Anorexia nervosa (AN) and bulimia nervosa (BN) are prevalent disorders in adolescent and adult women and are associated with high rates of morbidity and mortality. Substance use disorders (SUDs) often co-occur with eating disorders (EDs); however, the development of comorbidity and the relationship between the disorders have not been adequately described. Using a unique data set gathered from a longitudinal study of EDs, this proposal seeks to examine the co-occurrence of SUDs with AN and BN through a series of secondary analyses.
The aims of this study are to describe the influence of SUDs in women with EDs by evaluating their impact on ED course and outcome. We will examine differences between women with and without SUDs in ED symptomatology, rates of ED recovery and relapse, comorbid psychopathology, suicidality, treatment participation and psychosocial functioning. Additionally, potential predictors of onset, recovery, relapse and suicidality will be examined. [Lastly, the interaction between SUDs and specific covariates -- including MDD, markers of impulsivity, and life events -- will be described, and the mediating effects of these covariates on time to relapse and recovery will be examined.] Data were gathered on 246 women recruited into the Longitudinal Study of Anorexia and Bulimia Nervosa. Weekly assessments of ED symptoms, comorbid psychopathology, and treatment participation, as well as monthly ratings of psychosocial functioning were collected. A median of 9 years of data have been gathered, and the attrition rate is a low 7%. RDC diagnoses of alcoholism (ALC) and DUDs were used. DUDs were categorized into 3 groups: marijuana, stimulants, and other. DUD and ALC were found in 31 (13%) and 42 (17%) participants at intake, respectively. Ten new onset cases of DUD and 24 new onsets of ALC brought lifetime histories of DUD and ALC to 41 (17%) and 66 (27%), respectively, over the course of follow-up. To date, 11 women have died (10 AN, 1 BN). Controlling for age and duration of ED episode at intake in AN, presence of an SUD during the course of the study was significantly associated with increased hazard of death, (DUD: LRT=4.96, df=l, p=.026; ALC: LRT=ll.0, df=l, p=.0009). Findings from this project will increase our understanding of the longitudinal sequence of comorbidity between EDs and SUDs. They will also create a framework for the evaluation of current treatment efforts, assist in the design of future treatment studies, and provide clinicians, researchers and patients with important clinical information about comorbid SUDs and EDs.
| Thompson-Brenner, Heather; Eddy, Kamryn T; Franko, Debra L et al. (2008) A personality classification system for eating disorders: a longitudinal study. Compr Psychiatry 49:551-60 |
| Thompson-Brenner, Heather; Eddy, Kamryn T; Franko, Debra L et al. (2008) Personality pathology and substance abuse in eating disorders: a longitudinal study. Int J Eat Disord 41:203-8 |
| Herzog, David B; Franko, Debra L; Dorer, David J et al. (2006) Drug abuse in women with eating disorders. Int J Eat Disord 39:364-8 |
