Bulimia Nervosa and Substance Use Disorder: Similarities and Differences

Ram, Alpana; Stein, Dan J.; Sofer, Sivan; Kreitler, Shulamith

doi:10.1080/10640260802016803

Cited by 9 publications

(6 citation statements)

References 33 publications

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“…The overall conclusion is that current research indicates separate aetiologies and courses for each disorder [7,23,67]. Given the lack of causal evidence, it may be more appropriate to talk about risk factors for the development of co-occurring ED and SUD and to focus research and clinical efforts on the early identification of individuals at risk for this comorbidity.…”

Section: Reviewmentioning

confidence: 99%

A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders

2013

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IntroductionResearch has shown that eating disorder (ED) patients who abuse substances demonstrate worse ED symptomatology and poorer outcomes than those with EDs alone, including increased general medical complications and psychopathology, longer recovery times, poorer functional outcomes and higher relapse rates. This article provides a broad overview of the prevalence, aetiology, assessment and management of co-morbid EDs and substance use disorders (SUDs).ReviewThe co-occurrence of EDs and SUDs is high. The functional relationship between EDs and SUDs vary within and across ED subtypes, depends on the class of substance, and needs to be carefully assessed for each patient. Substances such as caffeine, tobacco, insulin, thyroid medications, stimulants or over the counter medications (laxatives, diuretics) may be used to aid weight loss and/or provide energy, and alcohol or psychoactive substances could be used for emotional regulation or as part of a pattern of impulsive behaviour. A key message conveyed in the current literature is the importance of screening and assessment for co-morbid SUDs and EDs in patients presenting with either disorder. There is a paucity of treatment studies on the management of co-occurring EDs and SUDs. Overall, the literature indicates that the ED and SUD should be addressed simultaneously using a multi-disciplinary approach. The need for medical stabilization, hospitalization or inpatient treatment needs to be assessed based on general medical and psychiatric considerations. Common features across therapeutic interventions include psycho-education about the aetiological commonalities, risks and sequelae of concurrent ED behaviours and substance abuse, dietary education and planning, cognitive challenging of eating disordered attitudes and beliefs, building of skills and coping mechanisms, addressing obstacles to improvement and the prevention of relapse. Emphasis should be placed on building a collaborative therapeutic relationship and avoiding power struggles. Cognitive behavioural therapy has been frequently used in the treatment of co-morbid EDs and SUDs, however there are no randomized controlled trials. More recently evidence has been found for the efficacy of dialectical behavioural therapy in reducing both ED and substance use behaviours.ConclusionFuture research would benefit from a meta-analysis of the current research in order to better understand the relationships between these two commonly co-occurring disorders.

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Section: Reviewmentioning

confidence: 99%

A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders

2013

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“…Merikangas et al (1998) revealed that in a large six-site study including both Europe and North America, 35% and 45% of individuals with drug dependence met criteria for a mood disorder and anxiety disorder, respectively, and that the number of mood and anxiety disorders was related to drug-dependence severity. Finally, individuals with BN or SUD similarly evidenced higher levels of anxiety and depression in comparison to healthy controls (Ram, Stein, Sofer, & Kreitler, 2008).…”

Section: Introductionmentioning

confidence: 96%

Depression and anxiety: predictors of eating disorder symptoms and substance addiction severity

Shapira

Courbasson

2011

Mental Health and Substance Use

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Depression, anxiety, and low self-esteem are frequently associated with eating and substance use disorders (SUD). Given the high prevalence of concurrent disorders in individuals with eating and substance use problems, it is critical to identify other psychological factors important for consideration in treatment of this population. Individuals (N ¼ 314) seeking treatment for eating disorder (ED) and problematic substance use were administered a self-report questionnaire battery. Regression analyses indicated that depressive (p 5 0.001) and anxiety (p ¼ 0.03) symptoms significantly predicted ED symptom severity. Anxiety (p ¼ 0.01) and self-esteem (p ¼ 0.06; trend) predicted whether or not participants used substances. Greater substance addiction severity was associated with higher anxiety (p ¼ 0.01) and lower self-esteem (p ¼ 0.04). These findings suggest the importance of assessing other mental health problems in individuals with concurrent eating and SUD, and offering strategies to help these individuals cope with depressive and anxiety symptoms, and low self-esteem. Integrated treatment issues are discussed.

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“…The present study has been carried in women as it is a continuation of our study about addictiveness in EDs [18]. Considerable differences are found between male and female substance abusers [26].…”

Section: Discussionmentioning

confidence: 99%

“…Along these lines of reasoning, ED patients have been found to show elevated addictiveness and to resemble SUD patients in major personality traits [4,5,17]. We have therefore used the CO-ED in SUD and ED patients [18], showing that ED patients resemble SUD patients and that both groups are markedly different from non-SUD non-ED controls in many motivational dispositions of the questionnaire. These findings have provided the theoretical background for preparing a modified CO-ED-Q for addictive populations (see Method).…”

Section: Introductionmentioning

confidence: 99%

Cognitive orientation in substance use disorders and chronic cigarette smoking

Stein¹,

Ram²,

Sofer³

et al. 2017

Ment Health Addict Res

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We sought to identify cognitive-motivational dispositions for addictiveness in females with different addictions. For this purpose we assessed 20 women with substance use disorders (SUDs), 19 women who were routinely smoking at least 10 cigarettes daily for several years, and 24 control women. Cognitive-motivational dispositions were assessed with the 108-item Cognitive Orientation of Addictive Tendencies Questionnaire (COAT-Q), that converges to 25 content-related motivational themes and four basic belief types. Anxiety, depression, and addictiveness were also assessed. We found that compared with the controls, the SUD patients scored higher on addictiveness, depression, anxiety, all four COAT-Q-beliefs types, and three COAT-Q-theme clusters: dissociation from the self and from contacts with others, rejecting bad parts of the self, and the coexistent wish and fear of being loved. The chronic smokers scored mostly in-between the SUD patients and controls. These findings suggest that specific cognitive motivational dispositions may orient towards addictive behaviours in SUDs and chronic smoking.

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Bulimia Nervosa and Substance Use Disorder: Similarities and Differences

Cited by 9 publications

References 33 publications

A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders

A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders

Depression and anxiety: predictors of eating disorder symptoms and substance addiction severity

Cognitive orientation in substance use disorders and chronic cigarette smoking

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