Eating Disorders and Alcoholism: Why Do They Often Occur Together?
Growing up in the late 1970’s and early 1980’s, I was about 10 pounds heavier than any of my friends. It doesn’t sound like much, especially in 2016, when nearly one-third of all Americans are considered obese. However, back then, at such a young age, it meant something.
I felt self-conscious about those few pounds. One summer I decided to lose them, and I did.
However, a year or so later, I hit puberty, and it all came back, with a vengeance. I gained about 30 pounds in a very short period of time.
You would think my mother would understand, but she was concerned. She was critical of the weight gain. I set out to lose yet again, although I had not yet finished my growth spurt.
My parents were both heavy drinkers. I grew up in the constant presence of alcohol. The same year I decided to lose weight again, I also had my first beer.
I’m not sure if it was coincidence, or a matter of prophecy, but for whatever reason, I developed both an eating disorder and serious alcohol problem that would affect me for decades.
But what it the connection, really? What are the factors involved that contribute to both of these conditions occuring together?
Both alcoholism and eating disorders often co-occur with each other, as well as other psychiatric, personality, and substance abuse disorders. While this implies there may be shared factors, so far research has not established conclusive links.
What are Eating Disorders?
The most common eating disorders are anorexia nervosa, bulimia and binge-eating disorders.
However, the Diagnostic and Statistical Manual of Mental Disorders (the psychiatrist’s bible) includes a possible diagnosis of non-specified – in other words, something with mixed characteristics or other possible symptoms.
Anorexia is defined as being 15% below normal weight for age and height, a fear of becoming fat, and often a high propensity for body image disorders.
This was me. As an adult I somewhat recovered, but my weight has continued to fluctuate over the years, and dropped to dangerous levels. I still weigh myself almost every day, and suffer from body image issues, as do many women.
Age and Gender
As in my case, the average onset for an eating disorder is adolescence or early adulthood. The peak range for anorexia is 14-18 (mine began at age 13). Women suffer from all forms of eating disorders more often than men.
Co–Occurrence of Eating Disorders and Substance Abuse: The Studies
Research has generally supported high rates of co-occurrence between eating disorders and substance abuse disorders. But across studies, there has been considerable variation, For example, one one review found that bulimia occurred in 8%-41% of substance abuse patients, while anorexia occurred between 2%-10%.
Whether the correlation is high or low, there does, however, seem to be one.
Another study reported that non-specified eating disorders (not full-blown anorexia or bulimia) were significantly more common in persons with substance abuse disorders than without.
In fact, a few studies have examined the specific features of eating disorders present among patients with substance abuse disorders, such as alcoholism.
For example, one study categorized a community-based sample of over 200 young women into the following groups: alcohol dependent, alcohol dependent with anxiety, anxiety disorders, and neither alcohol nor anxiety disorders.
Women with alcohol dependence had significantly higher levels of the behavioral features of eating disorders, and were more likely to meet the criteria for bulimia or a non-specified eating disorder than women without alcohol dependence.
If I had a guess based on my own experience, I would have to say there is a reason fewer full-blown anorexic women suffer from alcoholism – calories.
As an adult, I began to drink more and more, but I was more content at that point to maintain a reasonable weight, rather than an extremely thin frame.
And for most of my adult life, my dieting and body image disorders have, in some manner, been affect by alcoholism.
For one, I have been often known to “drink my dinner”. That is, I am very aware of the calories in alcohol. In an attempt to not gain weight, my abuse has taken over concern for my health. Moreover, I’d rather drink and not eat to maintain my weight.
However, when you are truly anorexic, you have to maintain an unrealistically thin ideal. The high-calorie content in alcohol doesn’t mesh with this philosophy.
With bulimia, or a non-specified eating disorder, this is not necessarily the case. In fact, bulimia (throwing up after meals) actually makes some sense (albeit dysfunction) when paired with alcoholism.
So Are There Common Factors?
Well, so far, research hasn’t been able to consistently come up with any. One potential explanation, however, is that these disorders are both manifestations of a common underlying cause.
For one, these associations often tend to appear in younger persons.
For example, a 1992 study found that among college women, increased severity of dieting and other eating disorder problems were associated with increase use of alcohol, cigarettes, and drug use.
Another study found that pre-adolescent dieting (among 6th graders) predicted future alcohol use. Bingo – at least in my case.
Other studies have also shown that food deprivation can increase use of alcohol and other drugs in lab animals. It was suggest that food deprivation may therefore cause changes in the central nervous system’s reward pathways, leading to an increase in the consumption of substances which reinforce these feelings (such as alcohol).
However, the fact that these problems are associated, does not necessarily indicate a common cause.
Brain Chemistry Studies
Animal studies of brain chemistry have revealed there may be some shared factors because eating disorders and alcohol use.
In addition, brain neurotransmitters, including serotonin, gamma–aminobutyric acid (GABA), and dopamine have been of focus of research across all of these disorders. Indeed, serotonin has been implicated as a means of controlling eating, moods, and impulsivity.
Other research has shown that selective serotonin reuptake inhibitors (SSRIs) have some effectiveness in treating eating disorders.
Again, on a personal note, a few years ago, I was prescribed SSRIs (anti-depressants which manage serotonin levels). I did find that my body image and eating issues subsided quite a bit – in addition to some obsessive-compulsive behaviors.
Family and Genetic Studies
Finally, some research has suggest that people with eating disorders are more likely to have family histories of substance abuse. However, large-scale studies have found that eating disorders and substance abuse disorders do not have the same genetic, family, or environmental risk factors.
For example, a 1996 study revealed that substance dependence only increased in first-degree relatives of women with co-occurring bulimia and substance dependence.
Of a related note, my mother was very weight conscious and did indeed have an alcohol abuse problem. All three of my siblings had substance abuse problems, and my sister has been weight- and body-conscious her whole life.
As a person who has suffered from a host of conditions related to substance abuse, eating disorders, body dysmorphia, obsessive-compulsive disorder, and bipolar disorder, honestly, a lot of what I’ve researched here makes sense to me.
I’ve long wondered how these conditions tend to co-exist, and yet there aren’t many absolute conclusions to be made. Perhaps its all about the perfect storm – brain chemistry, family history, and personal experiences growing up in this crazy world.
~ G. Nathalee Serrels, M.A., Psychology
* Disclaimer: Just Believe Recovery does not treat eating disorders, only substance abuse disorders, such as alcoholism. This article is for informational purposes only.