Comorbidity of Alcohol Abuse Disorders and Bulimia

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Co-Morbidity of Bulimia Nervosa (Bulimia) and Alcohol Use Disorders (AUD)


SL Roos

Table of Contents


2.Frequency of Co-Morbidity between Bulimia and AUD4

3.Reasons for the Possible Co-Morbidity of Bulimia and AUD4

3.1.Shared Etiologies4
3.1.1.Personality traits:4
3.1.2.Family History5
3.1.3.Biological Vulnerability5

3.2.Casual Etiology Group6
3.2.1.Self Medication6
3.2.2.Food Deprivation6
3.2.3.Bulimic Behaviours6

4.Treatment for Bulimia and AUD6

4.1.Treatment Approach6

4.2.Specific Treatment Plan7



1. Introduction

“Substance abuse and eating disorders have the highest mortality risks of all mental disorders and half of all clients with eating disorders abuse alcohol or illicit drugs”  (Carbaugh & Sias, 2010, p. 125). Clients with Eating Disorders are already at an increased risk for mortality, so alcohol or drug abuse places additional dangers onto this group. A study by Suzuki, Takeda, and Yoshino (2011) into mortality rates of patients with eating disorders, found the mortality of eating disorder patients with alcoholism were significantly higher than those without.

Eating Disorders (ED) are psychological disorders, characterized by and resulting in severe disturbances in eating behaviors, and can subdivided into Anorexia Nervosa (AN), Bulimia Nervosa (Bulimia), Binge–Eating Disorder (BED), and Eating disorder not otherwise specified (Palme, 2008).

Alcohol Use Disorder (AUD) is a substance abuse disorder, where the individual’s consumption of alcohol is great enough to damage or adversely affect their daily functioning and/or becomes a prerequisite for normal functioning (Gordon, 2008). AUD are subdivided into alcohol abuse and alcohol dependence disorders (Gordon, 2008).

Research into the co-morbidity of AUD and ED suggests AUD occurs more frequently with Bulimia than Anorexia (Kane. 1999). The National Institute on Drug Abuse (2011) defines “co-morbidity, as two or more mental disorders occurring in the same person at the same time, or one after the other.

Bulimia, is where an individual consumes huge quantities of food in a short period (binging) and then to prevent weight gain partakes in either purging (vomiting or taking laxatives) or non-purging (extreme exercising or periods of starvation) behaviors (Eating Disorders and Substance Abuse, 2010).

This purpose of this paper is to examine the prevalence of co-morbidity between Bulimia and AUD, the possible reasons for this co-morbidity, and the recommended treatment options available to clients.

2. Frequency of Co-Morbidity between Bulimia and AUD

Beary, Lacey, and Merry’s (1986) study into Alcoholism and eating disorders in woman found, “Fifty per cent of the bulimics either abused (40%) alcohol or used it to excess (10%)”, (p. 685). Dansky and Brewerton’s 2000 study into Bulimia and AUD co-morbidity, found 31% of bulimic woman suffered from AUD, compared to 9% in the general population. Baker, Mitchell and Neale’s (2010) study into ED and substance use disorders found 24% of the 118 bulimic women interviewed suffered from AUD.

Berry’s et al (1986) also suggests AUD may occur many years after the onset of Bulimia, for example, this study reported, “Alcohol abuse increased with age to 50% by the age of 35 and may be even higher by 40” (p. 685). The above research suggests a high level of co-morbidity between Bulimia and AUD, and suggests clients with bulimia are at a higher risk than the general population for developing AUD’s.

3. Reasons for the Possible Co-Morbidity of Bulimia and AUD

There are a number of different hypotheses explaining the reasons for the co-morbidity between Bulimia and AUD. Wolfe and Maisto (as cited in Carbaugh & Sias, 2010) categorised these hypotheses into (1) Shared etiologies, and (2) Causal etiologies. Etiologies refer to the underlying factors and...
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