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Smalley Z, Livanou M, Dalton B, Patsalos O, Wilks J, Keeler JL, Treasure J, Schmidt U, Hill G, Himmerich H. Exploring Alcohol-Related Behaviours in an Adult Sample with Anorexia Nervosa and Those in Recovery. Nutrients 2024; 16:732. [PMID: 38474860 DOI: 10.3390/nu16050732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/13/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
While individuals with Bulimia Nervosa (BN) and Binge Eating Disorder (BED) often present with a higher rate of Alcohol Use Disorder (AUD) than the general population, it is unclear whether this extends to AN. This cross-sectional study examined differences in alcohol-related behaviours, measured using the Alcohol Use Identification Test (AUDIT), between AN participants (n = 58), recovered AN (rec-AN) participants (n = 25), and healthy controls (n = 57). Statistical models controlled for age and ethnicity. The relationship between alcohol-related behaviours with ED psychopathology and with depression was also assessed. The findings indicated that acute AN participants were not at greater risk of AUD than healthy controls. However, rec-AN participants displayed greater total audit scores than those with acute AN, and more alcohol-related behaviours than healthy controls. Acute AN participants consumed significantly less alcohol than both the healthy control group and rec-AN group. No associations were found between ED psychopathology and alcohol-related behaviours in the AN group or rec-AN. This highlights alcohol as a potential coping mechanism following AN recovery. Clinicians should consider assessments for AUD and targeted interventions aimed at encouraging healthy coping mechanisms in this group. Future studies should look at alcohol use as a moderating factor for AN recovery.
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Affiliation(s)
- Zara Smalley
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Maria Livanou
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Bethan Dalton
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Olivia Patsalos
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Jessica Wilks
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Johanna Louise Keeler
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BC, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BC, UK
| | - Grace Hill
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BC, UK
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Aouad P, Morad A, Hay P, Soh N, Touyz S, Rhodes P. Chew and Spit (CHSP): An interpretative phenomenological analysis (IPA). Eat Behav 2020; 37:101388. [PMID: 32413733 DOI: 10.1016/j.eatbeh.2020.101388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/15/2022]
Abstract
Chew and Spit (CHSP) is a prevalent disordered eating symptom and has been thought to be associated with a number of adverse effects. In the current study, 18 participants (>90% female, aged between 18 and 51) took part in answering questions about their experiences, struggles, concerns, methods of coping, and personal meaning of CHSP and how it has impacted their lives. Data collection and analysis were conducted in accordance with Interpretative Phenomenological Analysis (IPA) methodology. Findings revealed 7 primary themes of CHSP, which highlighted that CHSP may be: (1) associated with negative emotions - primarily shame; (2) exacerbated by stress and may be a mechanism to help regain control; (3) temporarily provides pleasure; (4) a distraction or form of escapism; (5) a self-soothing or coping mechanism; (6) addictive, ritualistic, and similar to other eating disorders in that it can become part of an individual's self-identity; and (7) adversely impacting psychological, physiological, and social health. Some of the identified superordinate themes were in line with previous studies hypotheses. However, overall the findings indicated that individuals who CHSP are often embroiled in what they may perceive as a struggle, with no specific, efficacious, approach to helping them control the behavior. Future studies should focus on the treatment of CHSP, including treatment of CHSP as a potential primary symptom of pathological eating. Moreover, the perceived implications of engaging in CHSP should be examined more closely, with clinicians screening for the behavior and carefully considering their approach when attempting to treat patients for CHSP.
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Affiliation(s)
- Phillip Aouad
- School of Psychology, University of Sydney, Sydney, Australia; InsideOut Institute, Faculty of Medicine, University of Sydney, Sydney, Australia; School of Medicine, Western Sydney University, Penrith, Australia.
| | - Arshia Morad
- School of Psychology, University of Sydney, Sydney, Australia.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia.
| | - Nerissa Soh
- Honorary Associate, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia.
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia.
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Meule A, Gearhardt AN. Food addiction in the light of DSM-5. Nutrients 2014; 6:3653-71. [PMID: 25230209 PMCID: PMC4179181 DOI: 10.3390/nu6093653] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/21/2014] [Accepted: 08/25/2014] [Indexed: 12/18/2022] Open
Abstract
The idea that specific kind of foods may have an addiction potential and that some forms of overeating may represent an addicted behavior has been discussed for decades. In recent years, the interest in food addiction is growing and research on this topic lead to more precise definitions and assessment methods. For example, the Yale Food Addiction Scale has been developed for the measurement of addiction-like eating behavior based on the diagnostic criteria for substance dependence of the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In 2013, diagnostic criteria for substance abuse and-dependence were merged, thereby increasing the number of symptoms for substance use disorders (SUDs) in the DSM-5. Moreover, gambling disorder is now included along SUDs as a behavioral addiction. Although a plethora of review articles exist that discuss the applicability of the DSM-IV substance dependence criteria to eating behavior, the transferability of the newly added criteria to eating is unknown. Thus, the current article discusses if and how these new criteria may be translated to overeating. Furthermore, it is examined if the new SUD criteria will impact future research on food addiction, for example, if "diagnosing" food addiction should also be adapted by considering all of the new symptoms. Given the critical response to the revisions in DSM-5, we also discuss if the recent approach of Research Domain Criteria can be helpful in evaluating the concept of food addiction.
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Affiliation(s)
- Adrian Meule
- Institute of Psychology, University of Würzburg, Marcusstr. 9-11, Würzburg 97070, Germany.
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI 48109-1043, USA.
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Slane JD, Klump KL, McGue M, Iacono G. Genetic and environmental factors underlying comorbid bulimic behaviours and alcohol use disorders: a moderating role for the dysregulated personality cluster? EUROPEAN EATING DISORDERS REVIEW 2014; 22:159-69. [PMID: 24616026 DOI: 10.1002/erv.2284] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 01/05/2014] [Accepted: 01/06/2014] [Indexed: 11/09/2022]
Abstract
Women with bulimia nervosa (BN) frequently have co-occurring alcohol use disorders (AUDs). Studies of shared genetic transmission of these disorders have been mixed. Personality heterogeneity among individuals with BN may explain discrepant findings. Cluster analysis has characterized women with BN in groups on the basis of personality profiles. One group, the Dysregulated cluster, characterized largely by behavioural disinhibition and emotional dysregulation may be more closely linked etiologically to AUDs. This study examined whether genetic associations between BN and AUDs are the strongest among the Dysregulated cluster. Symptoms of BN and AUDs were assessed in female twins at ages 17 and 25 years from the Minnesota Twin Family Study. Personality clusters were defined using the Multidimensional Personality Questionnaire. Twin moderation models suggested small-to-moderate common genetic transmission between BN and AUDs. However, shared genetic effects did not differ by personality cluster. Findings suggest that personality clusters are unlikely to account for inconsistent findings regarding their shared aetiology.
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Affiliation(s)
- Jennifer D Slane
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; University of Pittsburgh Medical Center, Department of Psychiatry, Pittsburgh, PA, USA
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Gregorowski C, Seedat S, Jordaan GP. A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders. BMC Psychiatry 2013; 13:289. [PMID: 24200300 PMCID: PMC4226257 DOI: 10.1186/1471-244x-13-289] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/31/2013] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Research 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). REVIEW The 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. CONCLUSION Future 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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Affiliation(s)
- Claire Gregorowski
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Gerhard P Jordaan
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
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The relationship between Internet addiction and bulimia in a sample of Chinese college students: depression as partial mediator between Internet addiction and bulimia. Eat Weight Disord 2013; 18:233-43. [PMID: 23760906 DOI: 10.1007/s40519-013-0025-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 06/28/2012] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It has been reported that Internet addiction is associated with substance dependence. Eating disorders have high rates of co-morbidity with substance use disorders. The relationship between Internet addiction and eating disorders was reported in a previous study. AIMS To examine the hypothesis that Internet addiction is closely associated with bulimia. The hypothesis that depression mediates the relationship between Internet addiction and bulimia symptoms was also tested. METHODS 2,036 Chinese college students were assessed on Internet addiction, eating behaviors and depression. Binge eating, compensatory behaviors, weight concern, menarche and weight change were also reported. Multiple regression analysis was used to test the mediating effect of depression. RESULTS Internet addicts showed significantly higher scores on most subscales on EDI-1 than the controls. They reported significantly more binge eating, weight concern and weight change than the controls. Among all of the participants, depression was found to be a partial mediator in the relationship between Internet addiction and bulimia. CONCLUSION This survey provides evidence of the co-morbidity of Internet addiction and bulimia.
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DePierre JA, Puhl RM, Luedicke J. Public perceptions of food addiction: a comparison with alcohol and tobacco. JOURNAL OF SUBSTANCE USE 2013. [DOI: 10.3109/14659891.2012.696771] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Foreyt JP, Goodrick K. Do's and Don't's for Weight Management: Exercise Is Always Good, but Are Some Foods Bad? ACTA ACUST UNITED AC 2012; 2:378-9. [PMID: 16353585 DOI: 10.1002/j.1550-8528.1994.tb00078.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ho V, Arbour S, Hambley JM. Eating Disorders and Addiction: Comparing Eating Disorder Treatment Outcomes Among Clients With and Without Comorbid Substance Use Disorder. J Addict Nurs 2011. [DOI: 10.3109/10884602.2011.585721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Speranza M, Revah-Levy A, Giquel L, Loas G, Venisse JL, Jeammet P, Corcos M. An investigation of Goodman's addictive disorder criteria in eating disorders. EUROPEAN EATING DISORDERS REVIEW 2011; 20:182-9. [PMID: 21834026 DOI: 10.1002/erv.1140] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 05/16/2011] [Accepted: 05/19/2011] [Indexed: 11/09/2022]
Abstract
The aim of this study was to examine how far Goodman's addictive disorder criteria were met by individuals with eating disorders according to subtypes. The study provided a cross-sectional comparison among three samples of eating disorders [restricting anorexia nervosa (R-AN), N = 68; purging anorexia nervosa (P-AN), N = 42; and bulimia nervosa (BN), N = 66], a sample of substance-related disorders (SRDs, N = 48) and a sample of matched controls (N = 201). Diagnosis of addictive disorder was made following Goodman's criteria. Addictive personality traits were assessed with the Addiction Potential Scale of the Minnesota Multiphasic Personality Inventory--2 and with the Zuckerman's Sensation Seeking Scale. Results showed that individuals with BN met Goodman's addictive disorder criteria in the same proportion as drug-addicted individuals (65% vs 60%, p = NS). They both showed higher rates than R-AN individuals (35%; R-AN versus BN: F = 11.9, p < 0.001 and R-AN versus SRD: F = 7.16, p < 0.01). Although BN and SRD showed higher rates of addictive disorders compared with P-AN, differences were not significant. Scores on the Sensation Seeking and on the Addictive Potential scales paralleled the distribution of addictive disorders, with individuals with BN and with P-AN showing higher levels than individuals with R-AN. Results showed that a subgroup of individuals with an eating disorder experiences their disorder as an addiction and may deserve specific therapeutic attention.
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Affiliation(s)
- Mario Speranza
- Centre Hospitalier de Versailles, Service de Pédopsychiatrie, Le Chesnay, France.
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Wilson GT. Eating disorders, obesity and addiction. EUROPEAN EATING DISORDERS REVIEW 2010; 18:341-51. [PMID: 20821736 DOI: 10.1002/erv.1048] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- G Terence Wilson
- Graduate School of Applied and Professional Psychology, Rutgers-the State University of New Jersey, USA.
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Liu Y, von Deneen KM, Kobeissy FH, Gold MS. Food addiction and obesity: evidence from bench to bedside. J Psychoactive Drugs 2010; 42:133-45. [PMID: 20648909 DOI: 10.1080/02791072.2010.10400686] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Obesity has become a major health problem and epidemic. However, much of the current debate has been fractious and etiologies of obesity have been attributed to eating behavior or fast food, personality issues, depression, addiction, or genetics. One of the interesting new hypotheses for epidemic obesity is food addiction, which is associated with both substance-related disorder and eating disorder. Accumulating evidences have shown that there are many shared neural and hormonal pathways as well as distinct differences that may help researchers find why certain individuals overeat and become obese. Functional neuroimaging studies have further revealed that good or great smelling, looking, tasting, and reinforcing food has characteristics similar to that of drugs of abuse. Many of the brain changes reported for hedonic eating and obesity are also seen in various forms of addictions. Most importantly, overeating and obesity may have an acquired drive like drug addiction with respect to motivation and incentive; craving, wanting, and liking occur after early and repeated exposures to stimuli. The acquired drive for great 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.
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Affiliation(s)
- Yijun Liu
- Division of Global Tobacco, Alcohol, Obesity & Health Research, University of Florida, Department of Psychiatry and McKnight Brain Institute, PO Box 100256, Gainesville, FL 32610-0256, USA.
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Sysko R, Hildebrandt T. Cognitive-behavioural therapy for individuals with bulimia nervosa and a co-occurring substance use disorder. EUROPEAN EATING DISORDERS REVIEW 2009; 17:89-100. [PMID: 19130465 DOI: 10.1002/erv.906] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A significant percentage of individuals with bulimia nervosa (BN) also can be diagnosed with a co-occurring substance use disorder (SUD). Although studies have addressed the frequency of overlap between the disorders, etiology and shared personality traits, limited research is available about the treatment of these comorbid patients. Adapting cognitive-behaviour therapy (CBT) to serve as an integrated treatment for patients with both BN and a SUD is a viable option, as studies of CBT suggest that this form of treatment is efficacious for both disorders independently. The shared strategies in CBT for BN and SUDs facilitate the development of a combined treatment for individuals with both disorders with the addition of modules designed to address some common features of these disorders, such as motivation, difficulty with interpersonal relationships, reward sensitivity and impulsivity. Future research should begin to evaluate the efficacy of an integrated CBT in treating individuals with BN and a SUD.
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Affiliation(s)
- Robyn Sysko
- Columbia University, The New York State Psychiatric Institute, New York, NY 10032, USA.
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Inability to Control Eating: Addiction to Food or Normal Response to Abnormal Environment? ACTA ACUST UNITED AC 2008. [DOI: 10.1300/j023v15n01_07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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The Effects of Food on Mood and Behavior: Implications for the Addictions Model of Obesity and Eating Disorders. ACTA ACUST UNITED AC 2008. [DOI: 10.1300/j023v15n01_02] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cassin SE, von Ranson KM. Is binge eating experienced as an addiction? Appetite 2007; 49:687-90. [PMID: 17719677 DOI: 10.1016/j.appet.2007.06.012] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 06/09/2007] [Accepted: 06/12/2007] [Indexed: 10/23/2022]
Abstract
To ascertain to what degree binge eating is experienced as an addiction, this study examined the proportion of women with binge-eating disorder (BED) whose symptoms met criteria for an addiction. Women (N = 79) with current BED completed a structured telephone interview to assess for symptoms of a modified version of DSM-IV substance dependence and Goodman's [(1990). Addiction: Definition and implications. British Journal of Addiction, 85, 1403-1408] proposed diagnosis of 'addictive disorder'. Most binge eaters (92.4%) met modified DSM-IV criteria for substance dependence, whereas many fewer (40.5%) met Goodman's more restrictive criteria for addictive disorder. Women meeting criteria for addictive disorder had more frequent eating binges than those who did not. Despite certain observed similarities between binge eating and addictions, we argue that BED should remain classified as an eating disorder.
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Affiliation(s)
- Stephanie E Cassin
- Department of Psychology, University of Calgary, 2500 University Dr. N.W., Calgary, Alberta, Canada T2N 1N4
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Benjamin L, Wulfert E. Dispositional correlates of addictive behaviors in college women: binge eating and heavy drinking. Eat Behav 2005; 6:197-209. [PMID: 15854866 DOI: 10.1016/j.eatbeh.2003.08.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2003] [Accepted: 08/12/2003] [Indexed: 11/24/2022]
Abstract
Binge eating and alcohol abuse are often conceptualized as addictive behaviors. As these behaviors are relatively common among undergraduate college women, we examined whether common dispositional variables underlie their occurrence. Three hundred and thirty-five undergraduate women completed self-report questionnaires about their eating and alcohol use habits as well as dispositional measures of impulsivity, tolerance of deviance, self-esteem, rejection sensitivity, extraversion-introversion, conscientiousness, and emotional stability. Multiple regression analyses showed that women who either binge eat or abuse alcohol, but not both, have similar dispositional characteristics. Both groups exhibited a high degree of impulsivity and endorsed socially deviant attitudes; thus, both groups could be viewed as "externalizers." In contrast, women who admitted to both addictive behaviors, i.e., binge eating as well as alcohol abuse, were not particularly impulsive or socially deviant, but manifested a high degree of emotional instability ("neuroticism"); thus, these women might be considered "internalizers." The theoretical and clinical implications of these findings are discussed.
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Affiliation(s)
- Lily Benjamin
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY 12222, United States.
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Compulsive Eating and Substance Abuse Factors Among African-American Community College Students. J Ethn Subst Abuse 2004. [DOI: 10.1300/j233v02n04_05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Peñas-Lledó E, Sancho L, Waller G. Eating attitudes and the use of alcohol, tobacco, and exercise among male and female adolescents. Eat Behav 2004; 3:101-11. [PMID: 15001007 DOI: 10.1016/s1471-0153(01)00047-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the differences between male and female adolescents in the associations of disturbed eating attitudes with the use of smoking, alcohol, and exercise. METHOD Nonclinical adolescents-174 males and 157 females-completed the Eating Disorders Inventory (EDI) and a measure of engagement in the use of smoking, alcohol, and exercise. An analysis of variance (ANOVA) was used to determine the impact of Gender x Use of the behaviour upon eating and related attitudes. RESULTS Gender and use of smoking and alcohol were each related to eating attitudes. However, in the case of exercise, there were strong interactions of the behaviour and gender. Women who exercised regularly had higher levels of restriction, body dissatisfaction, and interoceptive awareness, whereas men did not. CONCLUSIONS It appears that men and women exercise for different reasons, in relation to their eating and related attitudes. It is possible that men exercise for positive goals (e.g., fitness), whereas women exercise to escape perceived negative consequences (e.g., weight gain). This is not the case for alcohol and tobacco use. These findings are discussed, and further research is proposed.
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Affiliation(s)
- Eva Peñas-Lledó
- Department of Pharmacology and Psychiatry, Medical School, University of Extremadura, Avenue of Elvas s/n, Badajoz 06071, Extremadura, Spain.
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von Ranson KM, Iacono WG, McGue M. Disordered eating and substance use in an epidemiological sample: I. Associations within individuals. Int J Eat Disord 2002; 31:389-403. [PMID: 11948644 DOI: 10.1002/eat.10050] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined the strength of associations between disordered eating and eating disorders and substance use and substance use disorders (SU/SUDs) in an epidemiological sample. METHODS 672 adolescent girls and 718 women completed structured interviews of lifetime eating disorders and substance use and misuse, as well as self-reported current disordered eating attitudes and behaviors. RESULTS Although effect sizes were small, eating attitudes and disorders were associated modestly with nicotine, alcohol, and drug use, and with nicotine dependence in adolescent girls. Alcohol use and misuse were related to eating attitudes and pathology in women. SU/SUDs were associated with restricting and bulimic behaviors and no prominent differences in associations were observed between substance classes. In contrast to findings in clinical populations, these community-based results were positive but generally weak, suggesting there is no strong, overarching relationship between eating and substance use problems. DISCUSSION These results have implications for the addiction model of eating disorders.
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Abstract
Anorexia nervosa and bulimia nervosa have emerged as the predominant eating disorders. We review the recent research evidence pertaining to the development of these disorders, including sociocultural factors (e.g., media and peer influences), family factors (e.g., enmeshment and criticism), negative affect, low self-esteem, and body dissatisfaction. Also reviewed are cognitive and biological aspects of eating disorders. Some contributory factors appear to be necessary for the appearance of eating disorders, but none is sufficient. Eating disorders may represent a way of coping with problems of identity and personal control.
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Affiliation(s)
- Janet Polivy
- Department of Psychology, University of Toronto, Erindale Campus, Mississauga, Ontario, Canada.
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23
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Pierrehumbert B, Bader M, Miljkovitch R, Mazet P, Amar M, Halfon O. Strategies of emotion regulation in adolescents and young adults with substance dependence or eating disorders. Clin Psychol Psychother 2002. [DOI: 10.1002/cpp.339] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Latner JD, Wilson GT. Cognitive-behavioral therapy and nutritional counseling in the treatment of bulimia nervosa and binge eating. Eat Behav 2000; 1:3-21. [PMID: 15001063 DOI: 10.1016/s1471-0153(00)00008-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The goals of manual-based cognitive-behavioral therapy (CBT) and nutritional counseling for eating disorders are similar, namely, eliminating dysfunctional patterns of eating. Modifying these behaviors requires specific therapeutic expertise in the principles and procedures of behavior change that is not typically part of the training of nutritionists and dieticians or mental health professionals without specific expertise. We discuss ways in which principles of behavior change can be applied to eating disorders by non-CBT experts. Specific nutritional rehabilitation programs have the potential to augment CBT in addressing the array of appetitive abnormalities present in eating disorder patients. The dysfunctional appetitive, hedonic, and metabolic characteristics of patients with bulimia nervosa (BN) and binge eating disorder are reviewed. These abnormalities constitute potential target areas that might be more fully addressed by nutritional interventions designed to restore normal appetitive function.
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Affiliation(s)
- J D Latner
- Graduate School of Applied Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Road, Piscataway, NJ 08854-8085, USA
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25
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Abstract
OBJECTIVE This study examines the relationship between binge eating and substance use behaviors and attitudes in adolescents and explores gender differences and mental health correlates. METHOD The data are derived from the 1997 Ontario Student Drug Use Survey of public and Catholic school students. A weighted sample of 1,031 girls and 888 boys was categorized as nonbingers, past bingers, and noncompensating or compensating binge eaters. RESULTS Binge eaters, particularly those who compensated, were more likely to use all types of substances, particularly cannabis and drugs other than tobacco and alcohol. Binge eating was associated with more problematic and heavier substance use and with lowered self-esteem and more depression. Female bingers were more likely to report compensatory behaviors than male students but gender differences in the relationship between binge eating and substance use were few. DISCUSSION Adolescent binge eaters who engage in compensatory behaviors may be an appropriate target group for preventive programs in high schools.
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Affiliation(s)
- H E Ross
- Addiction Research Foundation Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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26
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Abstract
A number of theories have been proposed to explain the substantial comorbidity between the eating disorders and the substance-related disorders. Among them is the claim that self-starvation--exacerbated by excessive exercising--is itself an addiction to the body's endogenous opioids. While efforts have also been made to identify an "addictive personality," attempts to establish whether eating-disordered patients share these characteristics have met with mixed success. The present study was designed to determine the degree to which anorexic and bulimic patients display addictive personality characteristics, and whether these traits are useful in predicting the severity of the patient's weight preoccupation and their degree of excessive exercising. Results confirmed that both anorexic and bulimic patients had high scores on the Addiction Scale of the Eysenck Personality Questionnaire, and that addictiveness and obsessive-compulsiveness were related simultaneously to weight preoccupation and excessive exercising in both patient groups. Findings are discussed within the framework of the auto-addiction opioid theory, and they highlight the similarities and differences in the personality structure of the eating-disorder subtypes.
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Affiliation(s)
- C Davis
- Graduate Programme in Exercise and Health Science, York University, Toronto, Canada
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27
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Abstract
In the present article, a learning model of binge eating is presented. It has been hypothesized that, parallel to drug intake, the craving and excessive food intake of binge eaters is cue controlled. Research in support of the model is reviewed and a series of predictions about clinical and non-clinical issues is derived from the model. Amongst other things, the model predicts that binge eating might be successfully treated with cue exposure and response prevention. Practical issues are discussed and preliminary pilot studies on cue exposure for bingers are reviewed.
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Affiliation(s)
- A Jansen
- Universiteit Maastricht, Department of Psychology, The Netherlands.
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28
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Gendall KA, Sullivan PF, Joyce PR, Fear JL, Bulik CM. Psychopathology and personality of young women who experience food cravings. Addict Behav 1997; 22:545-55. [PMID: 9290863 DOI: 10.1016/s0306-4603(96)00060-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The objective of the present study was to investigate the psychopathology and personality characteristics of women who experience food cravings. A total of 101 young women selected at random from the community completed the Diagnostic Interview for Genetic Studies with a trained interviewer. The interview included a section about food-craving experiences and associated factors. Subjects also completed a self-report questionnaire booklet containing the Temperament and Character Inventory (TCI) and the Eating Disorder Inventory (EDI). Compared to noncravers, women who reported food cravings were significantly more likely to report a history of alcohol abuse/dependence (p = .003), significant weight changes (p = .003), and to have undertaken dieting (p = .02), bingeing (p = .05), vomiting (p = .02), exercise (p = .04), diet pill (p = .03), and laxative use (p = .01) to control weight. There was a trend for the cravers to have higher novelty-seeking scores on the TCI (p = .06). Our findings suggest that women who experience food cravings are more likely to have met criteria for alcohol abuse/dependence and tend to have temperament characterized by higher levels of novelty seeking. In addition the high rates of eating-disorder symptomatology implies overconcern with body weight and shape in the women who experienced food cravings.
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Affiliation(s)
- K A Gendall
- University Department of Psychological Medicine, Christchurch School of Medicine, New Zealand
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29
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Kaye WH. Persistent alterations in behavior and serotonin activity after recovery from anorexia and bulimia nervosa. Ann N Y Acad Sci 1997; 817:162-78. [PMID: 9239186 DOI: 10.1111/j.1749-6632.1997.tb48204.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- W H Kaye
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
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30
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Welch SL, Fairburn CG. Impulsivity or comorbidity in bulimia nervosa. A controlled study of deliberate self-harm and alcohol and drug misuse in a community sample. Br J Psychiatry 1996; 169:451-8. [PMID: 8894196 DOI: 10.1192/bjp.169.4.451] [Citation(s) in RCA: 131] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies showing high rates of alcohol and drug misuse and deliberate self-harm in bulimia nervosa have led some authors to call for a distinct diagnostic subgroup, sometimes termed "multi-impulsive bulimia". However, these studies have been uncontrolled and of clinic samples and may be subject to sampling bias. METHOD One hundred and two women with DSM-III-R bulimia nervosa were compared with 204 normal controls and 102 controls with other psychiatric disorders, all recruited from the same community sample. Interview measures were used for diagnosis and for the assessment of alcohol and drug misuse and deliberate self-harm. RESULTS Bulimia nervosa cases did not differ from either of the control groups in terms of current alcohol consumption. Bulimia nervosa cases used more illicit drugs than either control group, but loss of control over drug use was very uncommon. Bulimia nervosa cases had a higher rate of deliberate self-harm than the controls. Only six (6%) bulimia nervosa cases had two or more of these behaviours concurrently. CONCLUSION Sampling bias is present in clinic-based studies of comorbidity in bulimia nervosa. Those with comorbid substance misuse and deliberate self-harm are probably heterogeneous in character, and their classification as a subgroup would therefore be premature.
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Affiliation(s)
- S L Welch
- Addiction Research Unit, Institute of Psychiatry, London
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31
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Kaye WH, Lilenfeld LR, Plotnicov K, Merikangas KR, Nagy L, Strober M, Bulik CM, Moss H, Greeno CG. Bulimia nervosa and substance dependence: association and family transmission. Alcohol Clin Exp Res 1996; 20:878-81. [PMID: 8865963 DOI: 10.1111/j.1530-0277.1996.tb05266.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Alcohol and drug use disorders are common among women with bulimia nervosa (BN) and their family members. However, it is not known whether there is a familial relationship between BN and substance use disorders. We compared 47 women with BN and 44 non-eating-disordered community control women, and their first-degree relatives (177 and 190, respectively). BN probands were stratified by the presence (43%) or absence (57%) of lifetime alcohol and/or drug dependence. The first-degree relatives of substance-dependent BN probands had significantly higher lifetime rates of alcohol/drug dependence (38%), compared with relatives of nonsubstance-dependent BN probands (10%) or relatives of community controls (18%). These data suggest that BN and substance dependence are transmitted independently in families.
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Affiliation(s)
- W H Kaye
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA
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32
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Abstract
OBJECTIVE To describe the rationale and use of a new procedure aimed at bringing binge/purge behavior directly under therapeutic control via the use of planned binges. METHOD Research investigating the specific effects of the various cognitive and behavioral components of the standard cognitive-behavioral treatment (CBT) approach for bulimia nervosa is examined in combination with comprehensive reviews of the treatment outcome literature. RESULTS These reviews suggest that while treatment has largely been effective at reducing binge-purge frequencies, it does not result in the elimination of the presenting problem for a significant proportion of participants. Evidence is presented to suggest that this may be accounted for by cognitive-behavioral approaches employing indirect procedures to bring the disordered patterns of eating under control. The application of the planned binge approach is illustrated by two cases treated at the University of New South Wales Post Graduate Psychology Clinic. DISCUSSION These cases in combination with the analysis of the potential deficits of the standard behavioral procedures employed in CBT provide tentative support for the use of planned binges as an addition to the strategies currently used in the treatment of binge and purge behavior. In conclusion the paper explores some of the ethical implications raised by asking subjects to engage in their problematic behavior.
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Affiliation(s)
- Z P Steel
- Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Liverpool Hospital, Australia
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33
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Abstract
During the last 10 yr, evidence has accumulated which indicates that the eating disorders of bulimia and anorexia nervosa (BN and AN) may be differentially affected by pharmacological treatment. Although the efficacy of drug treatment alone (relative to nonpharmacological approaches) has been debated, there is support for the generalization that all types of antidepressant medications have proven efficacious for bulimia but not for anorexia. These clinical observations are consistent with an extensive body of research concerning the regulation of ingestion, which indicates that the neurotransmitter serotonin plays an important role in mediating satiety. Such considerations have led to the "serotonin-hypothesis of bulimia," which postulates that BN represents an underlying "hyposerotonergic" condition and, conversely, that AN represents a "hyperserotonergic" state. Recently, however, two independent studies have shown that the antidepressant fluoxetine, which selectively blocks the synaptic re-uptake of serotonin, provided significant therapeutic benefit for anorexic patients. The implications of these apparently anomalous results for the "serotonin-hypothesis of BN" are discussed in an attempt to gain insight into the present pharmacotherapy of the eating disorders.
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Affiliation(s)
- C Advokat
- Department of Psychology, Louisiana State University, Baton Rouge 70803, USA
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34
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Varner LM. Dual diagnosis: patients with eating and substance-related disorders. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1995; 95:224-5. [PMID: 7852690 DOI: 10.1016/s0002-8223(95)00052-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- L M Varner
- Department of Psychology, Virginia Tech University, Blacksburg 24061
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35
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36
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Abstract
Research on the relationship between problem drinking and disordered eating in adolescent girls has produced conflicting results. This study examines this relationship using a state-of-the-art inventory for measuring eating disorder symptoms and a standardized inventory for detecting problem drinking among adolescents. Two hundred thirty-four female high school students (mean age = 15.5 years) completed the Adolescent Drinking Index and the Eating Disorder Examination Questionnaire. Girls diagnosed with an eating disorder were twice as likely to be problem drinkers than girls who were not diagnosed with an eating disorder. Regression analysis and comparisons of problem drinkers and non-problem drinkers point to the central role of body image concerns and dieting in the association of alcoholism and disordered eating among adolescent girls. Prospective studies are needed to explore the mechanisms underlying the links between drive for thinness and problem drinking.
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Affiliation(s)
- R H Striegel-Moore
- Department of Psychology, Wesleyan University, Middletown, CT 06459-0408
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37
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Abstract
Obese patients entering a weight control program were classified as binge eaters if they reported uncontrolled consumption of what others would regard as an unusually large amount of food at least once a week for the previous month. Binge eaters differed significantly from nonbingers across a broad range of eating and weight-related characteristics assessed using a self-report version of the Eating Disorder Examination. Attitudinal differences were marked. The results provided no support for the view that obese binge eaters have a pattern of general "addictiveness" to psychoactive substances or other activities.
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Affiliation(s)
- G T Wilson
- Rutgers University, Piscataway, NJ 08854
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38
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Strasser TJ, Pike KM, Walsh BT. The impact of prior substance abuse on treatment outcome for bulimia nervosa. Addict Behav 1992; 17:387-95. [PMID: 1502972 DOI: 10.1016/0306-4603(92)90044-v] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The present investigation examined the significance of a past history of substance abuse on treatment outcome for bulimia nervosa. Seventy-five women with bulimia nervosa participated in a 6-week double-blind outpatient trial of desipramine; 19 patients had a history of substance abuse and 56 did not. Although patients with a history of substance abuse reported higher levels of anxiety and depression at presentation for treatment than patients without such histories, the two groups reported a similar age of onset of their bulimia nervosa and similar severity of eating pathology with regards to binge and vomit frequencies and measures of concern about body shape and weight. On all outcome measures, the improvement of the substance abuse group was equal to or greater than that in the group without a history of substance abuse. Results suggest that a past history of substance abuse has no implication regarding response to pharmacological treatment for bulimia nervosa.
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Affiliation(s)
- T J Strasser
- Columbia University, College of Physicians and Surgeons, New York, NY 10032
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39
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Jansen A, Broekmate J, Heymans M. Cue-exposure vs self-control in the treatment of binge eating: a pilot study. Behav Res Ther 1992; 30:235-41. [PMID: 1586360 DOI: 10.1016/0005-7967(92)90069-s] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
From a recent theory on the learned nature of craving responses and binge eating, it follows that craving will extinguish when the CS-US bond is broken by prolonged exposure to the cues predicting excessive food intake with response prevention. The present authors treated six obese bulimics with cue exposure and response prevention. Six other patients learned to avoid or escape the binge-related cues with the aid of self control techniques. Although both treatments appeared to be effective in reducing the binge frequency, a most remarkable finding of the present study is that all patients treated by cue exposure were abstinent, directly after treatment and during the 1 yr follow-up. In contrast to the 100% binge-free subjects treated by cue exposure, self control techniques and relapse prevention led to abstinence in merely 33% of the subjects.
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Affiliation(s)
- A Jansen
- Department of Mental Health Sciences, Limburg University, Maastricht, The Netherlands
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40
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Kassel JD, Shiffman S. What can hunger teach us about drug craving? A comparative analysis of the two constructs. ACTA ACUST UNITED AC 1992. [DOI: 10.1016/0146-6402(92)90006-a] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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