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CORK Bibliography: Eating Disorders



34 citations. January 2009 to present

Prepared: March 2012



Alguacil LF; Salas E; Gonzalez-Martin C. Identification of new drug targets and biomarkers related to obesity and eating disorders: An approach based on reward deficit and addiction. (review). Current Pharmaceutical Design 17(5): 462- 470, 2011. (99 refs.)

Current pharmacological treatments for eating disorders and obesity are of limited value and thus the identification of novel targets is highly needed to enhance the development of more effective drugs. Among the bottlenecks limiting the introduction of new medicines is the reported heterogeneity of these diseases, which makes it difficult to find drugs with broad activity and the lack of animal models with translational validity, especially in the case of anorexia nervosa. Some kinds of obesity and eating disorders can be classified within the pathologies affecting the brain reward system together with drug addiction and others, and therefore specific treatments in these cases can be directed to restore normal function in brain reward pathways. Target identification in this field can greatly benefit from the combined application of genomic/proteomic techniques and robust animal models of reward deficits.

Copyright 2011, Bentham Science Publishing


Baker JH; Mitchell KS; Neale MC; Kendler KS. Eating disorder symptomatology and substance use disorders: Prevalence and shared risk in a population based twin sample. International Journal of Eating Disorders 43(7): 648-658, 2010. (40 refs.)

Objective: Research shows a significant association between eating disorders (ED) and substance use disorders (SUD). The objective of this study is to examine the prevalence, chronology, and possibility of shared familial risk between SUD and ED symptomatology. Method: Subjects included 1,206 monozygotic and 877 dizygotic adult female twins. ED symptomatology included anorexia (AN) and bulimia nervosa (BN) diagnosis, symptoms associated with diagnostic criteria, and BN symptom count. SOD included alcohol, illicit drug, and caffeine abuse/dependence. Generalized estimated equation modeling was used to examine phenotypic associations, and Choleksy decompositions were used to delineate the contribution of genes and environment to comorbidity. Results: There were no significant differences between SOD prevalence in women with AN and BN. Women with BN reported BN preceded SOD development while the reverse was true for AN. Twin analyses showed possible familial overlap between BN symptomatology and all SOD examined. Discussion: Results suggest an important difference in the chronology of EDs and SUDs. Women with BN may be turning to substances to dampen bulimic urges. Women with AN may be engaging in substance use initially in an effort to lose weight. Results also suggest familial factors contribute to the comorbidity between BN and SOD.

Copyright 2010, John Wiley & Sons


Berner LA; Bocarsly ME; Hoebel BG; Avena NM. Pharmacological interventions for binge eating: Lessons from animal models, current treatments, and future directions. (review). Current Pharmaceutical Design 17(12): 1180- 1187, 2011. (112 refs.)

Binge eating behavior has been noted in some eating disorders as well as in obesity. The goal of this paper is to review current, non-serotonergic pharmaceutical approaches to treat binge eating. Further, using information derived from preclinical models, we discuss candidate neurotransmitter systems for study as targets for the treatment of binge eating. Dopaminergic circuits have been implicated in both laboratory animal models and human studies of binge eating, though existing medications specifically targeting the dopaminergic system have been found to have adverse side effects. Opioidergic and gamma-aminobutyric acid (GABA) systems also appear to be highly involved in aspects of binge eating; further, opioid antagonists, such as naltrexone, and GABA agonists, such as baclofen, have all been shown to be effective in treating alcohol dependence and may be equally efficacious in attenuating binge eating. Preclinical evidence, and some clinical evidence, suggests that cannabinoid antagonism may also be useful in the treatment of binge eating, although the specific effect of antagonists on binge consumption remains unclear. Overall, each of these neurotransmitter systems provides a promising avenue for new pharmacotherapy development for binge eating, and preclinical and human studies provide a strong rationale for the development of highly-selective drugs that target this neurocircuitry.

Copyright 2011, Bentham Science Publishing


Calero-Elvira A; Krug I; Davis K; Lopez C; Fernandez-Aranda F; Treasure J. Meta-analysis on drugs in people with eating disorders. European Eating Disorders Review 17(4): 243-259, 2009. (68 refs.)

Objective: The aim of this study was to examine whether drug use (DU) is higher in people with eating disorders (EDs) compared to a healthy control group and to perform a meta-analysis on the literature related to DU in people with EDs. Method: We searched electronic databases (Medline, PsycINFO, Web of Science and CINAHL) and reviewed studies published from 1994 to August, 2007, in English, German or Spanish. A total of 16 papers fulfilled the inclusion criteria and were included. Results: The general meta-analysis revealed a negligible albeit significant effect size (0.119, p <.05). Risk was found to be higher in bulimia nervosa (BN, delta = 0.462, p = <.001), smaller in binge eating disorder (delta = 0.14, p <.05) and non-significant in anorexia nervosa (AN, delta = -.167, p = .070). Conclusions: The differential risk observed in patients with BN might be related to differences in temperament or might be the result of reward sensitization.

Copyright 2009, Eating Disorders Association


Carr KD. Food scarcity, neuroadaptations, and the pathogenic potential of dieting in an unnatural ecology: Binge eating and drug abuse. Physiology & Behavior 104(1, special issue): 162-167, 2011. (116 refs.)

In the laboratory, food restriction has been shown to induce neuroadaptations in brain reward circuitry which are likely to be among those that facilitate survival during periods of food scarcity in the wild. However, the upregulation of mechanisms that promote foraging and reward-related learning may pose a hazard when food restriction is self-imposed in an ecology of abundant appetitive rewards. For example, episodes of loss of control during weight-loss dieting, use of drugs with addictive potential as diet aids, and alternating fasting with alcohol consumption in order to avoid weight gain, may induce synaptic plasticity that increases the risk of enduring maladaptive reward-directed behavior. In the present mini-review, representative basic research findings are outlined which indicate that food restriction alters the function of mesoaccumbens dopamine neurons, potentiates cellular and behavioral responses to D-1 and D-2 dopamine receptor stimulation, and increases stimulus-induced synaptic insertion of AMPA receptors in nucleus accumbens. Possible mechanistic underpinnings of increased drug reward magnitude, drug-seeking, and binge intake of sucrose in food-restricted animal subjects are discussed and possible implications for human weight-loss dieting are considered.

Copyright 2011, Elsevier Science


Cocores JA; Gold MS. The Salted Food Addiction Hypothesis may explain overeating and the obesity epidemic. (review). Medical Hypotheses 73(6): 892-899, 2009. (111 refs.)

One plausible explanation for the controversy that surrounds the causes and clinical management of obesity is the notion that overeating and obesity may only be a couple of "symptoms" associated with a yet to be discovered medical disorder. Objectives: To introduce the Salted Food Addition Hypothesis. This theory proposes that salted food acts in the brain like an opiate agonist, producing a hedonic reward which has been perceived as being only peripherally "flavorful", "tasty" or "delicious". The Salted Food Addition Hypothesis also proposes that opiate receptor withdrawal has been perceived as "preference," "urges," "craving" or "hunger" for salted food. Methods: The Salted Food Addiction Hypothesis is made manifest by individually presenting a basic review of its primary coexisting components; the Neurological Component and the Psychosocial Component. We also designed a prospective study in order to test our hypothesis that opiate dependent subjects increase their consumption of salted food during opiate withdrawal. Results: The neuropsychiatric evidence integrated here suggests that salted food acts like an, albeit mild, opiate agonist which drives overeating and weight gain. The opiate dependent group studied (N = 27) developed a 6.6% increase in weight during opiate withdrawal. Conclusions: Salted Food may be an addictive substance that stimulates opiate and dopamine receptors in the brain's reward and pleasure center more than it is "tasty", while salted food preference, urge, craving and hunger may be manifestations of opiate withdrawal. Salted food and opiate withdrawal stimulate appetite, increases calorie consumption, augments the incidence of overeating, overweight, obesity and related illnesses. Obesity and related illnesses may be symptoms of Salted Food Addiction.

Copyright 2009, Churchill Livingstone


Cohen LR; Greenfield SF; Gordon S; Killeen T; Jiang HP; Zhang YL et al. Survey of eating disorder symptoms among women in treatment for substance abuse. American Journal on Addictions 19(3): 245-251, 2010. (38 refs.)

A strong association between substance use disorders (SUDs) and eating disorders (EDs) in women has been established. Yet, little is known about the rates and impact of ED symptoms in women presenting to addiction treatment. The current investigation assessed the prevalence of ED symptoms and their effect on treatment outcomes in a sample of substance abusing women with co-occurring posttraumatic stress disorder (PTSD) enrolled in outpatient substance use programs. Participants were 122 women who participated in a multisite clinical trial comparing two behavioral treatments for co-occurring SUD and PTSD. The Eating Disorder Examination-self report, and measures of PTSD and SUD symptoms were administered at baseline, during treatment and at four follow-up points. Two subgroups emerged; those reporting binge eating in the 28 days prior to baseline (Binge group; n = 35) and those who reported no binge eating episodes (No Binge group; n = 87). Women in the Binge group endorsed significantly higher ED, PTSD, and depression symptoms at baseline than those in the No Binge group. Although all participants showed significant reductions in PTSD symptoms and improvements in abstinence rates during the study period, the improvements for the Binge group were significantly lower. These findings suggest that a subgroup of women with co-occurring PTSD and SUDs, who endorsed binge ED symptoms, responded differently to SUD/PTSD group treatment. Identification of ED symptoms among treatment-seeking women with SUDs may be an important element in tailoring interventions and enhancing treatment outcomes.

Copyright 2010, Wiley-Blackwell


Courbasson C; Brunshaw JM. The relationship between concurrent substance use disorders and eating disorders with personality disorders. International Journal of Environmental Research and Public Health 6(7): 2076-2089, 2009. (53 refs.)

Objective: The current pilot study investigated whether patients with concurrent substance use disorders and eating disorders (SUD and ED) who experienced a reduction in SUD and ED symptoms following treatment for SUD and ED also experienced a reduction in personality disorder (PD) symptoms. Method: Twenty patients with SUD and ED and PD were assessed pre and post treatment using clinical interviews, self-report questionnaires, and a therapist questionnaire on DSM-IV-TR symptoms for PD. Results: Symptoms for the personality disorders were reduced following treatment. This reduction was correlated with a decrease in the number of symptoms of ED at post treatment. Discussion: Chronic concurrent SUD and ED may make it difficult to separate PD symptoms from co-occurring disorders. Many features attributed to PDs may be reduced when problematic substance use and disordered eating are addressed, a fact that may increase clinician and patients' optimism about therapeutic change.

Copyright 2009, Molecular Diversity Preservation International


Davis C; Carter JC. Compulsive overeating as an addiction disorder. A review of theory and evidence (review). Appetite 53(1): 1-8, 2009. (100 refs.)

In this paper we argue that compulsive overeating has compelling similarities to conventional drug addiction. Our case is based on their comparable clinical features, the biological mechanisms they have in common, and on evidence that the two disorders have a shared diathesis. In making the argument for overeating as an addictive behaviour, it is clearly not appropriate to include all cases of excessive food consumption in this taxon. Nor are we claiming that obesity and addiction are one and the same. However, it is proposed that Binge Eating Disorder (BED) is a phenotype particularly well-suited to such a conceptualization, and that sound clinical and scientific evidence exists to support this viewpoint. We have provided some recommendations for treatment modifications that recognize the similarities between treating drug dependence and compulsive overeating.

Copyright 2009, Elsevier Science


Denoth F; Siciliano V; Iozzo P; Fortunato L; Molinaro S. The association between overweight and illegal drug consumption in adolescents: Is there an underlying influence of the sociocultural environment? PLoS ONE 6(11): e27358, 2011. (40 refs.)

Background: The aims of the study were to: a) Examine the distribution of gender-stratified body mass index (BMI), eating attitudes and use of addictive substances, under the hypothesis of a confluent prevalence of weight abnormalities, eating disorders and substance abuse. b) Demonstrate the extent to which family, peer-related and psychosocial factors are common elements in categories of compulsive behaviour. Methodology/Principal Findings: In the present cross-sectional study, data were collected through self reported questionnaires administered to a large sample of 33,185 15-19 years old adolescents (ESPAD (R) Italia), divided into weight categories based on the BMI percentile distribution. Multinomial analyses were adopted to address the influence of social, family, leisure time factors, Eating Attitude Test (EAT26) on the association between weight categories and drug use. Recent drugs use was more frequent in overweight and underweight adolescents (p < 0.05), especially in females. An EAT26 score >= 20 was more common in overweight adolescents. Multinomial analysis abolished the relationship between overweight and the use of most drugs, implicating self-esteem, parents' educational level, and friendships as mediators of the association. Within the overweight category, adolescents reporting recent drug use, showed greater frequency of having drug-abusing friends (similar to 80%), and severe problems with parents and school (similar to 30%) compared to overweight adolescents without recent drug use. Conclusion: The frequent association of overweight and substance use and the presence of common underlying social factors, highlights the need for an interdisciplinary approach involving individual-focused treatment models as well as public health, social and environmental changes to reduce food-and substances-related problems.

Copyright 2011, Public Library of Science


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.

Copyright 2009, Elsevier Science


Harrop EN; Marlatt GA. The comorbidity of substance use disorders and eating disorders in women: Prevalence, etiology, and treatment. (review). Addictive Behaviors 35(5): 392-398, 2010. (30 refs.)

Substance use disorders often co-occur with eating disorders in female populations. This review addresses the prevalence and etiology of this comorbidity in women. Thirteen peer-reviewed journal articles are reviewed. Conclusions are drawn concerning prevalence rates, theory, and implications for treatment. Current research supports distinct etiologies and growth trajectories for both disorders. Thus, comorbidity presents with unique challenges, and often, worse outcomes. Though comorbidity rates are high, little research has been done concerning treatment. Given the high prevalence rates of these comorbid disorders, a specific treatment needs to be developed that targets both disorders simultaneously.

Copyright 2010, Elsevier Science


Ho V; Arbour S; Hambley JM. Eating disorders and addiction: Comparing eating disorder treatment outcomes among clients with and without comorbid substance use disorder. Journal of Addictions Nursing 22(3): 130-137, 2011. (44 refs.)

Studies have shown that eating disorders and substance use disorders often co-occur and share common clinical and biological substrates. Given the high prevalence of co-occurring eating and substance use disorders, it is important to explore the impact of the dual-diagnosis on treatment outcomes. The present study compared individuals with an eating disorder only (ED) to those with a comorbid eating and substance use disorder (ED-SUD) on several factors related to 6-month post-treatment outcomes in eating attitudes and behavior and quality of life. Results show that both ED and ED-SUD clients experience significant improvements in self-reported eating disorder symptoms and concerns, as well as quality of life functioning. There were no significant differences in outcomes between ED and ED-SUD clients, which suggests that the two conditions can be successfully treated together.

Copyright 2011, Informa Healthcare


Kelly-Weeder S. Binge drinking and disordered eating in college students. Journal of The American Academy of Nurse Practitioners 23(1): 33-41, 2011. (59 refs.)

Purpose: To explore the co-occurrence of binge drinking and disordered eating behaviors in college-aged students. Data sources: Data were collected from 211 college-aged students (mean age 20.7 years) at a private university in the northeastern United States using a web-based survey. Gender-specific binge drinking rates (five drinks per occasion for men and four drinks per occasion for women) were ascertained. Disordered eating behaviors included measures of binge eating as well as unhealthy weight loss behaviors (skipping meals, fasting, diet pills, laxatives, and self-induced vomiting). Conclusions: Binge drinking rates were high (63% of female, 83% of male students). Binge eating was reported by 48% of students and was correlated with healthy and unhealthy weight loss behaviors. Female students were more likely to endorse the use of skipping meals, fasting, use of diet pills, laxatives, and self-induced vomiting. Implications for practice: Binge drinking and disordered eating behaviors are practiced by both male and female students and are common occurrences on college campuses. Nurse practitioners need to be aware of these behaviors, their co-occurrence, and the need to assess and intervene with students who are at risk for the negative health outcomes associated with the use of these behaviors.

Copyright 2011, Wiley-Blackwell


Kendzor DE; Adams CE; Stewart DW; Baillie LE; Copeland AL. Cigarette smoking is associated with body shape concerns and bulimia symptoms among young adult females. Eating Behaviors 10(1): 56-58, 2009. (17 refs.)

Elevated rates of cigarette smoking have been reported among individuals with Bulimia Nervosa. However, little is known about eating disorder symptoms within non-clinical samples of smokers. The purpose of the present study was to compare the eating disorder symptoms Of young adult female smokers (n = 184) and non-smokers (n=56), to determine whether smokers were more likely to endorse bulimic symptoms and report greater body shape concern than non-smokers. Analyses indicated that smokers scored significantly higher than non-smokers on the Body Shape Questionnaire, p = .03. and the Bulimia Test-Revised, p=.006. In addition, a higher proportion of smokers than non-smokers scored :85 on the Bulimia Test-Revised, p = .05, suggesting the possibility that Bulimia Nervosa diagnoses were more prevalent among smokers. No differences Were found between smokers and non-smokers on other measures of eating behavior. Overall findings suggest that smoking is specifically associated with symptoms of Bulimia Nervosa and body shape concern among young adult females.

Copyright 2009, Elsevier Science BV


Khaylis A; Trockel M; Taylor CB. Binge drinking in women at risk for developing eating disorders. International Journal of Eating Disorders 42(5): 409-414, 2009. (41 refs.)

Objective: To determine binge drinking rates in college-age women at risk for eating disorders and to examine factors related to binge drinking over time. Method: Participants were 480 college-age women who were at high risk for developing an eating disorder (ED) and who had a body mass index (BMI) between 18 and 32. Participants were assessed annually for 4 years. Results: Participants reported high rates of binge drinking and frequent binge drinking throughout college. Binge drinking was positively correlated with dietary restraint, coping using substances, coping using denial, and life events. Discussion: The study's findings suggest that binge drinking is highly prevalent in women at high risk for developing eating disorders. Results also indicated that binge drinking was related to dieting and maladaptive coping patterns. Intervention for women with strong weight and shape concerns should also address problematic alcohol use.

Copyright 2009, John Wiley & Sons


Levitan RD; Davis C. Emotions and eating behaviour: Implications for the current obesity epidemic. University of Toronto Quarterly 79(2 (special issue)): 783-799, 2010. (80 refs.)

Developed countries around the world are experiencing an epidemic of overeating and obesity with significant costs at a personal, familial, and societal level. While most research on obesity has focused on metabolic factors, this paper considers how emotional factors might contribute to this problem. Two examples we address are the use of food to modify negative mood states, also called emotional eating, and food intake as an addiction. Our central question is what makes some individuals prone to emotional eating and/or food addiction, while others are clearly less vulnerable in this regard. Ultimately, we suggest how obesity research, prevention, and treatment might address the emotional underpinnings of the current overeating epidemic.

Copyright 2010, University of Toronto Press


MacLaren VV; Best LA. Multiple addictive behaviors in young adults: Student norms for the Shorter PROMIS Questionnaire. Addictive Behaviors 35(3): 252-255, 2010. (21 refs.)

The Shorter PROMIS Questionnaire (SPQ Christo, Jones, Haylett, Stephenson, Lefever & Lefever, 2003) is a multidimensional self report that measures 16 addictive behaviors. This study examined the psychometric properties of the SPQ and collected normative data from 948 students at two Canadian universities. Factor analysis confirmed the existence of two categories of addictive behavior, which Haylett and her colleagues (2004) labelled hedonistic and nurturant. The hedonistic categories included behaviors such as the use of prescription drugs, gambling, caffeine, illegal drugs, alcohol, tobacco and compulsive sex. The nurturant group included behaviors such as compulsive helping, work, relationships, shopping, disordered eating and exercise. Men (N=250) scored higher than women on dominant relationships, exercise, gambling, illegal drugs, alcohol. tobacco and sex. Women (N=698) scored higher on compulsive shopping, food binging and starving. These results suggest that the SPQ may be a useful index of multiple addictive behaviors in college-age people.

Copyright 2010, Elsevier Science


Meyer C; Taranis L. Exercise in the eating disorders: Terms and definitions. (editorial). European Eating Disorders Review 19(3, special issue): 169- 173, 2011. (55 refs.)


Neale A; Abraham S; Russell J. "Ice" use and eating disorders: A report of three cases. International Journal of Eating Disorders 42(2): 188-191, 2009. (8 refs.)

Objective: To describe the use of crystal methamphetamine hydrochloride "ice," a powerful, synthetic stimulant drug associated with rapid weight loss. Method: We report the first three cases of young women "ice" users requiring admission to a specialized eating disorders unit. Results: Case one had no prior history of an eating disorder and became emaciated following regular use of "ice"; she regarded weight gain positively. Case 2 had polysubstance abuse since early adolescence and commenced binge eating and vomiting in response to weight gain when not using "ice"; she learned to maintain her weight without weight losing behaviors. Case 3 developed anorexia nervosa in early adolescence, required numerous inpatient admissions and commenced using stimulant drugs for weight loss in her late teens; she discharged prematurely. All patients had features of personality disorder on interview and drug abuse had impaired their work and social adjustment. Discussion: "Ice" use may be associated with the onset of disordered eating or used as an efficient weight losing behavior in an established eating disorder.

Copyright 2009, John Wiley & Sons


Piran N; Robinson SR. Patterns of associations between eating disordered behaviors and substance use in two non-clinical samples: A university and a community based sample. Journal of Health Psychology 16(7): 1027-1037, 2011. (44 refs.)

This study examined shared patterns of associations between disordered eating behaviors and substance use in two different non-clinical samples of young women. Participants were recruited from a university (526 women) and varied community (517 women) settings. Participants completed the Women's Health Survey, examining engagement in a wide range of licit and illicit substances and disordered eating patterns during the past 12 months. In both samples, the cluster of bingeing, dieting and purging was significantly associated with binge drinking, drinking associated with negative consequences, and with cocaine use. The cluster of dieting and purging was associated with the use of stimulants/amphetamines. Health services, including assessment and treatment, and health promotion activities, should consider these patterns of comorbidity.

Copyright 2011, Sage Publications


Pomerleau CS; Snedecor SM; Pomerleau OF. Never-smokers with a positive family smoking history are more likely to be overweight or obese than never-smokers with a negative family smoking history. Eating Behaviors 10(1): 49-51, 2009. (14 refs.)

To shed light on the complex relationship between smoking and body weight, we used never-smokers stratified on family smoking history to model the effects of a diathesis for smoking on body weight without the potential confound of metabolic changes or decreased physical activity caused by chronic tobacco smoke exposure. Participants were 100 family history negative never-smokers (FH-: 2 never-smoking parents) and 71 family history positive never-smokers (FH+; 2 ever-smoking parents). Controlling for significant group differences in race and age, BMI was significantly higher in FH+ (26.7+/-.6) than in FH- (24.5+/-.4; F=10.351 p<.01). Further analysis using logistic regression showed that FH+ Were 2.7 times as likely to be overweight/obese (BMI >= 25: 95% C.I. 1.398-5.351: p<.01). FH+ scored significantly higher on the Dieting and Bingeing Severity Scale than FH- and were significantly more likely to score in the severe or at-risk range. FH+ drank significantly more alcohol than FH-; they scored significantly higher on the CAGE and on the Michigan Alcohol Screening Test. Our analyses provide support for the role of inherited and/or environmentally-driven tendencies towards disinhibited eating and/or risky behaviors in general in the observed differences in BMI. No group differences in BMI or likelihood of being overweight/obese emerged based Oil prenatal exposure to nicotine in FH+ smokers, although our sample was too small to Rile cot all association. Further research in larger samples, using more complex statistical models, will be needed to disentangle these issues and identify casual pathways.

Copyright 2009, Elsevier Science


Root TL; Pinheiro AP; Thornton L; Strober M; Fernandez-Aranda F; Brandt H et al. Substance use disorders in women with anorexia nervosa. International Journal of Eating Disorders 43(1): 14-21, 2010. (41 refs.)

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

Copyright 2010, John Wiley & Sons


Root TL; Pisetsky EM; Thornton L; Lichtenstein P; Pedersen NL; Bulik CM. Patterns of co-morbidity of eating disorders and substance use in Swedish females. Psychological Medicine 40(1): 105-115, 2010. (61 refs.)

Background. Little is known about the association of eating disorder subtypes across multiple categories of substance use in population-based samples. We examined the association between eating disorders and substance use in a large population-based sample. Method. Female participants (n = 13 297) were from the Swedish Twin Registry [Lichtenstein et al., Twin Research and Human Genetics (2006) 9, 875-882]. Substance use was examined in four defined groups - (1) anorexia nervosa (AN); (2) bulimia nervosa (BN); (3) AN and BN (ANBN); and (4) binge eating disorder (BED) as well as a referent group without eating disorder (no ED). Secondary analyses examined differences between restricting AN (RAN) and binge and/or purge AN (ANBP). Results. In general, eating disorders were associated with greater substance use relative to the referent. The AN group had significantly increased odds for all illicit drugs. Significant differences emerged across the RAN and ANBP groups for alcohol abuse/dependence, diet pills, Stimulants, and polysubstance use with greater use in the ANBP group. Across eating disorder groups, (1) the BN and ANBN groups were more likely to report alcohol abuse/dependence relative to the AN group, (2) the ANBN group was more likely to report diet pill use relative to the AN, BN and BED groups, and (3) the BN group was more likely to report diet pill use relative to the no ED, AN and BED groups. Conclusions. Eating disorders are associated with a range of substance use behaviors. Improved understanding of how they mutually influence risk could enhance understanding of etiology and prevention.

Copyright 2010, Cambridge University Press


Saules KK; Collings AS; Hoodin F; Angelella NE; Alschuler K; Ivezaj V et al. The contributions of weight problem perception, BMI, gender, mood, and smoking status to binge eating among college students. Eating Behaviors 10(1): 1-9, 2009. (66 refs.)

College student participants (N=1063: 77.8% response rate) completed a web-based survey assessing demographics, depression, anxiety, body image, cigarette smoking, and weight history. Among overweight participants, 42.6% of those who believed they were overweight admitted to binge eating, while only 30.1% who did not feel overweight did so (p<.05). Among non-overweight participants, 43.2% of those who believed they were overweight admitted to binge eating, while only 32.9% of those who did not feel overweight did so (p<.05). Weight Problem Perception (WPP) mediated the contribution of BMI on binge eating outcomes, and WPP contributed significantly to the prediction of binge eating, beyond the risk conferred by established correlates of binge eating (e.g., gender. mood, and cigarette smoking). Results suggest that when assessing risk for binge eating, a one-question assessment of whether or not an individual believes s/he is overweight has significant predictive power. Findings are consistent with literature Oil [lie importance of the "fat self-schema" [Stein. K.F. &, Corte. C. (2007). Identity impairment and the eating disorders: Content and organization of the self-concept in women with anorexia nervosa and bulimia nervosa. European Eating Disorders Review, 15 (1). 58-69] in disordered eating and theory implicating identity in the maintenance of addictive behavior.

Copyright 2009, Elsevier Science BV


Schienle A; Schafer A; Hermann A; Vaitl D. Binge-eating disorder: Reward sensitivity and brain activation to images of food. Biological Psychiatry 65(8): 654-661, 2009. (51 refs.)

Background: The underlying neurobiological mechanisms that account for the onset and maintenance of binge-eating disorder (BED) are not sufficiently understood. This functional magnetic resonance imaging (fMRI) study explored the neural correlates of visually induced food reward and loathing. Method: Sixty-seven female participants assigned to one of four groups (overweight BED patients, overweight healthy control subjects, normal-weight healthy control subjects, and normal-weight patients with bulimia nervosa) participated in the experiment. After an overnight fast, the participants' brain activation was recorded during each of the following three conditions: visual exposure to high-caloric food, to disgust-inducing pictures, and to affectively neutral pictures. After the fMRI experiment, the participants rated the affective value of the pictures. Results: Each of the groups experienced the food pictures as very pleasant. Relative to the neutral pictures, the visual food stimuli provoked increased activation in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and insula across all participants. The BED patients reported enhanced reward sensitivity and showed stronger medial OFC responses while viewing food pictures than all other groups. The bulimic patients displayed greater arousal, ACC activation, and insula activation than the other groups. Neural responses to the disgust-inducing pictures as well as trait disgust did not differ between the groups. Conclusions: This study provides first evidence of differential brain activation to visual food stimuli in patients suffering from BED and bulimia nervosa.

Copyright 2009, Elsevier Science


Sussman S; Lisha N; Griffiths M. Prevalence of the addictions: A problem of the majority or the minority? (review). Evaluation & the Health Professions 34(1): 3-56, 2011. (193 refs.)

An increasing number of research studies over the last three decades suggest that a wide range of substance and process addictions may serve similar functions. The current article considers 11 such potential addictions (tobacco, alcohol, illicit drugs, eating, gambling, Internet, love, sex, exercise, work, and shopping), their prevalence, and co-occurrence, based on a systematic review of the literature. Data from 83 studies each study n = at least 500 subjects) were presented and supplemented with small-scale data. Depending on which assumptions are made, overall 12-month prevalence of an addiction among U. S. adults varies from 15% to 61%. The authors assert that it is most plausible that 47% of the U. S. adult population suffers from maladaptive signs of an addictive disorder over a 12-month period and that it may be useful to think of addictions as due to problems of lifestyle as well as to person-level factors.

Copyright 2011, Sage Publication


Suzuki K; Takeda A; Yoshino A. Mortality 6 years after inpatient treatment of female Japanese patients with eating disorders associated with alcoholism. Psychiatry and Clinical Neurosciences 65(4): 326-332, 2011. (20 refs.)

Aims: This study was conducted to clarify the mortality of patients with eating disorders associated with alcoholism. We focused on the mortality rate 6 years after inpatient treatment of patients with eating disorders associated with alcoholism compared with eating disorder patients without alcoholism and alcoholic patients without eating disorders. Methods: The subjects were 164 female Japanese patients 30 years of age or younger with eating disorders or alcoholism who were inpatients at some time during the period from 1990 to 1998 at the Japanese National Hospital Organization, Kurihama Alcoholism Center. A semi-structured interview concerning alcohol problems, eating problems, psychiatric disorders and other clinical characteristics was conducted at the time of the first admission. A survey concerning survival was conducted in October 2001, and 100% of the patients were followed up. Results: The mortality of the 47 eating disorder patients with alcoholism, 86 eating disorder patients without alcoholism, and 31 alcoholics without eating disorders was 27.7%, 3.5%, and 19.4%, respectively, at 6 years after inpatient treatment, showing significant differences. On the Kaplan-Meier survival curves, the mortality of the eating disorder patients with alcoholism was significantly higher than that of the patients without alcoholism, but not significantly higher than that of young female alcoholics without eating disorders. The 13 eating disorder patients with alcoholism who had died were five anorexia nervosa and seven bulimia nervosa patients.

Copyright 2011, Wiley-Blackwell


VanBuskirk KA; Potenza MN. The treatment of obesity and its co-occurrence with substance use disorders. (review). Journal of Addiction Medicine 4(1): 1-10, 2010. (135 refs.)

Obesity and binge eating disorder are detrimental health conditions that are associated with lower qualities of life. Individuals with obesity often face societal discrimination and frequently experience related medical disorders such as diabetes, hypertension, and hyperlipidemia. Current research suggests neurobiological similarities among obesity, binge eating disorder, and substance dependence. In addition, behavioral similarities link the two conditions; obese and substance-dependent individuals often report similar features such as cravings and diminished control over consumption of food and substances, respectively. Treatment options for obesity have begun to use this information to formulate pharmacological and therapeutic interventions that may provide improved results for weight loss and decreased binge frequency. Similarly, treatment approaches to substance addictions should consider aspects of weight management. Findings from research and treatment studies are presented with the aim of reviewing the current literature of obesity within the context of an addiction framework and providing information on empirically supported approaches to the treatment of co-occurring obesity and substance addiction.

Copyright 2010, American Society of Addiction Medicine


White MA; Grilo CM; O'Malley SS; Potenza MN. Binge eating disorder, obesity, and tobacco smoking. (editorial). Journal of Addiction Medicine 4(1): 11-19, 2010. (73 refs.)


White MA; Peters EN; Toll BA. Effect of binge eating on treatment outcomes for smoking cessation. Nicotine & Tobacco Research 12(11): 1172-1175, 2010. (18 refs.)

Introduction: This study investigated the effect of binge eating on smoking cessation outcomes. Methods: Participants (n = 186) reported binge eating status at baseline and at a 6-week postquit evaluation during a larger clinical trial for smoking cessation. Binge eating was defined with a single self-report questionnaire item from the Dieting and Bingeing Severity Scale. Participant groups defined by binge eating status were compared on abstinence rates. Results: Among participants, 22% reported binge eating at baseline, 17% denied binge eating at baseline but endorsed binge eating by 6 weeks, and 61% denied binge eating at both timepoints. Participants who reported binge eating prior to or during treatment had lower quit rates at 6-week postquit and at the 24-week follow-up point than those without binge eating; the groups did not differ at the 12-week follow-up point. The group that experienced an emergence of binge eating reported significantly more weight gain than the other groups. Conclusions: These results suggest that treatments addressing problematic eating behaviors during smoking cessation are warranted.

Copyright 2010, Oxford University Press


Wilson GT. Eating disorders, obesity and addiction. European Eating Disorders Review 18(5): 341-351, 2010. (84 refs.)

An addiction model of both eating disorders and obesity has received increasing attention in the popular and scientific literature. The addiction is viewed as a brain disease that must be directly targeted if treatment is to succeed. Evidence from laboratory feeding studies, epidemiology, genetic and familial research, psychopathological mechanisms, and treatment outcome research on cognitive behaviour therapy (CBT) is inconsistent with the clinical validity or utility of the addiction model of eating disorders. Neurobiological research has shown commonalities in brain reward processes between obesity and substance abuse disorders. Yet emphasis on apparent similarities overlooks important differences between obesity and drug addiction. Interest in obesity as a brain disease should not detract from a public health focus on the 'toxic food environment' that is arguably responsible for the obesity epidemic and related nutrition-based chronic disease.

Copyright 2010, Eating Disorders Association


Yip SW; White MA; Grilo CM; Potenza MN. An exploratory study of clinical measures associated with subsyndromal pathological gambling in patients with binge eating disorder. Journal of Gambling Studies 27(2): 257-270, 2011. (60 refs.)

Both binge eating disorder (BED) and pathological gambling (PG) are characterized by impairments in impulse control. Subsyndromal levels of PG have been associated with measures of adverse health. The nature and significance of PG features in individuals with BED is unknown. Ninety-four patients with BED (28 men and 66 women) were classified by gambling group based on inclusionary criteria for Diagnostic and Statistical Manual-IV (DSM-IV) PG and compared on a range of behavioral, psychological and eating disorder (ED) psychopathology variables. One individual (1.1% of the sample) met criteria for PG, although 18.7% of patients with BED displayed one or more DSM-IV criteria for PG, hereafter referred to as problem gambling features. Men were more likely than women to have problem gambling features. BED patients with problem gambling features were distinguished by lower self-esteem and greater substance problem use. After controlling for gender, findings of reduced self-esteem and increased substance problem use among patients with problem gambling features remained significant. In patients with BED, problem gambling features are associated with a number of heightened clinical problems.

Copyright 2011, Springer


Zhang Y; von Deneen KM; Tian J; Gold MS; Liu YJ. Food addiction and neuroimaging. (review). Current Pharmaceutical Design 17(12): 1149- 1157, 2011. (145 refs.)

Obesity has become a serious epidemic and one of the leading global health problems. However, much of the current debate has been fractious, and etiologies of obesity have been attributed to eating behavior (i.e. fast food consumption), personality, depression, addiction or genetics. One of the interesting new hypotheses for explaining the development of obesity involves a food addiction model, which suggests that food is not eaten as much for survival as pleasure and that hedonic overeating is relevant to both substance-related disorders and eating disorders. Accumulating evidence has shown that there are a number of shared neural and hormonal pathways as well as distinct differences in these pathways that may help researchers discover why certain individuals continue to overeat despite health and other consequences, and becomes more and more obese. Functional neuroimaging studies have further revealed that pleasant smelling, looking, and tasting food has reinforcing characteristics similar to drugs of abuse. Many of the brain changes reported for hedonic eating and obesity are also seen in various types of addictions. Most importantly, overeating and obesity may have an acquired drive similar to drug addiction with respect to motivation and incentive craving. In both cases, the desire and continued satisfaction occur after early and repeated exposure to stimuli. The acquired drive for eating food and relative weakness of the satiety signal would cause an imbalance between the drive and hunger/reward centers in the brain and their regulation. In the current paper, we first provide a summary of literature on food addition from eight different perspectives, and then we proposed a research paradigm that may allow screening of new pharmacological treatment on the basis of functional magnetic resonance imaging (fMRI).

Copyright 2011, Bentham Science Publishing