Data on BN and AD from 407 female relatives in a family study of alcoholism were used to create three mutually exclusive groups: BN+AD+ (n = 30), BN+AD_ (n = 55), and BN_AD+ (n = 322). Bivariate analyses revealed fewer differences between BN+AD+ and BN_AD+ women than between BN+AD+ and BN+AD_ women. BN+AD+ women were more likely than BN+AD_ women to have drug dependence, conduct disorder, and suicidality, and were more likely to have major depression, lower GAF scores, and to engage in unsafe sex than both BN+AD_ and BN_AD+ women. After adjusting for other psychopathology and demographic variables, BN+AD+ women were more likely than BN+AD_ women to have major depression, drug dependence, and tobacco dependence and more likely than BN_AD+ women to have major depression and obsessive-compulsive disorder. These results suggest that BN+AD+ women exhibit more severe psychopathology than either BN+AD_ or BN_AD+ women and may represent a distinct subgroup within bulimia nervosa or alcohol dependence.

Duncan AE; Neuman RJ; Kramer J; Kuperman S; Hesselbrock V; Reich T et al. Are there subgroups of bulimia nervosa based on comorbid psychiatric disorders? International Journal of Eating Disorders 37(1): 19-25, 2005. (34 refs.)

Objective: The current study sought to determine whether there are subtypes of bulimia nervosa (BN) differentiated by comorbid psychiatric disorders. Method: Data on comorbid psychiatric diagnoses in female relatives of probands and controls in the Collaborative Study of the Genetics of Alcoholism (COGA) who met criteria for BN (as outlined in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders) were analyzed using latent class analysis. Resulting latent classes were compared on a variety of variables related to impulsive behaviors and psychological functioning. Results: The best-fitting solution, a two-class model, yielded one class (72%) characterized by substance dependence, depression, antisocial personality disorder (ASPD), and anxiety disorders, and another characterized by depression. The highly comorbid class had more suicidality, more daily smokers, sought help for emotional problems, and had lower Global Assessment of Functioning (GAF) scores compared with those in the comorbid depression only class. Discussion: Latent class findings suggest the existence of two classes of BN differentiated by substance dependence, impulsive behaviors, and poorer psychological functioning.

Elliot DL; Moe EL; Goldberg L; DeFrancesco CA; Durham MB; Hix-Small H. Definition and outcome of a curriculum to prevent disordered eating and body-shaping drug use. Journal of School Health 76(2): 67-73, 2006. (37 refs.)

Almost one half of male and female students participate in high school-sponsored athletics, and high school also is a time when classroom health promotion curricula are less effective. The Athletes Training and Learning to Avoid Steroids is a sport team-centered drug-use prevention program for male high school athletes, which has been shown to reduce alcohol and illicit drug use. Just as anabolic steroid use is associated with male athletes, female sport participants may be at a greater risk for disordered eating and body-shaping drug use. Extending sport team-centered programs to young women athletes required defining and ranking factors related to developing those harmful behaviors. Survey results from a cross-sectional cohort of female middle and high school student athletes were used to identify and prioritize potential curriculum components, including mood and self-esteem, norms of behavior, perceptions of healthy body weight, effects of media depictions of women, and societal pressures to be thin. The derived sport team-centered program was prospectively assessed among a second group of female student athletes from 18 high schools, randomized to receive the intervention or the usual care control condition. The Athletes Targeting Healthy Exercise and Nutrition Alternatives (ATHENA) intervention is a scripted, coach-facilitated, peer-led 8-session program, which was incorporated into a teams usual training activities. The ATHENA program significantly altered the targeted risk factors and reduced ongoing and new use of diet pills and body-shaping substances (amphetamines, anabolic steroids, and sport supplements). These findings illustrate the utility of a structured process to define curriculum content, and the program's positive results also confirm the sport team's potential as a vehicle to effectively deter health-harming behaviors.

Fischer S; Anderson KG; Smith GT. Coping with distress by eating or drinking: Role of trait urgency and expectancies. Psychology of Addictive Behaviors 18(3): 269-274, 2004. (44 refs.)

The authors propose that trait urgency (the tendency to act rashly when distressed) is a risk factor for both alcohol abuse and bulimic symptoms, that disorder-specific expectancies influence whether one engages in one behavior or the other, and that expectancies moderate urgency's influence on those behaviors. Cross-sectional findings were consistent with the model. Problems from alcohol use were comorbid with binge eating and purging. Trait urgency was associated with both behaviors. Alcohol expectancies were associated with drinking levels and with problem drinking, but not with eating. Eating expectancies were associated with binge eating, but not with alcohol use or problems. Urgency's effect on binge eating was moderated by expectancies, but its effect on alcohol use and problem drinking was not.

Fischer S; Smith GT. Binge eating, problem drinking, and pathological gambling: Linking behavior to shared traits and social learning. Personality and Individual Differences 44(4): 789-800, 2008. (51 refs.)

Varied definitions of the construct impulsivity may account for inconsistencies in studies that examine its relationship to bulimic symptoms, pathological gambling, and alcohol abuse. We examined the influence of urgency, sensation seeking, lack of planning, and lack of persistence on these three addictive behavior patterns in 246 college students. In structural equation modeling analyses that included all four constructs, only urgency, defined as the tendency to act rashly when distressed, explained significant variance in symptom level for each of the three addictive behaviors. Sensation seeking related to frequency of gambling and drinking, but not to symptoms of abuse. Additionally, behavior specific expectancies moderated the effect of urgency on gambling for men and binge eating for women. Urgency may influence vulnerability to many types of addictive behaviors. However, whether or not individuals engage in drinking, gambling, or binge eating may be influenced by behavior specific expectancies.

Fischer S; Smith GT; Anderson KG; Flory K. Expectancy influences the operation of personality on behavior. Psychology of Addictive Behaviors 17(2): 108-114, 2003. (38 refs.)

The authors investigated the moderating effect of expectancies on personality for 2 different addictive behavior processes: (a) drinking and (b) binge eating and purging characteristic of bulimia nervosa. Study 1 found that positive expectancies for social facilitation from drinking moderated the effect of extraversion on drinking behavior among undergraduate men and women. Study 2 found that the expectancy that eating will help manage negative affect moderated the effect of trait urgency on bulimic symptoms among undergraduate women. Thus, the relationships of the trait risk factors to these 2 addictive behaviors are stronger if one also holds certain expectancies for reinforcement from those behaviors.

Fischer S; Smith GT; Annus A; Hendricks M. The relationship of neuroticism and urgency to negative consequences of alcohol use in women with bulimic symptoms. Personality and Individual Differences 43(5): 1199-1209, 2007. (36 refs.)

The purpose of this study was to test hypotheses regarding why eating disordered college women report more frequent negative consequences of alcohol use than controls. Thirty-two women with eating disorder (ED) symptoms and 34 women without eating disorder symptom were individually administered structured clinical interviews regarding alcohol abuse/dependence and the eating disorders examination. They also completed self-report measures of neuroticism, urgency, sensation seeking, planning, and persistence. Women with ED symptoms reported more negative consequences of alcohol use, and higher levels of neuroticism and urgency. However, the two groups did not differ on any other personality variable. The presence of high levels of trait urgency moderated the effect of neuroticism on the negative consequences of drinking such that women with high levels of both traits reported the most consequences related to alcohol use. Rash affect regulation may be a characteristic of ED women and influence consequences of alcohol use.

Franko DL; Dorer DJ; Keel PK; Jackson S; Manzo MP; Herzog DB. Interactions between eating disorders and drug abuse. Journal of Nervous and Mental Disease 196(7): 556-561, 2008. (41 refs.)

To examine the relationship between drug abuse and eating disorders in a longitudinal sample. In a prospective study, women diagnosed with either DSM-IV anorexia nervosa (n = 136) or bulimia nervosa (n = 110) were interviewed and assessed for research diagnostic criteria drug use disorder (DUD) every 6-12 months over 8.6 years. Contrary to expectation, DUD did not influence recovery from either eating disorder. Multivariate analyses indicated that alcohol use and suicide attempts over the course of the study, as well as hospitalization for an affective disorder before the study, predicted DUD in anorexia nervosa. For bulimia nervosa, multivariate predictors included the severity of alcohol use and the severity of bulimic symptoms over the course of the study, and a hospitalization before study entry for a nonaffective disorder. Drug abuse in women with eating disorders is an area of clinical concern and should be monitored routinely.

Franko DL; Dorer DJ; Keel PK; Jackson S; Manzo MP; Herzog DB. How do eating disorders and alcohol use disorder influence each other? International Journal of Eating Disorders 38(3): 200-207, 2005. (32 refs.)

Objective: Although eating disorders and alcohol use disorder (AUD) are known to co-occur, the influence of one on the other has not been studied. Method: In a prospective study, women diagnosed with either anorexia nervosa (AN; n = 136) or bulimia nervosa (BN; n = 110) were interviewed and assessed for Research Diagnostic Criteria (RDC) AUD every 6-12 months over 8.6 years. Results: Over one fourth of the sample (n - 66 [27%]) reported a lifetime history of AUD. Ten percent of the study subjects (n = 24) developed AUD over the course of the study. AUD did not influence recovery from either eating disorder. Poor psychosocial functioning and history of substance use predicted prospective onset of an episode of AUD for both diagnostic groups. Unique predictors for AUD for women with AN were depression, overconcern with body image, and vomiting. Recovery from AUD was predicted by group therapy and hospitalization (women with AN) and individual therapy and exercise (women with BN). Conclusion: The influence of eating disorders on AUD appears to be greater than the reverse. A substantial number of patients who initially present with an eating disorder develop alcohol problems over the course of time, suggesting that the risk is an ongoing one that should be monitored by clinicians.

Gadalla T; Piran N. Co-occurrence of eating disorders and alcohol use disorders in women: A meta analysis. (review). Archives of Women's Mental Health 10(4): 133-140, 2007. (55 refs.)

This meta analysis involved 41 studies published between January of 1985 and May of 2006, which examined the co-occurrence of eating disorders (ED) and alcohol use disorders (AUD) in women. Studies were reviewed and a quantitative synthesis of their results was carried out via the calculation of standardised effect sizes. Direction and strength of the relationships between AUD and specific disordered eating patterns were examined. Heterogeneity of reported results was also assessed and examined. Only 4 out of 41 studies reported negative associations between ED and AUD. The magnitude of the associations between eating-disordered patterns and AUD ranged from small to medium size and were statistically significant for any ED, bulimia nervosa (BN)/bulimic behavior, purging, binge eating disorder (BED) and eating disorders not otherwise specified (EDNOS). No association was found between anorexia nervosa (AN) and AUD. The magnitude of the association between BN and AUD was the most divergent across studies and those between each of BED and dietary restriction and AUD were the most consistent across studies. Reported associations of different patterns of disordered eating and AUD were generally weakest and most divergent when participants were recruited from clinical settings and strongest and most homogeneous when participants were recruited from student populations.

Garry JP; Morrissey SL; Whetstone LM. Substance use and weight loss tactics among middle school youth. International Journal of Eating Disorders 33(1): 55-63, 2003. (30 refs.)

Objective: Diet pills (DP) and vomiting or laxative (VL) use as weight loss tactics are associated with substance use in older adolescent populations. This study examined the association of weight loss tactics and substance use among middle school students. Methods: A Youth Risk Behavior Survey was administered to 6,957 middle school students in eastern North Carolina. Multiple logistic regression examined substance use as predictors of DP and VL use. Results: DP and VL use was reported by 6.0% and 7.1% of students, respectively, with each reported more frequently by females and White students. Regression analysis demonstrated alcohol, cigarette, or marijuana use as predictors for individual race/gender groups whereas steroid use was a predictor for all race/gender groups. We found a clustering effect of alcohol and cigarette use with both DP and VL use. Discussion: Substance use is associated with weight loss tactics as early as middle school. More research in the areas of clustering of behaviors and age at onset is needed.

George A; Waller G. Motivators for smoking in women with eating disorders. European Eating Disorders Review 13(6): 417-423, 2005. (20 refs.)

Women with eating disorders sometimes smoke to control their weight. This study examined the relative contributions of the range of factors that motivate smoking in women with eating disorders. Twenty-five women with anorexia nervosa and 16 women with bulimia nervosa were compared with 21 women with a depressive mood disorder. Each completed measures of current and lifetime prevalence of smoking, motivation to smoke and dependence on smoking. Smoking was less prevalent in anorexia nervosa than in bulimia nervosa or in mood disorders. Although the eating-disordered women had a higher motivation to smoke for weight control than the mood-disordered group, overall motivation to smoke was higher in the eating-disordered women. Their strongest motivator for smoking was coping with stress. The eating-disordered women showed similar levels of dependence on smoking to the mood-disordered group, but tended to have a lower desire to give up smoking. Clinical interventions for women with eating disorders who smoke might be targeted at helping them cope with stress, as well as viewing their smoking as a method of weight control. Assessment of women with eating disorders should address the use of nicotine and motivations for its use, to help identify targets for intervention.

Gold MS. Eating disorders, overeating, and pathological attachment to food: Independent or addictive disorders? Introduction. Journal of Addictive Diseases 23(3): 1-3, 2004. (0 refs.)

Gordon SM; Johnson JA; Greenfield SF; Cohen L; Killeen T; Roman PM. Assessment and treatment of co-occurring eating disorders in publicly funded addiction treatment programs. Psychiatric Services 59(9): 1056-1059, 2008. (12 refs.)

Objective: Publicly funded addiction treatment programs were surveyed to increase understanding of treatment options for persons with co-occurring eating and substance use disorders. Methods: Data were collected between 2002 and 2004 from face-to-face interviews with program directors of a nationally representative sample of 351 addiction treatment programs. Results: Half of the programs screen patients for eating disorders; 29% admit all persons with eating disorders, and 48% admit persons with eating disorders of low severity. Few programs attempt to treat eating disorders. Programs that admit and treat patients with eating disorders are more likely to emphasize a medical-psychiatric model of addiction, use psychiatric medications, admit patients with other psychiatric disorders, and have a lower caseload of African-American patients. Conclusions: Generally, patients with co-occurring eating and substance use disorders do not appear to receive structured assessment or treatment for eating disorders in addiction treatment programs. These results highlight the need for education of addiction treatment professionals in assessment of eating disorders.

Gutgesell ME; Moreau KL; Thompson DL. Weight concerns, problem eating behaviors, and problem drinking behaviors in female collegiate athletes. Journal of Athletic Training 38(1): 62-66, 2003. (30 refs.)

Objective: To compare eating behaviors and alcohol drinking habits between 2 groups of female college students: varsity athletes and controls (nonathletes). Design and Setting: We obtained descriptive data using an anonymous, self-report survey instrument. The instrument assessed eating habits and behaviors as well as alcohol consumption and drinking behaviors. Subjects: One hundred forty-nine female varsity athletes and 209 female controls (nonathletes) from 2 National Collegiate Athletic Association Division I universities. Measurements: Data collected included weight and desired weight, meal patterns, methods of gaining or losing weight, details of past or current eating problem, 2-week alcohol consumption quantity and frequency (binge drinking), and problem alcohol behaviors. We used chi-square analysis for nominal data and t tests and multivariate analysis of variance for interval data. Results: Compared with athletes, nonathletes ate fewer meals, and more of them reported feeling that they were too heavy and lied about their weight-control practices. Neither group reported high rates of pathologic behaviors such as vomiting. Nearly 18% of athletes and 26% of controls reported a past or current eating disorder. Athletes did not differ from controls in reported 2-week alcohol consumption, including binge drinking (nearly 50% of both groups). Conclusions: Self-reported problem drinking and eating behaviors exist in both athletes and controls but not at different rates. This finding may be a result of coach, athletic trainer, and peer-group counseling at these 2 schools or a general trend for lower rates of unhealthy behaviors among female athletes.

Harrell ZA; Slane JD; Klurnp KL. Predictors of alcohol problems in college women: The role of depressive symptoms, disordered eating, and family history of alcoholism. Addictive Behaviors 34(3): 252-257, 2009. (51 refs.)

Disordered eating and depressive symptoms are established correlates of alcohol use in college women. Family history of alcoholism (FHA) is also related to problematic alcohol use, but there have been limited studies of how it relates to other established cofactors in women. Predictive associations between disordered eating (i.e., overall levels as well as binge eating), depressive symptoms, and alcohol problems were examined in a sample of 295 female twins. The direct and moderating effects of FHA on the relationships between alcohol problems, disordered eating, and depressive symptoms were investigated. Using hierarchical linear modeling depressive symptoms, but not disordered eating or FHA, significantly predicted alcohol problems. However, there was a significant interaction between disordered eating and FHA; disordered eating was associated with alcohol problems in those with a positive FHA. The implications for high-risk subgroups of college women are discussed.

Herzog DB; Franko DL; Dorer DJ; Keel PK; Jackson S; Manzo MP. Drug abuse in women with eating disorders. International Journal of Eating Disorders 39(5): 364-368, 2006. (23 refs.)

Objective: Drug abuse in women with eating disorders has received relatively little attention. The frequency of drug use disorder (DUD) by specific drug type was examined in the current longitudinal study. Method: In a prospective study, women diagnosed with either anorexia nervosa (AN; n = 136) or bulimia nervosa (BN; n = 110), were interviewed and assessed for research diagnostic criteria (RDC) DUD every 6-12 months over 8.6 years. Results: Forty-two (17%) women in the current longitudinal study had a lifetime history of DUD, with 19 prospective onsets over the course of the study (9 AN and 10 BN). The most commonly abused illicit drugs were amphetamines, cocaine, and marijuana, and rates of DUD did not differ between intake diagnoses of AN and BN. Conclusion: Drug abuse in women with eating disorders is an area of clinical concern and should be monitored routinely throughout the treatment process.

Hodson C; Newcomb MD; Locke TF; Goodyear RK. Childhood adversity, poly-substance use, and disordered eating in adolescent Latinas: Mediated and indirect paths in a community sample. Child Abuse and Neglect 30(9): 1017-1036, 2006. (62 refs.)

Objective: Although many studies have identified associations between childhood maltreatment and later substance use and disordered eating, few have examined causal or explanatory pathways, and whether victim characteristics predict the development of one versus the other of these outcomes remains uninvestigated. Furthermore, relatively little childhood maltreatment research has examined Latino samples. To address these gaps, this study examined among Latina adolescents the effects of sexual abuse, physical/emotional abuse, neglect, disconnection from family, and parental alcohol problems on poly-substance use and disordered eating, and whether five individual characteristics explain or differentiate these outcomes. Method: Data from a community sample of 361 Latina adolescents were analyzed using structural equation modeling. Results: Physical/emotional abuse predicted poly-substance use and weight concerns, and these associations were mediated by impaired current attachment. Disconnection from family predicted bulimic behaviors, and this association was mediated by dysphoria. One indirect path also emerged: Disconnection from family predicted low social conformity, and low social conformity predicted poly-substance use. Childhood sexual abuse did not uniquely predict any adverse outcome or individual characteristic examined. Conclusions: Dysphoria and impaired current attachment appear to play important roles in the development of substance use and disordered eating in Latina adolescents when physical/emotional abuse or disconnection from family predicts these outcomes. Dysphoria and low social conformity may differentiate the development of bulimic behaviors and poly-substance use, respectively, when family disconnection predicts these outcomes.

John U; Meyer C; Rumpf HJ; Hapke U. Psychiatric comorbidity including nicotine dependence among individuals with eating disorder criteria in an adult general population sample. Psychiatry Research 141(1): 71-79, 2006. (27 refs.)

The goal was to analyze psychiatric disorders among individuals who satisfied at least one eating disorder criterion (EDC). The data derived from a cross-sectional survey study with a probability sample of residents of a northern German area with 4075 study participants, aged 18-64 years (participation rate 70.2%). Face-to-face in-home computer-aided interviews (Composite International Diagnostic Interview) were used to assess the diagnostic criteria of eating disorders and nicotine dependence, alcohol dependence, depressive, anxiety, and somatoform disorders according to the Diagnostic and Statistical Manual (DSM-IV). Former or current smokers had an odds ratio (OR) of 1.7 (95% confidence intervals, CI, 1.1-2.4 and 1.1-2.6, respectively) for one EDC compared with never smokers. Subjects with a lifetime psychiatric disorder were more likely to have two or more EDC than individuals who never had the respective disorder (nicotine dependence: OR 2.5, CI 1.5-4.2; alcohol dependence or abuse: OR 2.4, CI 1.2-4.7; depressive disorders: OR 2.2, CI 1.4-3.4; anxiety disorders: OR 2.9, CI 1.9-4.5). To conclude, nicotine dependence, alcohol dependence or abuse, depressive disorders, and anxiety disorders are related to two or more EDC in this adult general population sample.

Kalra SP; Kalra PS. Overlapping and interactive pathways regulating appetite and craving. Journal of Addictive Diseases 23(3): 5-21, 2004. (83 refs.)

Multidisciplinary research in recent years has delineated the hypothalamic hardcore wiring that encodes appetitive drive. The appetite regulating network (ARN) consisting of distinct orexigenic and anorexigenic circuitries operates in the arcuate nucleus-paraventricular nucleus axis of the hypothalamus to propagate and relay the appetitive drive, and is subject to modulation by excitatory and inhibitory messages from the lateral hypothalamus and ventromedial nucleus, respectively. Reciprocal afferent humoral signals, comprised of anorexigenic leptin from white adipose tissue and orexigenic ghrelin from stomach, to the ARN integrate the moment-to-moment regulation of energy homeostasis. Various loci in the ARN and afferent hormonal feedback circuitry in the rodent brain are important for food craving elicited by drugs of abuse. This convergence of neurochemical and hormonal signaling has now paved the way to address the fundamental question of whether cellular and molecular events that underlie the appetitive drive in response to diminished energy stores in the body are akin to drug craving during withdrawl in humans.

Keel PK; Dorer DJ; Eddy KT; Franko D; Charatan DL; Herzog DB. Predictors of mortality in eating disorders. Archives of General Psychiatry 60(2): 179-183, 2003. (28 refs.)

Background: Anorexia nervosa, but not bulimia nervosa, has one of the highest mortality rates among psychiatric disorders. However, potential predictors of mortality, such as comorbid psychiatric illnesses, remain unclear. We sought to determine mortality ratios and predictors of fatal outcome in women diagnosed as having anorexia or bulimia nervosa. Methods: Women (N = 246) diagnosed as having either DSM-IV anorexia nervosa (n = 136) or bulimia nervosa (n = 110) between January 1, 1987, and December 31, 1991, participated in a prospective longitudinal study. Vital status was determined by ongoing contact and a National Death Index search as of December 1998 (overall ascertainment, 99.8%) and telephone contact as of October 2000 (ascertainment, 95.0%). Results: Eleven women died. Standardized mortality ratios were elevated for all causes of mortality (11.6; 95% confidence interval, 5.5-21.3) and suicide (56.9; 95% confidence interval, 15.3-145.7) in anorexia nervosa but not for death (1.3; 95% confidence interval, 0.0-7.2) in bulimia nervosa. Predictors of mortality in anorexia nervosa included severity of alcohol use disorder during follow-up (P<.001). Hospitalization for an affective disorder before baseline assessment seemed to protect women from a fatal outcome (P<.001). Conclusions: Physicians treating patients with anorexia nervosa should carefully assess patterns of alcohol use during the course of care because one third of women who had alcoholism and died had no history of alcohol use disorder at intake.

Krug I; Treasure J; Anderluh M; Bellodi L; Cellini E; Di Bernardo M et al. Present and lifetime comorbidity of tobacco, alcohol and drug use in eating disorders: A European multicenter study. Drug and Alcohol Dependence 97(1-2): 169-179, 2008. (84 refs.)

Objectives: To assess the differences in comorbid lifetime and current substance use (tobacco, alcohol and drug use) between eating disorder (ED) patients and healthy controls in five different European countries. Method: A total of 1664 participants took part in the present study. ED cases (n=879) were referred to specialized ED units in five European countries. The ED cases were compared to a balanced control group of 785 healthy individuals. Assessment: Participants completed the Substance Use Subscale of the Cross Cultural (Environmental) Questionnaire (CCQ), a measure of lifetime tobacco, alcohol and drug use. In the control group, also the GHQ-28, the SCID-1 interview and the EAT-26 were used. Results: ED patients had higher lifetime and current tobacco and general drug use. The only non-significant result was obtained for lifetime and current alcohol use. Significant differences across ED subdiagnoses and controls also emerged, with BN and AN-BP generally presenting the highest and AN-R and controls the lowest rates. The only exception was detected for alcohol use where EDNOS demonstrated the highest values. Only a few cultural differences between countries emerged. Conclusions: With the exception of alcohol consumption, tobacco and drug use appear to be more prevalent in ED patients than healthy controls. The differential risk observed in patients with bulimic features might be related to differences in temperament or might be the result of increased sensitivity to reward.

Landgren S; Jerlhag E; Zetterberg H; Gonzalez-Quintela A; Campos J; Olofsson U et al. Association of pro-ghrelin and GHS-R1A gene polymorphisms and haplotypes with heavy alcohol use and body mass. Alcoholism: Clinical and Experimental Research 32(12): 2054-2061, 2008. (63 refs.)

Ghrelin, an orexigenic peptide, acts on growth hormone secretagogue receptors (GHS-R1A), expressed in the hypothalamus as well as in important reward nodes such as the ventral tegmental area. Interestingly, ghrelin has been found to activate an important part of the reward systems, i.e., the cholinergic-dopaminergic reward link. Additionally, the rewarding and neurochemical properties of alcohol are, at least in part, mediated via this reward link. There is comorbidity between alcohol dependence and eating disorders. Thus, plasma levels of ghrelin are altered in patients with addictive behaviors such as alcohol and nicotine dependence and in binge eating disorder. This overlap prompted as to investigate the pro-ghrelin and GHS-R1A genes in a haplotype analysis of heavy alcohol-using individuals. A total of 417 Spanish individuals (abstainers, moderate, and heavy alcohol drinkers) were investigated in a haplotype analysis of the pro-ghrelin and GHS-R1A genes. Tag SNPs were chosen using HapMap data and the Tagger and Haploview softwares. These SNPs were then genotyped using TaqMan Allelic Discrimination. SNP rs2232165 of the GHS-R1A gene was associated with heavy alcohol consumption and SNP rs2948694 of the same gene as well as haplotypes of both the pro-ghrelin and the GHS-R1A genes were associated with body mass in heavy alcohol consuming individuals. The present findings are the first to disclose an association between the pro-ghrelin and GHS-R1A genes and heavy alcohol use, further strengthening the role of the ghrelin system in addictive behaviors and brain reward.

Levine MD; Kalarchian MA; Courcoulas AP; Wisinski MSC; Marcus MD. History of smoking and postcessation weight gain among weight loss surgery candidates. Addictive Behaviors 32(10): 2365-2371, 2007. (30 refs.)

Smoking cessation often results in weight gain. Although smoking cessation frequently is recommended to patients presenting for weight loss surgery (WLS), the relationship between smoking cessation and weight gain among WLS candidates is poorly understood. Thus, we sought to document the history and prevalence of smoking and smoking-related weight gain among WLS candidates. Subjects (N = 67) presenting for bariatric surgery provided demographic information, were interviewed about smoking, and were weighed and measured prior to operation. Sixty-seven percent of patients reported a lifetime history of smoking, and 26.9% were current smokers. Among lifetime smokers who had attempted to quit, the average maximum amount of weight gained following smoking cessation was 28.1 lb, but there was wide variability in postcessation weight gain. These data suggest that smoking among candidates for bariatric surgery is prevalent and that previous cessation attempts were associated with considerable weight gain. Because patients often receive recommendations to quit smoking and lose weight prior to surgery, additional information on the impact of presurgical smoking cessation on long-tem weight control in this population is needed.

Loas G; Guilbaud O; Perez-Diaz F; Verrier A; Stephan P; Lang F; Reseau INSERM no494013 et al. Dependency and suicidality in addictive disorders. Psychiatry Research 137(1-2): 103-111, 2005. (27 refs.)

Excessive interpersonal dependency has been described in depression and addictive disorders. Moreover, excessive dependency and suicidality are linked in psychiatric subjects, but their relationships have not been studied in specific addictions. Separate samples of female anorectic patients (n = 150), female bulimic patients (n = 95), male (n = 150) or female (n = 68) alcoholics, male (n = 94) or female (n = 54) drug abusers and non-psychiatric control subjects (n = 683) were included in the study. On the basis of a structured interview, suicidal ideations, number of previous suicide attempts and diagnoses of dependent personality disorder (DSM-IV) were collected, and the subjects completed the Interpersonal Dependency Inventory and the Beck Depression Inventory. Logistic regression analysis revealed that excessive dependency and notably dependent personality disorder increased the likelihood of suicidal ideation or suicide attempts with a range of 2.65 to 9.42 in bulimic patients, female alcoholics and male drug abusers. Excessive dependency in specific addictive disorders as well as in male non-psychiatric subjects could constitute a risk factor for suicide. This hypothesis must be confirmed using prospective studies.

Loxton NJ; Dawe S. Reward and punishment sensitivity in dysfunctional eating and hazardous drinking women: Associations with family risk. Appetite 47(3): 361-371, 2006. (59 refs.)

Biologically based personality traits such as reward and punishment sensitivity, and family factors, such as maternal dysfunctional eating and parental alcohol abuse, have been linked to hazardous drinking and disordered eating. However, specific relationships between personality and family factors in the development of these disorders are still unclear. A total of 443 women completed measures of reward and punishment sensitivity, family environment, maternal eating and parental drinking. Reward sensitivity was directly associated with both dysfunctional eating and drinking. Punishment sensitivity was associated with dysfunctional eating but not hazardous drinking. Punishment sensitivity mediated a chaotic family environment and daughters' dysfunctional eating. It is suggested that reward and punishment sensitivity are key traits to examine when investigating vulnerability to risky behaviour. Future research into disordered eating is likely to be advanced by an active search for mediators and moderators of family risk.

Matthews CR. Examining problem drinking and eating disorders from a gendered perspective. Journal of Addictive Diseases 23(3): 67-80, 2004. (35 refs.)

The two studies presented here examined the relationship between problem drinking and eating disorders in college students. Although there was little evidence of a concurrent relationship between the two, there were differences related to gender. In addition, there were differences between women who were and were not sorority members with respect to problem drinking, but not eating disorders. The value of addressing these problems from a gendered perspective is discussed.

Mcginnes DE. Meta-analysis: Comparison of the coprevalence of alcohol abuse in eating disorders and a family history of alcohol abuse as a risk factor. Dissertation Abstracts International: Section B 63(11-B): 5528, 2003

The eating disorders of Anorexia Nervosa and Bulimia Nervosa are no longer considered a rare or esoteric syndrome. Researchers suggest estimates as high as 27% of all young women are affected. Additionally, approximately 25% of these individuals have a current or prior history of alcohol abuse or dependence. Two meta-analyses were conducted. For the first study, a weighted effect size and follow up chi-square analysis were conducted to compare the frequency of alcohol use among anorexics and bulimics. A second meta-analysis was conducted to determine the effect of familial alcohol abuse or dependency on eating disorders. To achieve a consistent comparison for effect size across all studies, a control group was established using the well-established prevalence of 10% within families across the United States having at least one alcoholic parent. Results of the first analysis showed bulimics abuse alcohol to a greater extent than anorexics but not significantly so. Moreover, in contrast to what previous research has observed, anorexics are abusing alcohol to a greater extent than the normal population and almost as much as bulimics. The second meta-analysis showed a medium effect size for a positive family history among anorexics and a large effect size for the bulimic families. Thus, showing a positive family history of alcohol abuse/dependency is indeed a risk factor for the morbidity of Anorexia Nervosa and Bulimia Nervosa.

McIntyre RS; McElroy SL; Konarski JZ; Soczynska JK; Bottas A; Castel S et al. Substance use disorders and overweight/obesity in bipolar I disorder: Preliminary evidence for competing addictions. Journal of Clinical Psychiatry 68(9): 1352-1357, 2007. (60 refs.)

Objective: This investigation was undertaken to, explore the relationship between alcohol/illicit drug dependence and overweight/obesity in individuals with bipolar I disorder. Method. The data for this analysis were procured from the Canadian Community Health Survey-Mental Health and Well-Being (CCHS) conducted by Statistics Canada in 2002. Bipolar I disorder was defined as persons screening positive for a lifetime manic episode using the World Mental Health 2000 version of the Composite International Diagnostic Interview (WMH-CIDI). Substance abuse and illicit drug dependence were determined using criteria commensurate with the DSM-IV-TR. Overweight and obesity were defined as a body mass index of 25.0 to 29.9 and greater than or equal to 30.0 kg/m(2), respectively. Results: The total sample comprised 36,984 individuals (! 15 years old) screening positive for a lifetime manic episode. Subgroup analysis indicated that overweight/obese bipolar individuals had a significantly lower rate of substance dependence than the normal weight sample (13% vs. 21%, p <.01). Conversely, bipolar individuals who screened positive for substance dependence had a lower rate of overweight/obesity when compared with non-substance-dependant bipolar respondents (39% vs. 54%, p <.0 1). The inverse association between the presence of these 2 co-morbid conditions in bipolar I disorder continued to be statistically significant in multivariate analysis (OR = 0.57, 95% Cl = 0.34 to 0.95, p <.05). Conclusions: An inverse relationship between the presence of comorbid overweight/obesity and substance use disorders was observed in bipolar I disorder. These results suggest that comorbid addictive disorders (i.e., substance use and compulsive overeating) may compete for the same brain reward systems.

McKee SA; Nhean S; Hinson RE; Mase T. Smoking for weight control: Effect of priming for body image in female restrained eaters. Addictive Behaviors 31(12): 2319-2323, 2006. (12 refs.)

Women are more likely than men to believe that smoking helps to control their weight, and this relationship may be more pronounced in those with eating disturbances, such as eating restraint. Restrained eaters have been shown to be more susceptible to media portrayals of idealized body image, like those used in tobacco advertising. The primary aim of this study was to examine the effect of an implicit prime for body image on expectations that smoking can control weight in restrained and non-restrained eaters. Participants were 40 females, who smoked an average of 7.65 (S.D. = 4.38) cigarettes per day. Participants were presented with a bogus task of rating slides; either participants viewed 30 slides of nature scenes (neutral prime); or viewed 30 slides depicting fashion models (body image prime). Participants then completed questionnaires that assessed smoking expectancies, smoking history, and eating restraint. As hypothesized, restrained eaters who viewed the slides depicting models had greater likelihood ratings that smoking helps to control appetite and manage weight, in comparison to restrained eaters who viewed the control slides and non-restrained eaters who viewed either type of slides. There were no other group differences across the remaining smoking expectancy factors. Images similar to those used in tobacco advertising targeting women had the ability to elicit stronger beliefs that smoking is beneficial for weight control in a group of women who are at heightened risk for such beliefs.

Measelle JR; Slice E; Hogansen JM. Developmental trajectories of co-occurring depressive, eating, antisocial and substance abuse problems in female adolescents. Journal of Abnormal Psychology 115(3): 524-538, 2006. (98 refs.)

Growth trajectories of co-occurring symptomatology were examined in a community sample of 493 female adolescents who were followed annually from early to late adolescence. On average, depression, eating disorder, and substance abuse symptoms increased over time, whereas antisocial behavior decreased. Increases in each symptom domain were associated with relative increases in all other domains. Initial depressive and antisocial behavior symptoms predicted future increases in the other; substance abuse and antisocial behavior symptoms also showed prospective reciprocal relations. Initial depression predicted increases in eating disorder and substance abuse symptoms. Initial eating disorder symptoms predicted increases in substance abuse problems. Finally, the results suggest that the developmental covariation between depressive and eating disorder symptoms and between antisocial behavior and substance abuse symptoms was accounted for by distinct but related 2nd-order growth parameters.

Nolen-Hoeksema S; Stice E; Wade E; Bohon C. Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. Journal of Abnormal Psychology 116(1): 198-207, 2007. (60 refs.)

The authors examined the reciprocal relations between rumination and symptoms of depression, bulimia, and substance abuse with longitudinal data from 496 female adolescents. Rumination predicted future increases in bulimic and substance abuse symptoms, as well as onset of major depression, binge eating, and substance abuse. Depressive and bulimic, but not substance abuse, symptoms predicted increases in rumination. Rumination did not predict increases in externalizing symptoms, providing evidence for the specificity of effects of rumination, although externalizing symptoms predicted future increases in rumination. Results suggest rumination may contribute to the etiology of depressive, bulimic, and substance abuse pathology and that the former two disturbances may foster increased rumination. Results imply that it might be beneficial for prevention programs to target this cognitive vulnerability.

Okasaka Y; Morita N; Nakatani Y; Fujisawa K. Correlation between addictive behaviors and mental health in university students. Psychiatry and Clinical Neurosciences 62(1): 84-92, 2008. (31 refs.)

Aims: The present study aims to clarify the relationships of addictive behaviors and addiction overlap to stress, acceptance from others and purpose in life. Methods: A survey was conducted on 691 students at eight universities. The Eating Attitude Test-20 was used to identify students with food addiction or food addictive tendencies. The Kurihama Alcoholism Screening Test was used to identify students with alcohol addiction or alcohol addictive tendencies. The Fagerstrom Test for Nicotine Dependence was used to identify students with nicotine addictive tendencies or nicotine addiction. The Visual Analog Scale was used to assess stress and acceptance from others. The Purpose in Life Test was used to measure meaning and purpose in life. Results were compared between students with addictive behaviors, with addictive tendencies and without addictive behaviors. Results: Significant differences among the three groups were observed for stress, acceptance from others, and Purpose in Life scores for students with food and nicotine addiction, but no significant differences existed in relation to alcohol addiction. In addition, 28.8% of students displayed addictive behaviors in one of the three areas (food, alcohol or nicotine), 8.5% displayed addictive behaviors in two of the three areas, and 0.4% had addictive behaviors in all three areas. Significant differences existed in stress and acceptance from others among students with one addictive behavior, >= two addictive behaviors and no addictive behaviors. However, no significant differences existed in Purpose in Life scores with respect to overlapping addictions. Conclusion: The results suggest a relationship between mental health, addictive behaviors and overlapping addiction among university students.

O'Malley SS; Sinha R; Grilo CM; Capone C; Farren CK; Mckee SA et al. Naltrexone and cognitive behavioral coping skills therapy for the treatment of alcohol drinking and eating disorder features in alcohol-dependent women: A randomized controlled trial. Alcoholism: Clinical and Experimental Research 31(4): 625-634, 2007. (64 refs.)

Background: Despite important gender differences in drinking patterns, physiological effects of alcohol, and co-occurring psychiatric conditions, relatively little is known about the efficacy of naltrexone for the treatment of alcohol dependence in women. This study investigated the safety and efficacy of naltrexone in combination with Cognitive Behavioral Coping Skills Therapy (CBCST) in a sample of alcohol-dependent women, some with comorbid eating pathology. Methods: One hundred three women meeting DSM-IV criteria for alcohol dependence (29 with comorbid eating disturbances) were randomized to receive either naltrexone 50 mg or placebo for 12 weeks in addition to weekly group CBCST. Subjects were enrolled between October 1995 and December 2000 at an outpatient research clinic. Results: No significant differences were observed on the primary outcomes of time to first drinking day, time to first day of heavy drinking, or the percentage of participants who continued to meet the criteria for alcohol dependence. Secondary analyses revealed that naltrexone significantly delayed the time to the second (chi(2)=5.37, p=0.02) and third (chi(2)=4.35, p=0.04) drinking days among subjects who did not maintain abstinence from alcohol. Among those with eating disturbances, symptoms of eating pathology improved during treatment, but the effects did not differ according to medication condition. Conclusions: When used in conjunction with CBCST, naltrexone did not significantly improve drinking outcomes in the overall sample of alcohol-dependent women. However, naltrexone may be of benefit to women who are unable to maintain total abstinence from alcohol. For women with concurrent eating pathology, participation in treatment for alcoholism may be associated with improvements in eating pathology.

Piran N; Gadalla T. Eating disorders and substance abuse in Canadian women: A national study. Addiction 102(1): 105-113, 2007. (31 refs.)

This study aimed to examine the comorbidity between eating disorders and substance use in a large nationally representative sample of Canadian adult women. Recent as well as life-time measures of substance use were used. The research was based on secondary analyses of data collected, using multi-stage stratified probability sampling, by Statistics Canada in the Mental Health and Well-being cycle 1.2 of the Canadian Community Health Survey (CCHS). The Eating Attitude Test (EAT-26) was used to measure risk of eating disorders. Alcohol use, dependence and interference, and illicit drug use, dependence and interference were measured using relevant modules from the short form of the Composite International Diagnostic Interview (CIDI-SF). Data on a nationally representative sample of Canadian adult women, grouped into three age groups, were used for this research. Alcohol dependence and alcohol interference were associated significantly with the risk for an eating disorder in the three adult age groups. Significant associations were also found in the three age groups between risk for an eating disorder and the life-time abuse of and dependence on illicit drugs. Significant associations were found in the 15-24 and 25-44-year age groups when the 12-month time-frame was used. The study findings support the call for the development of short screening instruments for adult women with eating disorders and substance abuse, as well as for the development of treatment strategies that address the co-occurrence of eating disorders and substance use.

Piran N; Robinson SR. Associations between disordered eating behaviors and licit and illicit substance use and abuse in a university sample. Addictive Behaviors 31(10): 1761-1775, 2006. (63 refs.)

Objectives: To examine associations between discrete eating disordered behaviors as well as clusters of eating disordered behaviors in relation to the use and abuse of a wide spectrum of substance classes, both licit and illicit, in a female university sample. Methods: Women with particular types of eating disordered behaviors were selected from a pool of 526 students who completed the Women's Health Survey. Analyses compared the frequencies of lifetime engagement in a wide range of licit and illicit substances between each of the eating disorder groups and the normal control group. Results: Associations were found between severe levels of alcohol consumption and binge eating, dieting with purging and the use of central nervous stimulants, and bingeing with dieting and tobacco use and the abuse of prescription medications. Conclusion: Examining a broad range of substance classes, with differing physiological properties and effects, in relation to specific disordered eating behaviors, could contribute to theory development regarding the functions of the specific co-occurring behaviors.

Piran N; Robinson SR. The association between disordered eating and substance use and abuse in women: A community-based investigation. Women & Health 44(1): 1-20, 2006. (40 refs.)

A behavioral analysis was conducted of various eating disorder behaviors and their relationship with the lifetime use of different substances in a community-based sample of young adult women, aged 18-25 years. Women with particular eating disorder behaviors were selected from the 517 women who completed the Women's Health Survey. Analyses compared the frequencies of lifetime use of a range of licit and illicit substances as well as the abuse of prescription medications between each of the eating disorder groups and the normal control group. Results showed that as eating disorder behaviors became more severe, or were clustered together, the number of substance classes used increased. Severe bingeing was consistently associated with alcohol use. Dieting and purging, with or without bingeing, was associated with the use of stimulants/amphetamines and the abuse of sleeping pills. The results of this study suggest that the co-occurrence between subclinical levels of eating disorders and the use and abuse of a wide range of substances should inform assessment and treatment planning for adult women.

Pisetsky EM; Chao YM; Dierker LC; May AM; Striegel-Moore RH. Disordered eating and substance use in high-school students: Results from the youth risk behavior surveillance system. International Journal of Eating Disorders 41(5): 464-470, 2008. (31 refs.)

Objective: To examine the association between disordered eating (fasting, diet product use, and vomiting or laxative use) and use of 10 substances (cigarettes, alcohol, marijuana, cocaine, inhalants, heroin, methamphetamines, ecstasy, steroids, and hallucinogens) in a nationally representative adolescent sample. Method: Participants were 13,917 U.S. high-school students participating in the 2005 Youth Risk Behavior Surveillance System. Results: Disordered eating was significantly associated with the use of each substance. Using effect size estimates that take base rates into consideration, for female students, associations between substance use and disordered eating were weak for all but three forms of substance use: current smoking, binge drinking, and inhalants. Among male students, strong (marijuana, steroids, and inhalants) or moderate effects (all other substances) were observed. Conclusion: Future research needs to focus on inhalant use and methamphetamine use in males. Increased medical attention should be directed toward adolescents who practice disordered eating behaviors because they are also at elevated risk for using cigarettes, alcohol, inhalants, methamphetamines, and steroids.

Plant M; Miller P; Plant M. The relationship between alcohol consumption and problem behaviours: Gender differences among British adults. Journal of Substance Use 10(1): 22-30, 2005. (37 refs.)

This study sets out to investigate the possible association between alcohol consumption and eight types of problem behaviour in the lives of a sample of 2027 British adults. It also examines gender differences in the prevalence of these problems. The problems considered were related to working, eating, shopping, use of the Internet, sexual activity, exercise, gambling and dieting. Last occasion's alcohol consumption was significantly associated with having experienced problems related to work, gambling, dieting and sexual activity. Total previous week's drinking was only associated with two of these problems--gambling and sexual activity. There were a number of distinct gender differences in the levels of specific problems reported. Females were significantly more likely than males to report having experienced problems related to eating and dieting. Conversely, males were more likely than females to report having had problems related to work, use of the Internet, sexual activity and gambling. These findings do indicate that adult drinking was associated with several forms of "problem behaviour". Even so, they do not support the conclusion that all such behaviours are necessarily interconnected. The gender differences that emerged were not unexpected in view of prevailing social norms and stereotypes concerning the behaviour of the sexes.

Pomerleau CS; Saules K. Body image, body satisfaction, and eating patterns in normal-weight and overweight/obese women current smokers and never-smokers. Addictive Behaviors 32(10): 2329-2334, 2007. (17 refs.)

To explore differences between women smokers and never-smokers in body image and eating patterns, we analyzed data obtained from 587 women (18-55 years old) recruited to participate in laboratory investigations not focused on weight concerns. The sample consisted of 420 current smokers and 167 never-smokers; 44% of each group were overweight or obese (BMI >= 25). Questionnaires included measures of body image, body dissatisfaction, and restrained and disinhibited eating. Smokers did not differ from never-smokers on perceived body shape but endorsed a thinner preferred body shape and scored lower on body satisfaction than never-smokers. Smokers also scored higher on measures of disinhibited eating. Among smokers, those who were overweight/obese scored higher than normal-weight smokers on concerns about post-cessation weight gain and lower on self-efficacy to avoid relapse if weight increased. Our findings suggest that women smokers may require help in attaining a more realistic body image and attention to dysfunctional eating patterns if they are to achieve and maintain a healthful weight and/or to quit smoking successfully. They also indicate that overweight smokers may be at elevated risk of relapse in the face of post-cessation weight gain.

Rafiroiu AC; Sargent RG; Parra-Medina D; Drane WJ; Valois RF. Covariations of adolescent weight-control, health-risk and health-promoting behaviors. American Journal of Health Behavior 27(1): 3-14, 2003. (28 refs.)

Assessed the prevalence of dieting and investigated clusters of risk behaviors among adolescents. Data were secured from a random sample of 4,187 adolescents and analyzed using bivariate methods and logistic regression. From the survey sample, 19.2% adolescents were classified as extreme, 43.2% as moderate dieters, 37.2% as nondieters. Extreme dieters were more likely to use alcohol, cigarettes, and/or marijuana and to attempt suicide and less likely to practice vigorous exercise. Moderate dieters were less likely to use cigarettes, marijuana and more likely to engage in vigorous exercise, with differences across gender-race categories. Results have relevance for developing multicomponent programs for adolescents.

Rodriguez-Llera MC; Domingo-Salvany A; Brugal MT; Silva TC; Sanchez-Niubo A; Torrens M. Psychiatric comorbidity in young heroin users. Drug and Alcohol Dependence 84(1): 48-55, 2006. (32 refs.)

In order to determine the prevalence of psychiatric comorbidity in a population of young heroin users recruited from outside of the healthcare context, a sample was assembled by targeted sampling and nomination techniques; it was comprised of regular current users of heroin aged between 18 and 30 years and resident in Barcelona, Spain. Psychiatric evaluation was done with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) semi-structured interview. Of 149 individuals evaluated, 33% were women, whose mean age was 25.1 years; 93% received a diagnosis of heroin dependence and 71% of cocaine dependence. Thirty-two percent of the subjects had never been treated for substance use. Around two-thirds (67.1%, 95% CI: 59.6-74.7%) of the sample had lifetime psychiatric comorbidity, with antisocial personality and mood disorders being the most frequent conditions (33% and 26%, respectively). Mood, anxiety and eating disorders were more common among women than men. There were no differences in ever having been in treatment for drug use according to the presence of psychiatric comorbidity, although comorbidity was lower among those currently in treatment. Young heroin users recruited on the street presented a high prevalence of psychiatric comorbidity which was unrelated to past treatment history.

Rofey DL; Corcoran KJ; Tran GQ; Nabors LA; Matthews GD. Demand on mental workload: Relation to cue reactivity and craving in women with disordered eating and problematic drinking. Addiction Research & Theory 15(2): 189-203, 2007. (86 refs.)

The present study introduces a novel paradigm that combines the clinical aspects of disordered eating and problematic drinking utilizing mental demand to measure the information-processing load imposed by a task. A total of 175 female undergraduates (median age 19) rated the mental demand of receiving alcohol-and food-related olfactory cues and performing a disorder-salient Stroop task. Results show that women who were high on disordered eating symptomatology were more likely to engage in hazardous drinking. Both disordered eating and problematic drinking contributed to women rating the olfactory and Stroop tasks as being difficult on measures of mental workload. Problematic drinking accounted for more variance in measures of mental demand than disordered eating. Measures of food and alcohol craving were not significant moderators for the relationship between disordered eating, problematic drinking, and mental workload. Findings suggest that targeting cognitions pertinent to disordered eating or hazardous drinking may facilitate treatment.

Spring B; Schneider K; Smith M; Kendzor D; Appelhans B; Hedeker D et al. Abuse potential of carbohydrates for overweight carbohydrate cravers. Psychopharmacology 197(4): 637-647, 2008. (58 refs.)

Rationale: The long-rejected construct of food addiction is undergoing re-examination. Objectives: To evaluate whether a novel carbohydrate food shows abuse potential for rigorously defined carbohydrate cravers, as evidenced by selective self-administration and mood enhancement during double-blind discrimination testing. Materials and methods Discrete trials choice testing was performed with 61 overweight (BMI m = 27.64, SD = 2.59) women (ages 18-45; 19.70% African American) whose diet records showed > 4 weekly afternoon/evening emotional-eating episodes confined to snacks with carbohydrate to protein ratio of > 6:1. After being induced into a sad mood, participants were exposed, double-blind and in counterbalanced order, to taste-matched carbohydrate and protein beverages. They were asked to choose and self-administer the drink that made them feel better. Results: Women overwhelmingly chose the carbohydrate beverage, even though blinded. Mixed-effects regression modeling, controlling for beverage order, revealed greater liking and greater reduction in dysphoria after administration of the carbohydrate beverage compared to the protein beverage but no differential effect on vigor. Conclusion: For women who crave them, carbohydrates appear to display abuse potential, plausibly contributing to overconsumption and overweight.

Stewart SH; Brown CG; Devoulyte K; Theakston J; Larsen SE. Why do women with alcohol problems binge eat? Exploring connections between binge eating and heavy drinking in women receiving treatment for alcohol problems. Journal of Health Psychology 11(3): 409-425, 2006. (53 refs.)

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-caters. 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.

Stice E; Burton EM; Shaw H. Prospective relations between bulimic pathology, depression, and substance abuse: Unpacking comorbidity in adolescent girls. Journal of Consulting and Clinical Psychology 72(1): 62-71, 2004. (66 refs.)

To elucidate the processes that contribute to the comorbidity between bulimic pathology, depression, and substance abuse, the authors tested the temporal relations between these disturbances with prospective data from adolescent girls (N = 496). Multivariate analyses indicated that depressive symptoms predicted onset of bulimic pathology but not of substance abuse, bulimic symptoms predicted onset of depression but not of substance abuse, and substance abuse symptoms predicted onset of depression but not of bulimic pathology. Results suggest that the comorbidity arises because certain disorders are risk factors for the other disorders. Findings also provide support for select etiologic theories and further establish the clinical significance of these conditions by showing that they increase risk for onset of other psychiatric disturbances.

Stice E; Shaw H. Prospective relations of body image, eating, and affective disturbances to smoking onset in adolescent girls: How Virginia slims. Journal of Consulting and Clinical Psychology 71(1): 129-135, 2003. (38 refs.)

This study tested whether body image, eating, and affective disturbances prospectively predicted onset of cigarette smoking in adolescent girls (N = 496). Elevated body dissatisfaction and eating pathology, as well as elevated negative affectivity, showed significant univariate relations to subsequent onset of smoking. In the multivariate model, the effect for body image and eating disturbances remained significant, but the effect for negative affectivity did not. Results support the theory that body image and eating disturbances markedly increase risk for smoking initiation in adolescent girls and further establish the clinical significance of these disturbances. Results also support the theory that negative affect is a risk factor for smoking initiation but suggest that the self-medication model may have less predictive power than previously concluded.

Striegel-Moore RH; Franko DL; Thompson D; Barton B; Schreiber GB; Daniels SR. Caffeine intake in eating disorders. International Journal of Eating Disorders 39(2): 162-165, 2006. (10 refs.)

Objective: The current study compares caffeine consumption in females with an eating disorder and females without an eating disorder. Method: Caffeine intake in three diagnostic groups (10 females with anorexia nervosa, 27 females with bulimia nervosa, and 42 females with binge eating disorder [BED]) was compared with caffeine intake in three comparison groups (n = 659 each). Data were obtained from a longitudinal study of Black and White girls. Three-day food records were examined for the years before the onset of the eating disorder, the onset year, and the years after the onset of the eating disorder. Data from the same years were used for the comparison groups. Results: Caffeine intake increased over time between ages 9 and 19 years across all groups and this trend was not moderated by diagnostic status. For anorexia nervosa, relative to the non-eating disorder group, the proportional intake of caffeine from soda increased significantly before onset to onset to after onset and ingestion of chocolate-containing foods decreased sharply over time. Conclusion: Caffeine consumption in young girls with eating disorders differs from girls with no eating disorders only for anorexia nervosa, but not for bulimia nervosa or BED.

Thompson-Brenner H; Eddy KT; Franko DL; Dorer D; Vashchenko M; Herzog DB. Personality pathology and substance abuse in eating disorders: A longitudinal study. International Journal of Eating Disorders 41(3): 203-208, 2008. (30 refs.)

Objective: Substance abuse has been shown to predict poor outcome in eating disorder (ED) samples, and prior cross-sectional data on personality subtypes of EDs suggest that substance abuse is associated with dysregulated and possibly avoidant-insecure subtypes. This study investigates longitudinal associations between personality and substance use. Method: Personality pathology and substance use were assessed in 213 individuals with anorexia nervosa and bulimia nervosa at baseline; substance use was assessed at regular follow-up intervals over a 9-year period. Results: Of the five personality factors identified, the obsessional-sensitive and high-functioning types were negatively associated with substance abuse at baseline, while the behaviorally dysregulated type was positively associated with substance abuse at baseline. Longitudinal associations were observed, suggesting that obsessional-sensitive personality type was protective against the development of substance abuse. Longitudinal associations between the other personality types and substance abuse were nonsignificant after baseline substance abuse history was included as a covariate in the model. Conclusion: Substance use demonstrates cross-sectional associations with personality style, but substance abuse history appears to be the most important predictor of future substance abuse in women with eating disorders.

Abbate-Daga G; Amianto F; Rogna L; Fassino S. Do anorectic men share personality traits with opiate dependent men? A case-control study. Addictive Behaviors 32(1): 170-174, 2007. (16 refs.)

Background: Eating disorders (ED) and substance use disorders (SUD) display clinical and psychodynamic analogies. The co-diagnosis of a substance use disorder in male ED patients is frequent. Nevertheless, knowledge about the mutual predisposing factors or personality analogies is currently scarce and hypotheses are controversial. Methods: The Temperament and Character Inventory (TCI) was used to assess 21 anorectic men, 79 heroin-dependent men, and 75 control men matched for age and education. Results: Anorectic and opiate-addicted patients displayed higher Harm Avoidance and lower Self-directedness and Cooperativeness. Anorectic men displayed lower Reward Dependence and higher Persistence. Opiate addicts had higher Novelty Seeking and Self-transcendence. Discussion: Anorectic and heroin-dependent subjects share personality traits related to anxiety, fearfulness and antisocial features. Nevertheless, the personality profile does not completely overlap and this could influence the choice of the �substance� of abuse and the related clinical differences between anorexia and heroin dependence.

von Ranson KM; McGue M; Iacono WG. Disordered eating and substance use in an epidemiological sample: II. Associations within families. Psychology of Addictive Behaviors 17(3): 193-202, 2003. (62 refs.)

This study investigated familial associations of disordered eating (DE) with substance use and substance use disorders (SU/SUDs) in a community-based sample of 620 adolescent girls, their 3 10 mothers, and 299 fathers. Female participants completed structured interviews of lifetime anorexia nervosa, bulimia nervosa, binge eating disorder, and SU/SUD; daughters also completed a self-report measure of current DE attitudes and behaviors. Fathers completed interviews assessing lifetime SUD. Evaluation of independent and combined associations of mothers' bulimic eating disturbance (ED) and parents' SUDs with daughters' DE/EDs and SU/SUDs revealed links between mothers' ED and daughters' DE but no relationship between EDs and SU/SUDs across generations. These results suggest that these problems are not cross-transmitted within families and suggest that the addiction model of eating disorders may be simplistic.

White MA; Grilo CM. Psychiatric comorbidity in binge-eating disorder as a function of smoking history. Journal of Clinical Psychiatry 67(4): 594-599, 2006. (35 refs.)

Objective: To examine the comorbidity of psychiatric disorders in obese women with binge-eating disorder (BED) as a function of smoking history. Method: A consecutive series of 103 obese treatment-seeking women with current DSM-IV diagnoses of BED were administered structured diagnostic interviews to assess all DSM-IV Axis I psychiatric disorders. Participants were classified as "never" or "daily" smokers, and lifetime rates of comorbid psychopathology were compared across smoking groups using logistic regression. The study was conducted from February 2003 to March 2005. Results: Smokers were significantly more likely to meet criteria for co-occurring diagnoses of major depressive disorder (p = .03), panic disorder (p = .01), posttraumatic stress disorder (p < .05), and substance abuse or dependence (p = .01). Even after excluding participants with substance use disorders, significant differences remained, with lifetime smokers having significantly higher rates of co-occurring anxiety disorders. Conclusions: It is possible that for some obese women with BED, binge eating and cigarette smoking share common functions, i.e., both behaviors may serve to modulate negative affect and/or anxiety. Although the current findings are consistent with a view of a common diathesis for the development of impulsive eating, cigarette or other substance use, and additional Axis I psychopathology, prospective longitudinal studies are needed to elucidate the nature of potential pathways.

Wild TC. Social control and coercion in addiction treatment: Towards evidence-based policy and practice. (review). Addiction 101(1): 40-49, 2006. (75 refs.)

Background: Social pressures are often an integral part of the process of seeking addiction treatment. However, scientists have not developed conclusive evidence on the processes, benefits and limitations of using legal, formal and informal social control tactics to inform policy makers, service providers and the public. This paper characterizes barriers to a robust interdisciplinary analysis of social control and coercion in addiction treatment and provides directions for future research. Approach: Conceptual analysis and review of key studies and trends in the area are used to describe eight implicit assumptions underlying policy, practice and scholarship on this topic. Findings: Many policies, programmes and researchers are guided by a simplistic behaviourist and health-service perspective on social controls that (a) overemphasizes the use of criminal justice systems to compel individuals into treatment and (b) fails to take into account provider, patient and public views. Conclusions: Policies and programmes that expand addiction treatment options deserve support. However, drawing a firm distinction between social controls (objective use of social pressure) and coercion (client perceptions and decision-making processes) supports a parallel position that rejects treatment policies, programmes, and associated practices that create client perceptions of coercion.

Wolfe WL; Maisto SA. The effect of alcohol on body size discrepancy and self-awareness in young women. Addictive Behaviors 32(10): 2340-2344, 2007. (11 refs.)

Research has repeatedly verified high co-prevalence rates for bulimia and alcohol abuse. Two heuristics may help explain this co-occurrence. The self-inflation component of Steele and Josephs' myopia model has been evaluated and results have indicated that alcohol consumption results in decreased self-discrepancy. Research on Hull's self-awareness model also has largely found that alcohol decreases self-awareness among highly self-conscious individuals. Body size discrepancy and high self-awareness are believed to be core features of bulimia. Therefore, evidence that alcohol decreases body size discrepancy and self-awareness might clarify high rates of alcohol use in this population. A placebo-control design was used to examine the effect of alcohol on changes in body size discrepancy and self-awareness among female participants (N = 57). However, results did not show a significant effect of alcohol on body size discrepancy or self-awareness, regardless of bulimic symptom severity.

Woodside BD; Staab R. Management of psychiatric comorbidity in anorexia nervosa and bulimia nervosa. CNS Drugs 20(8): 655-663, 2006. (14 refs.)

The eating disorders anorexia nervosa and bulimia nervosa present with comorbidity in a number of important areas, including depression, bipolar disorder, anxiety disorders (obsessive-compulsive disorder, panic disorder, social anxiety disorder and other phobias, and post-traumatic stress disorder) and substance abuse. The most important principle of treating comorbidity in these conditions is the recognition of the effect of starvation and unstable eating on both the diagnosis and response to treatment of the comorbidity. This article reviews the identification of the most common areas of comorbidity and describes treatment approaches for these conditions. When it occurs, clinicians should treat comorbidity in patients with eating disorders in the usual fashion, but must remain aware that the disturbed eating itself will negatively affect response to treatment.

Yates A; Edman JD; Crago M; Crowell D. Eating disorder symptoms in runners, cyclists, and paddlers. (rapid communication). Addictive Behaviors 28(8): 1473-1480, 2003. (8 refs.)

Objective: To differentiate groups of highly conditioned, competitive athletes on the basis of Exercise Orientation Questionnaire (EOQ) scores and self-reported psychiatric symptoms. Method: A total of 99 runners, 36 cyclists, and 55 paddlers were administered the EOQ and a symptom checklist. Results: Analysis of variance and chi-square associated self-loathing subscale (SLSS) scores with self-reported eating disorder (ED) symptoms for the entire group [F(1)=4.83; P<.05] and for females only [F(1)=9.30; P<.001]. The paddler group reported more anxiety/panic symptoms than runners or cyclists (2=7.91; P<.01) and higher SLSS scores than cyclists [F(2)=6.91; P<.01]. The female-only paddler group reported more anxiety/panic [2(1)=10.27; P<.001] than the other groups. Although total group scores were comparable to controls, 12% runners, 14% cyclists, and 18% paddlers scored above previously established ED patient mean. Discussion: The paddler group appeared less healthy than runners or cyclists and were more likely to report ED symptoms. These differences could have been related to a dissimilar ethnic composition or particular social stress generated within paddling groups. In this study, SLSS was highly specific in its association with ED symptoms. This is of particular interest because SLSS is based on questions about exercise rather than eating pathology.