Am J Psychiatry 1996; 153:74-82
Copyright © 1996 by American Psychiatric Association
Anorexia nervosa and bulimia nervosa in alcohol-dependent men and women and their relatives
MA Schuckit, JE Tipp, RM Anthenelli, KK Bucholz, VM Hesselbrock and JI Nurnberger Jr
Department of Psychiatry, VA Medical Center, San Diego, CA 92161-2002, USA.
OBJECTIVE: Many of the studies linking anorexia nervosa and bulimia nervosa
to substance use disorders suffer from problems with small samples; some
lack rigorous definitions of the syndromes, and it is difficult to
determine whether eating problems were primarily temporary consequences of
heavy substance use or drugs were temporarily used in an effort to control
appetite. The goal of this study was to evaluate the relationship between
alcohol dependence and eating disorders. METHOD: Structured interviews were
carried out with 2,283 women and 1,982 men as part of the Collaborative
Study on the Genetics of Alcoholism. Data on drug abuse and dependence,
psychiatric disorders, and symptoms of anorexia and bulimia were evaluated
among alcohol- dependent probands, their relatives, comparison probands,
and their relatives. RESULTS: Lifetime rates for anorexia and bulimia were
1.41% and 6.17%, respectively, for the alcohol-dependent women, and bulimia
was observed in 1.35% of the alcoholic men. However, once the impact of
additional primary diagnoses was controlled for, anorexia was seen in only
1.26% of the women with primary alcohol dependence and none of the
alcohol-dependent men; the rates for bulimia were 3.46% and 0.72%,
respectively. There was no evidence of a strong familial crossover between
alcohol dependence and anorexia or bulimia. CONCLUSIONS: While the rate of
anorexia was not elevated in alcoholics after controlling for other
disorders, bulimia did occur at a greater than expected rate. However, both
eating disorders were relatively rare, and much of the association with
alcoholism occurred in the context of additional preexisting or secondary
psychiatric disorders.
