The comorbidity of substance use disorders and eating disorders in women: Prevalence, etiology, and treatment
Introduction
Many women with substance use disorders also struggle with eating disorders. Of considerable concern is that both disorders are associated with the highest mortality risks of all psychological disorders (Franko et al., 2005, Harris & Barraclough, 1998). Individually, both disorders present with complex physical, emotional, and social challenges; together, they are a particularly dangerous combination (Franko et al.). Further, when both disorders are present, diseases have worse courses and outcomes (Keel et al., 1999, Pearlstein, 2002).
In the past 20 years, significant research has been done in both the eating disorder (ED) and addiction fields to determine the prevalence of comorbidity. Several theories have been posited to explain the etiology of these co-occurring disorders. However, few investigators have explored treatment options when these disorders present concurrently. The research poses three main questions: (a) how prevalent is the comorbidity of substance use disorders (SUDs) and EDs? (b) what theories exist to explain this comorbidity? and, (c) what are the implications for treatment?
This paper reviews current literature concerning the comorbidity of eating and substance use disorders. After reviewing the major themes in prevalence and etiological research, it is argued that treatment efficacy research should be given the highest priority in this field. Given the high prevalence rates of these comorbid disorders, a specific treatment needs to be developed that targets both disorders simultaneously.
Section snippets
Method
To identify pertinent research, searches were performed on Psych Info and Medline. The key words used were: anorexia nervosa (AN), bulimia nervosa (BN), eating disorders, substance use, substance abuse, chemical use, chemical abuse, chemical dependency, alcohol use disorder (AUD) and drug use disorder (DUD). Articles were eliminated if they addressed only: BN populations, male populations, binge eating disorder (BED), and highly specific populations. Ultimately, 13 articles were selected for
Prevalence
Substance use disorders are reported to occur in women with a lifetime prevalence rate of 18% (Pearlstein, 2002). Exploration of SUD prevalence rates raises several key classification issues. The research covers many degrees of substance abuse, ranging from one-time use to physiological dependence. In addition, researchers often choose to focus on specific substances, such as alcohol or opiates. This review addresses both alcohol use disorders and drug use disorders as they occur in association
Conclusions concerning prevalence, etiology and treatment
Concerning prevalence, individuals with one disorder have increased risk for the other disorder (Bulik et al., 1992, Gilchrist et al., 2007, Peveler & Fairburn, 1990, Wiederman & Pryor, 1996). In fact, women with SUD or an ED were over four times more likely to develop the other disorder than women in the general population not presenting with such disorders (Gadalla & Piran, 2007b). Eating disorder symptomatology appears to be more indicative of SUD than ED type (Wiederman & Pryor). Severity
Role of Funding source
This review was not funded financially by any sources.
Contributors
Harrop conducted literature searches, provided summaries of previous research, and composed the first draft of the manuscript. Marlatt provided background information of previous research and assisted in revision of the document. Both authors contributed to and have approved the final manuscript.
Conflict of Interest
There are no conflicts of interest declared by either author.
Acknowledgements
The authors wish to thank Mike Beck and Jared Harrop who assisted in editing the manuscript.
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