Bulimia and alcohol addiction

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Bulimia nervosa (BN) is an eating disorder associated with multiple negative health outcomes, including esophageal problems, irritable bowel syndrome, gastroesophageal reflux disease, dental problems, and irregular heart rhythms. (1) In addition to these physical health conditions, BN is linked to co-occurring mental health disorders. (2) Co-occurring bulimia nervosa and alcohol addiction are particularly common. In this article, we will be discussing the prevalence of bulimia nervosa and alcohol addiction, as well as some possible reasons for this co-occurrence.

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Statistics on bulimia and alcohol addiction 

There is a high overlap between bulimia and alcohol addiction. According to the available research, around 46% of people with bulimia nervosa have an alcohol use disorder, which is the clinical term for an alcohol addiction, at some point during their lives. (2)

Earlier research has shown that alcohol use disorders are more common among people with bulimia nervosa when compared to individuals diagnosed with anorexia nervosa (AN). For the majority of people, the development of the eating disorder occurs prior to the development of an alcohol use disorder. (3)

Why the overlap?

Statistics have established that alcohol use disorders are prevalent among people with bulimia nervosa, and research into this matter provides some insight into the overlap between bulimia nervosa and alcohol addiction. One study found that there seem to be overlapping symptoms that occur with both bulimia nervosa and alcohol misuse. (4)

For example, binge drinking was found to be common to bulimia nervosa and alcohol misuse. Furthermore, guilt about drinking and feelings of body dissatisfaction also tended to occur together, and study authors concluded that underlying shame likely contributes to both of these symptoms. Based upon the findings of this study, it was concluded that there are thinking patterns that are common to both bulimia nervosa and alcohol addiction. In addition, drinking and eating disorder behaviors can both serve as an unhealthy way of coping. (4)

Additional research has found that individuals who live with both bulimia nervosa and an alcohol use disorder often have anxious, perfectionistic, and impulsive personality traits. (3) It is possible that these traits can contribute to both bulimia nervosa and alcohol addiction. There is also evidence that depression among individuals with bulimia nervosa can increase the risk of an alcohol use disorder. Finally, history of trauma from physical or sexual abuse can increase the risk of bulimia nervosa, as well as the risk of alcohol addiction. (2)

Based upon the total body of research, it appears that bulimia nervosa and alcohol addiction may occur together because of risk factors that contribute to the development of both conditions. For instance, underlying mental health conditions can lead to coping through alcohol misuse and eating disorder behaviors. Harmful thinking patterns, such as those surrounding shame and perfectionism, can also lead to the development of both bulimia nervosa and alcohol addiction. 

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Treating co-occurring bulimia nervosa and alcohol addiction 

Patients who live with both bulimia nervosa and alcohol addiction can recover with treatment. When selecting a treatment program, it is important to choose one that addresses both conditions. If an eating disorder is untreated, a person may return to alcohol misuse in order to cope, and vice versa. When people have co-occurring conditions like bulimia nervosa and an alcohol use disorder, the conditions are often treated with a combination of medication and therapy, with treatment plans individualized to meet a patient’s unique needs. (5)

Some specific therapies have been found to be beneficial for treating co-occurring disorders. For instance, cognitive behavioral therapy (CBT) has been shown to help people to change irrational thinking patterns, and it can allow them to alter their unhealthy beliefs pertaining to body image and alcohol consumption. Another form of therapy called dialectical behavior therapy (DBT) can also be beneficial, as it teaches skills for managing emotions and reducing self-destructive behaviors like substance misuse and self-harm. (5)

While recovering from both bulimia nervosa and alcohol addiction may feel incredibly daunting, help is available and it is never too late to start the healing process.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Jain, A., & Yilani, M. (2020). Bulimia nervosa. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK562178/
  2. Patel, R.S., Olten, B., Patel, P., Shah, K., & Mansuri, Z. (2018). Hospitalization outcomes and comorbidities of bulimia nervosa: A nationwide inpatient study. Cureus, 10(5), e2583. https://doi.org/10.7759/cureus.2583
  3. Bulik, C.M., Klump, K.L., Thornton, L., Kaplan, A.S., Devlin, B., Fichter, M.M., Halmi, K.A., Strober, M., Woodside, B.D., Crow, S., Mitchell, J.E., Rotondo, A., Mauri, M., Cassano, G.B., Keel, P.K., Berrettini, W.H., Kaye, W.H. (2004). The Journal of Clinical Psychiatry, 65(7), 1000-1006. https://doi.org/10.4088/jcp.v65n0718
  4. Cusack, C.E., Christian, C., Drake, J.E., & Levinson, C.A. (2021). A network analysis of eating disorder symptoms and co-occurring alcohol misuse among heterosexual and sexual minority college women. Addictive Behaviors, 118. https://doi.org/10.1016/j.addbeh.2021.106867
  5. National Institute of Mental Health. (2021, March). Substance use and co-occurring mental disorders. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health

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