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Eating Disorders and Alcoholism:

How an addiction to food ultimately leads to thirst

Margaret Gaby

May 4, 2010

 

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BACKGROUND

 

According to MedlinePlus, an elite information site serviced by the U.S. National Library of Medicine and the National Institutes of Health, there are nearly 17.6 millions American adults who have acquired alcoholism or alcohol related problems.  For years researchers have attempted to study possible causes and risk factors of this treatable disease but have still yet to define every risk factor associated with the disease.  Alcohol is a national issue in several countries around the world, but especially in the United States where the drinking age is 21, and underage alcohol consumption is prevalent.  (MedlinePlus, 2010)  Not only has alcoholism become even more prevalent in our society today, but the development of eating disorders has also shown a similar trend.

 

Eating disorders are very complex mental and physical diseases but are treatable. An eating disorder is characterized by “severe disturbances in eating behavior, such as extreme reduction of food intake or extreme overeating, or feelings of extreme distress or concern about body weight or shape”. Anorexia and bulimia nervosas are the two most prevalent and recognized forms of eating disorders.   Eating disorder may encompass a variety of behaviors including restricting, purging, excess exercise, or binging.  Scientific research has still yet to expose the biological, behavioral and social foundations of these illnesses. According to the National Institute of Mental Health, eating disorders are frequently associated with depression as well as substance abuse or anxiety. There is a collection of serious side effects associated with these disorders including osteoporosis, slowed breathing, and lethargy, but it has been noted that physical illnesses are also associated with the development of an eating disorder.  Such side effects may include depression, anxiety, obsessive behavior, substance abuse, cardiovascular and neurological complications, and impaired physical development.  Eating disorders are serious and possibly deadly.  Science has still yet to uncover all of the complications associated with these disorders but it has been explicitly noted that eating disorders may play a significant role in the development of alcoholism.  (National Institute of Mental Health, 2009)

 

Societal pressures have become increasingly demanding of the “skinny” idea.  In consequence, women especially have fell victim to these pressures.  In the workplace, in the home, and in society, women strive for perfection.  Alcoholism, in some cases, is a response to these pressures.  The development of eating disorders usually occurs at younger ages when women are vulnerable to the pressures of peer, family, and the media.  In later years when alcohol plays a more common role, these women tend to be more vulnerable to its abuse.  Although this is still speculative, several studies and study reviews have been performed to research the relationship between eating disorders and the development of alcohol abuse. 

 

LITERATURE REVIEW

 

Multiple studies have been performed to evaluate the possible connection between eating disorders and the development of alcoholism.  In a 1986 study performed by leading researchers at St. George’s Hospital in London, research suggested the connection in young women between the development of alcohol abuse in patients suffering or having suffered eating disorders. This study consisted of three phases.  The first phase identified 20 women who had participated in an alcoholism unit.  The second identified 20 patients of same age who had attended an eating disorders clinic.  These women in both the eating disorders group and the alcohol group posted minimum known weights that were significantly lower and maximum known weights that were significantly greater than the control group.  A control group was also identified during this phase.  Members of the control group had no previous history of an eating disorder.  The last phase analyzed 112 patients attending the same eating disorders clinic to review the connection between alcohol abuse and age.  Data collected showed a “steady rise in the percentage of those judged to have seriously abused alcohol with age”.  The study concluded that 35% of alcoholics had previous major eating disorders.  This conclusion supports the study’s presented observation of connection.  The study also concluded that 50% of bulimics either abused (40%) alcohol or used it to excess (10%).  This data also provided support for the correlation between eating disorders and alcoholism.   Based on the data collected during the study, researchers concluded, “history of an eating disorder should alert physicians to the diagnosis of future alcoholism”.  This study provided a baseline for future studies to elaborate from based on the analysis of this study. The results of this study confirm the connection between bulimia nervosa and alcohol abuse especially in women of younger age.  Based on the data collected during the trials, it appears that eating disorders evolve at a much younger age than alcohol abuse, yet the presence of an eating disorder does show a heightened risk of developing alcoholism.  An interesting find in this study was the dependence of alcohol on weight maintenance.  One patient’s addictive personality flopped between her dependence on alcohol for maintaining her weight and on her bulimia, which was influenced heavily by the amount of alcohol she consumed.  When alcohol free, her bulimia worsened.  When her bulimia improved, her alcohol abuse increased.  These results suggest the influence of addiction on both alcohol and eating disorders.  This may have been a very unique case to study; however, this data does provide very clear evidence of a connection between alcohol and eating disorders abuse.  Although this study is dated, it provides evidence of age connection and disordered connection among women suffering from alcohol abuse.  (Beary et al., 1986)

 

In a more recent review study preformed by the Department of Psychiatry at the Toronto Hospital, researchers found that “bulimia nervosa now represents the most prevalent eating disorder, affecting 1-3% of adolescent and young adult female population”.  In a study performed by Ross et al in 1988, research demonstrated that bulimia and anorexia nervosas were related with higher vulnerability in patients identified with alcohol abuse.  Szmujler and Tantam (1984) compared the “addiction to starvation” in anorexia nervosa patients to alcohol dependence, finding similarities in food abuse to substance abuse.  This study suggests that alcohol in excess, similar to extreme food restriction, can become a “loss of control” behavior that will result in a variety of adverse side effects.  The consequences of alcoholism including dependence, tolerance, and social deprivation also appear in patients suffering from eating disorders.  The study also examines the potential deregulatory side effects of dinking and eating as “consummatory behaviors”.  What this may mean is that these behaviors are done solely for consummation and based on patient observation, it has been noted that the side effects of these behaviors have caused harm to the patient’s health.  This has led scientists to postulate about the possible connection between the two behaviors.  In a controlled study performed by Marcus and Halmi in 1988, 30 females were admitted to a substance misuse unit.  After strict observation and observation, 47% of these women were diagnosed with Anorexia Nervosa or Bulimia nervosa.  Multiple other studies reported similar data including Corrigan et al, 1990 and Hudson et al, 1992.  Goldbloom and colleagues (1992) identified 30% of a group of 70 women reporting problems of alcohol with a greater incidence of eating disorders.  In a study performed by Leon et al in 1979, researchers attempted to identify whether an “addictive personality” was present in eating disordered patients.  The results from this study did find that this type of personality was present in bulimia nervosa patients but was lacking in patients with anorexia nervosa.  Lacey and Moureli (1986) performed a cohort study of 27 women suffering from alcoholism.  Their results showed that 11 of them reported bulimia nervosa and in most often the “eating disorder preceded the alcohol misuse”.  Conclusions of this study point to the connection between bulimia nervosa and alcohol abuse is most prevalent.  This study also suggests future clarifications of this connection based on psychological and biological models, especially their relationship with time.  (Goldbloom, 1993)

 

In a study performed by the Department of Psychiatry at Yale University School of Medicine, research points to the relationship between eating disorders and the development of alcohol abuse.  Both Goldbloom and Wilson studies performed in 1993 support the association between eating disorders and the increased prevalence of alcoholism.   In a 1986 study performed by Beary et al, reports concluded that 35% of alcoholic women admitted to an alcohol unit reported a prior eating disorder. Lacey and Mourelli (1986) performed a similar study in the same year analyzing similar conditions and found that 40% of hospitalized alcoholic women had a past or present eating disorder.  Eating disorders have also been related to other psychological problems besides alcoholism.  In a study performed by Suzuki et al. in 1993, the study recoded higher incidence of depression and personality disorder in women suffering from alcoholism and an eating disorder.  However, this review study does point out the observation that all of the above studies do have limitations.  Clinic-based populations were evaluated rather than community samples and the interviews used to evaluate patients were not properly monitored or standardized using medical procedure.  Yet, the study does still provide viable evidence to point towards a relationship between eating disorders and the development or presence of alcoholism.  In the evaluation of the study performed by Sinha et al. (1996), a study evaluating the association between alcoholism and eating disorders in a community sample compared to samples with and without eating disorders, the data collected revealed that women suffering from an eating disorder condition had increased prevalence of alcoholism.  These same women had relatively higher scores when evaluated using a monitored interview in areas of Food Restraint, Weight Concern, and Shape Concern.  This data indicated an apparent connection between the two behaviors and provided evidence to further study the relationship between theses two behaviors.  In a study performed by Krahn et al. (1992), evidence suggests a relationship between the severity of eating disorders and the abuse of alcohol.  When studying a group of college women, researchers found that an increased severity of dieting was associated with an increased abuse of alcohol, cigarette, and marijuana use.  This same relationship was also noted while examining a group of sixth grade adolescents when compared to ninth grade adolescents.   This study also suggested the relationship between deprivation of food and resulting decreased functioning of the central nervous system.  This in turn could possibly, as the study alludes to, reinforce substance abuse.  The conclusions drawn from these studies do in fact suggest a clear relationship between alcoholism and eating disorders.  However, this review study does also suggest that the need for future studies including closer analysis of the “time course of alcohol and eating symptoms, the range of problems that exist among alcoholic women with eating problems, and better description of the types of services that best meet those problems”.  In conclusion, based on the data collected in these studies, it appears there is a direct relationship between the occurrence of eating disorders and development of alcoholism. The development of an eating disorder, based on the data collected, can heighten the probability of developing alcohol abuse.  (Sinha et Malley, 2000)

 

CONCLUSION

 

The relationship between the development of alcoholism and previous diagnosis of an eating disorder continues to be blurred.  However, there is much evidence that supports this connection.  The unclearness of this relationship is based primarily on the fact that these behaviors are biological and psychological.  Therefore it is difficult to measure an accurate diagnosis of this relationship.  Eating disorders, although more recently they have become better defined, continue to be difficult to diagnose.  Therefore, data may not always represent actual fact.  However, the data drawn from these studies does suggest a connection.  Apparent in the results of these studies, research does suggest that the development of alcoholism is significantly related to the presence or past presence of an eating disorder.  Some studies suggest that this connection may be contributed to the presence of an “addictive personality”, which may be quite true.  Based solely on patient data, it is clear there is a connection between these two behaviors.  More studies should be preformed to further analyze the relationship between these behaviors.  These studies are dated but continue to present viable information.  Eating disorders have been more explicitly defined in recent years.  Therefore, studies with updated classifications of these disorders may provide more viable evidence of a relationship.  However, based on the studies performed in the past years, researchers have found a connection between alcoholism and eating disorders.  


WORKS CITED

1.    Alcohol and Eating Disorders: Implication for Alcohol Treatment and Health Services Research.  Rajita Sinha and Stephanie S. O’Malley. http://www3.interscience.wiley.com/cgi-bin/fulltext/119040356/PDFSTART. Alcohol Clin Exp Res, Vol 24, No 8, 2000: pp 1312–1319. 

2.    Alcohol Misuse and Eating Disorders: Aspects of an association.  David S. Goldbloom, 1993. Alcohol A Alcoholism. Vol 28. No 4. pp 375-381.1993Printed IB Great Britain. http://alcalc.oxfordjournals.org/cgi/reprint/28/4/375?view=long&pmid=8397519.

3.    Alcoholism and Eating Disorders in Women of Fertile Age.  M. D. Beary, M.A., M.R.C. Psych., J. H. Lacey M. Phil. F. R. C. Psych. & Julius Merry, M.D., F.R.C.Psych.  British Journal of Addiction (1986) 81, 685-689

4.    Alcoholism.  Medline Plus.  March 23, 2010. http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm

5.    Eating Disorders.  National Institute of Mental Health; June 12, 2009. U.S. Department of Health and Human Services. NIH Publication No. 07-4901Revised 2007. http://www.nimh.nih.gov/health/publications/eating-disorders/complete-index.shtml.

6.    Goldbloom, D. S., Naranjo, C. A., Bremner, K.E. and Hicks, L. K. Eating disorders and alcohol abuse in women.  1992.  British Journal of Addiction 87, 913-920

 

 

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