Risk factors for eating dis orders and substance abuse are strikingly similar.
By Russell Marx, M.D. Princeton HealthCare System
Earlier this year we saw a flurry of news reports about an increasing trend among college women to skip meals and save calories so they can drink alcohol without worrying about gaining weight.
Alarm bells went off and many parents began questioning their daughters about this dangerous combination of binge drinking and self-starvation. Whether to classify this behavior as an eating disorder remains up for debate. What is certain, however, is that eating disorders and substance abuse are often linked.
Consider these statistics from a groundbreaking study released in 2003 by The National Center on Addiction and Substance Abuse at Columbia University:
• Individuals with eating disorders are up to five times more likely to abuse alcohol or illicit drugs.
• Those who abuse alcohol or illicit drugs are up to 11 times more likely to have eating disorders.
• Eating disorders occur in 5 to 10 million Americans, mostly girls and young women.
Moreover, a new report released last month found that substance abuse is higher among women with bulimia nervosa than in women with other eating disorders and women in the general population.
Bulimia nervosa is characterized by a cycle of bingeing and purging. People with bulimia tend to feel a loss of control over their eating habits and consume large amounts of food in a short period of time. This binge is often followed by feelings of guilt that cause the individual to purge, whether by self-induced vomiting, laxative or diuretic abuse, fasting and obsessive or compulsive exercise.
Like people with anorexia nervosa, those with bulimia have an extreme concern with their body weight and size.
Anorexia, however, is a disorder of self-starvation in which individuals restrict their food intake and are obsessed with controlling their eating. Given the restrictive nature of anorexia, people with the disorder tend to avoid alcohol and its high calories altogether, but they may abuse other substances, such as cocaine, to help avoid gaining weight.
People with eating disorders may also abuse caffeine, tobacco, amphetamines, heroin and over- the-counter medications, such as diuretics, emetics or laxatives, to suppress appetite, increase metabolism and purge themselves, according to the study by The National Center on Addiction and Substance Abuse.
The study also determined that risk factors for eating disorders and substance abuse are strikingly similar. Both share a common brain chemistry and family history; both emerge in times of stress or transition, and both are more likely to develop in people with low self-esteem, depression, anxiety, or a history of physical or sexual abuse. Additionally, both may be influenced by a family history of substance abuse or poor dieting behaviors, social pressures and the media’s portrayal that “thin is in.”
Women with bulimia are especially prone to substance abuse because they tend to have more impulsive personalities, in general. In addition to abusing substances, women with bulimia may also be frequent gamblers or habitual shoplifters. They may be more promiscuous and self-destructive. Many people with bulimia also have a history of trauma.
The health consequences of eating disorders and substance abuse are devastating and potentially life- threatening.
Bulimia and anorexia can cause electrolyte imbalances due to dehydration that lead to irregular heartbeats and possible heart and/or kidney failure and death. People with bulimia may also experience tooth decay and staining caused by stomach acids released during vomiting, and may damage the esophagus from frequent vomiting. Individuals with anorexia may have dry hair and skin and may experience muscle loss, fatigue and weakness.
The signs of bulimia and anorexia are often obvious, although many people tend to miss them, so it’s important to be aware of them.
Signs may include:
• Severe weight loss.
• Preoccupation with being thin or an intense fear of being overweight.
• Severe diets or odd behaviors about food.
• Depression.
• Loss of menstrual periods.
• Hyperactivity, compulsive exercising.
• Low body temperature — the person wears layers and layers of clothing because he or she can’t get warm.
• Dental damage, due to vomiting.
• Unusual odors.
• Frequent trips to the bathroom during meals.
• Excessive food bills.
• Hidden food wrappers.
If you have an eating disorder — whether coupled with substance abuse, or not — or know someone who does, the time to get help is now. The longer the disorder persists, the harder it is for people to recover.
Treatment for eating disorders generally includes a range of therapies that address the various components of the complex condition, from the medical to the emotional. If a person is also struggling with alcohol or drugs, it is critical they also seek help for their substance abuse in order to make a full recovery. In severe cases, hospitalization may be necessary.
The first step in any case, however, is to acknowledge the problem and contact a physician who can help return the patient to a normal life.
The Eating Disorders Program at University Medical Center at Princeton provides comprehensive treatment for adults, adolescents and children who are suffering from anorexia, bulimia and other eating disorders. To learn more about the program or to schedule an appointment for an evaluation with a physician, call the intake coordinator at 609-497-4490 or 877-932 -8935. All inquiries are confidential.
Dr. Russell Marx is a board-certified psychiatrist and medical director of the Eating Disorders Program at University Medical Center at Princeton. He also is the author of the book “It’s Not Your Fault: Overcoming Anorexia and Bulimia.”