Eating disorders and substance abuse occur together more often than some might think. Research, summarized in a report from Psychiatric Clinics of North America, indicates that lifetime eating disorders occurred with substance use disorders in up to 40% of women. While men are less likely to have eating disorders, those who do are also likely to have a high risk of substance abuse.
Bulimia, an eating disorder that involves bingeing and purging behaviors, is no exception to this rule. As with any co-occurring mental health and substance use disorders, the effects of these conditions, as well as the ability to diagnose and treat them, are adversely affected by having both at the same time. However, being aware of the challenges of treating bulimia and substance abuse together is the first step in finding help to recover from both disorders.
What Is Bulimia?
Bulimia is defined by the Diagnostic and Statistical Manual of Mental Disorders as a condition in which a person binges on food – meaning that the person overeats to the point of discomfort in a short period of time – and then uses extreme means to purge what has been eaten in order to avoid weight gain. This purge may be achieved by inducing vomiting or by using laxatives or diuretics. The person may also fast or engage in extreme amounts of exercise to try to avoid the weight gain expected after a binge.
The person generally feels a lack of control over the binge episodes but is extremely averse to weight gain. Unlike those with anorexia, people with bulimia are generally at a normal weight or slightly overweight, and they are extremely unhappy with their body and appearance. Bingeing often takes place in secret because the person is ashamed of the inability to control the eating behavior.
Signs of Bulimia
According to the National Institute of Mental Health, signs that someone might be struggling with bulimia include:
- Severe dehydration and electrolyte imbalance
- Inflamed throat and swollen salivary glands in the neck and face
- Sensitive teeth and worn tooth enamel due to stomach acid
- Stomach and intestinal upset from laxative use
- Preoccupation with food
- Calorie restriction or avoiding particular foods between binges
People with bulimia might also become secretive about eating when they binge, and they may keep a food stash hidden that they can access when the urge to binge arises.
Bulimia and Substance Abuse
According to research from the Substance Abuse and Mental Health Services Administration, women who develop binge eating disorder or a substance use disorder are at least four times more likely to develop the other disorder.
In addition, research shows that people who start dieting before puberty, or who diet regularly, are more likely to start or increase use of drugs, cigarettes, or alcohol. One study from the Journal of Substance Abuse found that girls who diet starting as early as 6th grade are more likely to start using alcohol by 9th grade than those who have other risk factors, such as peer approval of alcohol use.
This early start can lead to a strong connection between substance abuse and bulimia, specifically. A study from Psychiatric Times showed that 31% of women with bulimia had a co-occurring alcohol use disorder, while less than 22% of women without an eating disorder reported alcohol abuse.
Recognizing Co-occurring Substance Abuse and Bulimia
As mentioned above, it may sometimes be hard to tell when someone is exhibiting signs of bulimia and substance abuse, because the person tends to hide the behaviors out of shame or guilt. However, it may be possible to tell that someone is dealing with both disorders if the above bulimia signs are accompanied by the signs of substance abuse, which include:
- Continued focus on drug- or alcohol-seeking behaviors
- Avoiding activities that used to be enjoyed
- Problems with daily responsibilities
- Trouble with important relationships, but making no effort to resolve them
- Continuing substance use even if it has negative effects
Depending on the drug of abuse, other signs may be prevalent. For example, the article in Biological Psychiatry states that women who have bulimia are even more likely than women with anorexia to engage in amphetamine use, which can result in rapid or excessive weight loss, tooth and gum problems, and skin damage, such as cuts and scratches that won’t heal.
Common Drugs of Abuse for People with Bulimia
A study in Addictive Behaviors indicates that there are some specific correlations between the type of eating disorder and the drugs of abuse. In this research, women with bingeing behaviors were more likely than others to have higher rates of alcoholism, for example. Women with bingeing and dieting behaviors were more likely to use tobacco and abuse prescription medications.
In addition, the article in Biological Psychiatry reported on research showing that women with bulimia are more likely than women with anorexia to use:
- Amphetamines: 18% of women with bulimia reported use vs. 3% of women with anorexia
- Barbiturates: 10% of women with bulimia vs. 2.2% of women with anorexia
- Marijuana: 24.7% of women with bulimia vs. 5.2% of women with anorexia
- Cocaine: 12.5% of women with bulimia vs. 1.5% of women with anorexia
Treatment Options for Bulimia with Substance Abuse
A study in the journal showed that only about 51% of people who enter substance abuse treatment are screened for eating disorders, and only 29% who screen positive are admitted. However, experts recommend that people who have co-occurring disorders are most likely to have positive outcomes if the disorders are treated together using an integrated treatment model. This is particularly important given the degree to which bulimia and substance abuse are correlated.
A study in the journal Psychiatric Services showed that only about 51% of people who enter substance abuse treatment are screened for eating disorders, and only 29% who screen positive are admitted. However, experts recommend that people who have co-occurring disorders are most likely to have positive outcomes if the disorders are treated together using an integrated treatment model. This is particularly important given the degree to which bulimia and substance abuse are correlated.
For this reason, it’s important to screen for eating disorders in those who seek substance abuse treatment. The first step is to find a specialized inpatient treatment facility for substance abuse that has the experience and knowledge to provide research-based therapies to treat co-occurring disorders like bulimia.