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Patterns of co-morbidity of eating disorders and substance use in Swedish females

Published online by Cambridge University Press:  20 April 2009

T. L. Root ,
E. M. Pisetsky ,
L. Thornton ,
P. Lichtenstein ,
N. L. Pedersen  and
C. M. Bulik
T. L. Root
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
E. M. Pisetsky
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
L. Thornton
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
P. Lichtenstein
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
N. L. Pedersen
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Psychology, University of Southern California, Los Angeles, CA, USA
C. M. Bulik*
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
*
*Address for correspondence: C. M. Bulik, Ph.D., Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7160, Chapel Hill, NC27599-7160, USA. (Email: cbulik@med.unc.edu)
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Abstract

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.

Keywords

Alcoholanorexia nervosabinge-eating disordersbulimia nervosatobacco
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 1 , January 2010 , pp. 105 - 115
Copyright
Copyright © Cambridge University Press 2009

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References

Adams, TB, Araas, TE (2006). Purging and alcohol-related effects in college women. International Journal of Eating Disorders 39, 240–244.CrossRefGoogle ScholarPubMed
Anzengruber, D, Klump, KL, Thornton, L, Brandt, H, Crawford, S, Fichter, MM, Halmi, KA, Johnson, C, Kaplan, AS, LaVia, M, Mitchell, J, Strober, M, Woodside, DB, Rotondo, A, Berrettini, WH, Kaye, WH, Bulik, CM (2006). Smoking in eating disorders. Eating Behaviors 7, 291–299.CrossRefGoogle ScholarPubMed
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, revised. American Psychiatric Press: Washington, DC.Google Scholar
Baker, JH, Mazzeo, SE, Kendler, KS (2007). Association between broadly defined bulimia nervosa and drug use disorders: common genetic and environmental influences. International Journal of Eating Disorders 40, 673–678.CrossRefGoogle ScholarPubMed
Benjamini, Y, Hochberg, Y (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society 57, 289–300.Google Scholar
Blinder, BJ, Cumella, EJ, Sanathara, VA (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine 68, 454–462.CrossRefGoogle ScholarPubMed
Bulik, CM, Klump, KL, Thornton, L, Kaplan, AS, Devlin, B, Fichter, M, Halmi, K, Strober, M, Woodside, DB, Crow, S, Mitchell, JE, Rotondo, A, Mauri, M, Cassano, GB, Keel, P, Berrettini, WH, Kaye, WH (2004 a). Alcohol use disorder comorbidity in eating disorders: a multicenter study. Journal of Clinical Psychiatry 65, 1000–1006.CrossRefGoogle ScholarPubMed
Bulik, CM, Slof, S, Sullivan, PF (2004 b). Eating disorders and substance use disorders. In Dual Diagnosis: Substance Abuse and Comorbid Medical and Psychiatric Conditions, 2nd edn (ed. Rounsaville, B. and Kranzler, H.), pp. 317–348. Marcel Dekker: New York.Google Scholar
Bulik, CM, Sullivan, PF, Tozzi, F, Furberg, H, Lichtenstein, P, Pedersen, N (2006). Prevalence, heritability and prospective risk factors for anorexia nervosa. Archives of General Psychiatry 63, 305–312.CrossRefGoogle ScholarPubMed
Bulik, CM, Slof-Op 't Landt, MC, van Furth, EF, Sullivan, PF (2007). The genetics of anorexia nervosa. Annual Review of Nutrition 27, 263–275.CrossRefGoogle ScholarPubMed
Bulik, CM, Sullivan, PF, Wade, TD, Kendler, KS (2000). Twin studies of eating disorders: a review. International Journal of Eating Disorders 27, 1–20.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
Carroll, ME, Meisch, RA (1984). Increased drug-reinforced behavior due to food deprivation. In Advances in Behavioral Pharmacology (ed. Thompson, T., Dews, P. B. and Barrett, J. E.), pp. 47–88. Academic Press: New York.Google Scholar
Cassin, SE, von Ranson, KM (2005). Personality and eating disorders: a decade in review. Clinical Psychology Review 25, 895–916.CrossRefGoogle ScholarPubMed
Conway, KP, Kane, RJ, Ball, SA, Poling, JC, Rounsaville, BJ (2003). Personality, substance of choice, and polysubstance involvement among substance dependent patients. Drug and Alcohol Dependence 71, 65–75.CrossRefGoogle ScholarPubMed
Eaves, L, Silberg, J, Foley, D, Bulik, CM, Maes, H, Erkanli, A, Angold, A, Costello, EJ, Worthman, C (2004). Genetic and environmental influences on the relative timing of pubertal change. Twin Research 7, 471–481.CrossRefGoogle ScholarPubMed
Eddy, KT, Keel, PK, Dorer, DJ, Delinsky, SS, Franko, DL, Herzog, DB (2002). Longitudinal comparison of anorexia nervosa subtypes. International Journal of Eating Disorders 31, 191–201.CrossRefGoogle ScholarPubMed
Fernandez-Aranda, F, Jimenez-Murcia, S, Alvarez-Moya, EM, Granero, R, Vallejo, J, Bulik, CM (2006). Impulse control disorders in eating disorders: clinical and therapeutic implications. Comprehensive Psychiatry 47, 482–488.CrossRefGoogle ScholarPubMed
Fernandez-Aranda, F, Pinheiro, AP, Tozzi, F, Thornton, LM, Fichter, MM, Halmi, KA, Kaplan, AS, Klump, KL, Strober, M, Woodside, DB, Crow, S, Mitchell, J, Rotondo, A, Keel, P, Plotnicov, KH, Berrettini, WH, Kaye, WH, Crawford, SF, Johnson, C, Brandt, H, La Via, M, Bulik, CM (2007). Symptom profile of major depressive disorder in women with eating disorders. Australian and New Zealand Journal of Psychiatry 41, 24–31.CrossRefGoogle ScholarPubMed
Field, AE, Austin, SB, Frazier, AL, Gillman, MW, Camargo, CA Jr., Colditz, GA (2002). Smoking, getting drunk and engaging in bulimic behaviors: in which order are the behaviors adopted? Journal of the American Academy of Child and Adolescent Psychiatry 41, 846–853.CrossRefGoogle ScholarPubMed
Franko, DL, Dorer, DJ, Keel, PK, Jackson, S, Manzo, MP, Herzog, DB (2005). How do eating disorders and alcohol use disorder influence each other? International Journal of Eating Disorders 38, 200–207.CrossRefGoogle ScholarPubMed
Furberg, H, Lichtenstein, P, Pedersen, NL, Bulik, CM, Sullivan, PF (2006). Cigarettes and oral snuff use in Sweden: prevalence and transitions. Addiction 101, 1509–1515.CrossRefGoogle ScholarPubMed
Godart, NT, Flament, MF, Lecrubier, Y, Jeammet, P (2000). Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance. European Psychiatry 15, 38–45.CrossRefGoogle ScholarPubMed
Godart, NT, Perdereau, F, Curt, F, Rein, Z, Lang, F, Venisse, JL, Halfon, O, Bizouard, P, Loas, G, Corcos, M, Jeammet, P, Flament, MF (2006). Is major depressive episode related to anxiety disorders in anorexics and bulimics? Comprehensive Psychiatry 47, 91–98.CrossRefGoogle ScholarPubMed
Herzog, DB, Franko, DL, Dorer, DJ, Keel, PK, Jackson, S, Manzo, MP (2006). Drug abuse in women with eating disorders. International Journal of Eating Disorders 39, 364–368.CrossRefGoogle ScholarPubMed
Herzog, DB, Keller, MB, Sacks, NR, Yeh, CJ, Lavori, PW (1992). Psychiatric comorbidity in treatment-seeking anorexics and bulimics. Journal of the American Academy of Child and Adolescent Psychiatry 31, 810–818.CrossRefGoogle ScholarPubMed
Holderness, CC, Brooks-Gunn, J, Warren, MP (1994). Co-morbidity of eating disorders and substance abuse review of the literature. International Journal of Eating Disorders 16, 1–34.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Hsieh, YS, Yang, SF, Chiou, HL, Kuo, DY (2005). Transcriptional involvement of protein kinase C-alpha isozyme in amphetamine-mediated appetite suppression. European Journal of Neurosciences 22, 715–723.CrossRefGoogle ScholarPubMed
Hudson, JI, Hiripi, E, Pope, HG Jr., Kessler, RC (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry 61, 348–358.CrossRefGoogle ScholarPubMed
Hudson, JI, Weiss, R, Pope, HG Jr., McElroy, SL, Mirin, SM (1992). Eating disorders in hospitalized substance abusers. American Journal of Drug and Alcohol Abuse 18, 75–85.CrossRefGoogle ScholarPubMed
Kaye, WH, Lilenfeld, LR, Plotnikov, K, Merikangas, KR, Nagy, L, Strober, M, Bulik, CM, Moss, H, Greeno, CG (1996). Bulimia nervosa and substance dependence: association and family transmission. Alcoholism: Clinical and Experimental Research 20, 878–881.CrossRefGoogle ScholarPubMed
Kaye, WH, Greeno, CG, Moss, H, Fernstrom, J, Fernstrom, M, Lilenfeld, LR, Weltzin, TE, Mann, JJ (1998). Alterations in serotonin activity and psychiatric symptoms after recovery from bulimia nervosa. Archives of General Psychiatry 55, 927–935.CrossRefGoogle ScholarPubMed
Keel, PK, Dorer, DJ, Eddy, KT, Franko, DL, Charatan, DL, Herzog, DB (2003). Predictors of mortality in eating disorders. Archives of General Psychiatry 60, 179–183.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA (1999). A population-based twin study of lifetime major depression in men and women. Archives of General Psychiatry 56, 39–44.CrossRefGoogle ScholarPubMed
Kendler, KS, Walters, EE, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1995). The structure of the genetic and environmental risk factors for six major psychiatric disorders in women: phobia, generalized anxiety disorder, panic disorder, bulimia, major depression and alcoholism. Archives of General Psychiatry 52, 374–383.CrossRefGoogle ScholarPubMed
Lachman, HM (2006). An overview of the genetics of substance use disorders. Current Psychiatry Reports 8, 133–143.CrossRefGoogle ScholarPubMed
Lagergren, J, Bergstrom, R, Lindgren, A, Nyren, O (2000). The role of tobacco, snuff and alcohol use in the aetiology of cancer of the oesophagus and gastric cardia. International Journal of Cancer 85, 340–346.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Lewin, F, Norell, SE, Johansson, H, Gustavsson, P, Wennerberg, J, Biorklund, A, Rutqvist, LE (1998). Smoking tobacco, oral snuff, and alcohol in the etiology of squamous cell carcinoma of the head and neck: a population-based case-referent study in Sweden. Cancer 82, 1367–1375.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Lichtenstein, P, Sullivan, PF, Cnattingius, S, Gatz, M, Johansson, S, Carlstrom, E, Bjork, C, Svartengren, M, Wolk, A, Klareskog, L, de Faire, U, Schalling, M, Palmgren, J, Pedersen, NL (2006). The Swedish Twin Registry in the third millennium: an update. Twin Research and Human Genetics 9, 875–882.CrossRefGoogle ScholarPubMed
Lilenfeld, LR, Kaye, WH, Greeno, CG, Merikangas, KR, Plotnikov, K, Pollice, C, Rao, R, Strober, M, Bulik, CM, Nagy, L (1998). A controlled family study of restricting anorexia and bulimia nervosa: comorbidity in probands and disorders in first-degree relatives. Archives of General Psychiatry 55, 603–610.CrossRefGoogle ScholarPubMed
Lynskey, MT, Agrawal, A, Bucholz, KK, Nelson, EC, Madden, PA, Todorov, AA, Grant, JD, Martin, NG, Heath, AC (2006). Subtypes of illicit drug users: a latent class analysis of data from an Australian twin sample. Twin Research and Human Genetics 9, 523–530.CrossRefGoogle ScholarPubMed
Marshall, DM (1994). Breed differences and genetic parameters for body composition traits in beef cattle. Journal of Animal Sciences 72, 2745–2755.CrossRefGoogle ScholarPubMed
Neovius, M, Janson, A, Rossner, S (2006). Prevalence of obesity in Sweden. Obesity Reviews 7, 1–3.CrossRefGoogle ScholarPubMed
Ogden, CL, Carroll, MD, Curtin, LR, McDowell, MA, Tabak, CJ, Flegal, K (2006). Prevalence of overweight and obesity in the United States, 1999–2004. Journal of the American Medical Association 295, 1549–1555.CrossRefGoogle ScholarPubMed
Osterdahl, BG, Jansson, C, Paccou, A (2004). Decreased levels of tobacco-specific N-nitrosamines in moist snuff on the Swedish market. Journal of Agricultural and Food Chemistry 52, 5085–5088.CrossRefGoogle ScholarPubMed
Pinheiro, AP, Sullivan, PF, Bacaltchuck, J, Prado-Lima, PA, Bulik, CM (2006). Genetics in eating disorders: extending the boundaries of research. Brazilian Journal of Psychiatry 28, 218–225.CrossRefGoogle ScholarPubMed
Prescott, CA, Madden, PA, Stallings, MC (2006). Challenges in genetic studies of the etiology of substance use and substance use disorders: introduction to the special issue. Behavior Genetics 36, 473–482.CrossRefGoogle ScholarPubMed
Reba, L, Thornton, L, Tozzi, F, Klump, KL, Brandt, H, Crawford, S, Crow, S, Fichter, MM, Halmi, KA, Johnson, C, Kaplan, AS, Keel, P, LaVia, M, Mitchell, J, Strober, M, Woodside, DB, Rotondo, A, Berrettini, WH, Kaye, WH, Bulik, CM (2005). Relationships between features associated with vomiting in purging-type eating disorders. International Journal of Eating Disorders 38, 287–294.CrossRefGoogle ScholarPubMed
Reba-Harrelson, L, Von Holle, A, Thornton, LM, Klump, KL, Berrettini, WH, Brandt, H, Crawford, S, Crow, S, Fichter, MM, Goldman, D, Halmi, KA, Johnson, C, Kaplan, AS, Keel, P, LaVia, M, Mitchell, J, Plotnicov, K, Rotondo, A, Strober, M, Treasure, J, Woodside, DB, Kaye, WH, Bulik, CM (2008). Features associated with diet pill use in individuals with eating disorders. Eating Behaviors 9, 73–81.CrossRefGoogle ScholarPubMed
Roerig, JL, Mitchell, JE, de Zwaan, M, Wonderlich, SA, Kamran, S, Engbloom, S, Burgard, M, Lancaster, K (2003). The eating disorders medicine cabinet revisited: a clinician's guide to appetite suppressants and diuretics. International Journal of Eating Disorders 33, 443–457.CrossRefGoogle ScholarPubMed
Root, TL, Pinheiro, AP, Thornton, L, Strober, M, Fernandez-Aranda, F, Brandt, H, Crawford, S, Fichter, MM, Halmi, KA, Johnson, C, Kaplan, AS, Klump, KL, La Via, M, Mitchell, J, Woodside, DB, Rotondo, A, Berrettini, WH, Kaye, WH, Bulik, CM (2009). Substance use disorders in women with anorexia nervosa. International Journal of Eating Disorders. Published online: 3 March 2009. doi: 10.1002/eat.20670.Google Scholar
Ross, HE, Ivis, F (1999). Binge eating and substance use among male and female adolescents. International Journal of Eating Disorders 26, 245–260.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
Slof-Op 't Landt, MC, van Furth, EF, Meulenbelt, I, Slagboom, PE, Bartels, M, Boomsma, D, Bulik, C (2005). Eating disorders: from twin studies to candidate genes and beyond. Twin Research and Human Genetics 16, 467–482.CrossRefGoogle Scholar
Steiger, H, Bruce, KR (2007). Phenotypes, endophenotypes, and genotypes in bulimia spectrum eating disorders. Canadian Journal of Psychiatry 52, 220–227.CrossRefGoogle ScholarPubMed
Stice, E, Shaw, HE (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings. Journal of Psychosomatic Research 53, 985–993.CrossRefGoogle Scholar
Strong, K, Bonita, R (2003). The SuRF Report 1. Surveillance of Risk Factors Related to Noncommunicable Diseases: Current Status of Global Data. WHO: Geneva.Google Scholar
Swinbourne, JM, Touyz, SW (2007). The co-morbidity of eating disorders and anxiety disorders: a review. European Eating Disorders Review 15, 253–274.CrossRefGoogle ScholarPubMed
The National Center on Addiction and Substance Abuse at Columbia University (2003). Food for Thought: Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse (CASA) at Columbia University: New York.Google Scholar
von Ranson, KM, Iacono, WG, McGue, M (2002). Disordered eating and substance use in an epidemiological sample: I. Associations within individuals. International Journal of Eating Disorders 31, 389–403.CrossRefGoogle Scholar
Wade, TD, Bulik, CM, Neale, M, Kendler, KS (2000). Anorexia nervosa and major depression: shared genetic and environmental risk factors. American Journal of Psychiatry 157, 469–471.CrossRefGoogle ScholarPubMed
Wersall, JP, Eklund, G (1998). The decline of smoking among Swedish men. International Journal of Epidemiology 27, 20–26.CrossRefGoogle ScholarPubMed
Wiederman, MW, Pryor, T (1996). Substance use among women with eating disorders. International Journal of Eating Disorders 20, 163–168.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
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