One of my recent blog posts focused on the comorbidity and link between eating disorders and substance use. In this post, I want to specifically focus on the co-occurrence of alcoholism and bulimia.
Research has demonstrated that 34% of individuals with bulimia exhibit abuse or dependence on alcohol, and that those with bulimia are more likely to abuse alcohol than those without eating disorders. In fact, 30 to 35% of women seeking bulimia treatment also exhibit an alcohol use disorder (Hudson, Hiripi, Pope, & Kessler, 2007). Statistics show that women with both bulimia and alcohol dependence have higher rates of anxiety, personality, conduct, and/or other substance use disorders compared to those who do not abuse alcohol.
Signs, Symptoms, and Behavioral Patterns
Someone who exhibits both behaviors of bulimia and alcohol abuse engages in the binging and purging of food and alcohol – that is, they consume excessive amounts of food and alcohol in discrete periods of time, either together or in insolation.
An individual with both disorders may exhibit a severe change in weight due to lack of food consumption or absorption from using compensatory behaviors, alcohol-induced purging, or from excessive drinking. They may engage in restriction of food during the day with heavy drinking at night – an attempt to avoid calories by not eating, and compensating with their calories from alcohol. An individual could also eat during the day but drink excessively until they need to purge. Another pattern is to engage in binge eating while intoxicated, as alcohol tends to reduce inhibitions, followed by purging.
Because of the lack of food/nutrients in the body to absorb alcohol, an individual with bulimia can experience heavy intoxication. Subsequently, this amount of alcohol can induce purging. Not only is purging in itself dangerous, but for someone with bulimia who is not receiving adequate nutrients, purging can bring about intense dehydration and organ complications.
The Dangers of this Combination
The use of bulimic behaviors – binging and compensatory behaviors such as self-induced vomiting, laxative and diuretic abuse, and excessive exercise – have their own inevitable deleterious outcomes on the individual, such as nutritional deficiencies, cardiac, gastrointestinal, and menstrual complications, and psychological implications. Moreover, engaging in frequent and heavy consumption of alcohol produces similar harmful consequences, including alcohol poisoning, cardiac issues, cognitive impairment, or liver complications. Subsequently, someone who struggles with both bulimia and alcoholism is at a higher risk for developing any of these complications and others, which could become fatal. The co-occurrence of bulimia and alcohol abuse also increase the individual’s risk for anxiety and depression, and subsequently the rate of suicide attempts, impulsive behaviors, and psychiatric hospitalizations. Overall, this co-occurrence can intensely impair the individual’s social, occupational, and interpersonal functioning, and lead to severe medical and psychological conditions. As a result, the simultaneous occurrence of both conditions creates more treatment obstacles, which underscores the need for both disorders to be addressed, rather than one in isolation.
How Might Someone Develop Both?
The patterns of behavior in alcoholism and bulimia can feed into one another, as alcohol can help induce purging, whereas restriction/compensatory behaviors allow for higher levels of intoxication. Moreover, both disorders can arise from common risk factors or sources – biological, environmental, or psychological.
For example, food deprivation (as a result of bulimia) interferes with the brain’s reward or pleasure system; without receiving the reward from food, the individual may seek pleasure and reward from alcohol use. Moreover, addictive personality styles, personality disorders (i.e. borderline personality disorder) or impulsivity patterns could also be common underlying factors of these disorders occurring in conjunction. Psychological factors also contribute to this comorbidity – for instance, a need for emotional regulation can make the individual susceptible to both patterns of behaviors. This need could be the result of another psychiatric condition, such as depression, PTSD, or anxiety. Moreover, the feelings of guilt and shame that often arise through binging behaviors could also be emotions that the individual may try to regulate through purging and/or alcohol abuse.
What Do I Treat First?
Co-occurring alcoholism and bulimia is common, and so various dual-diagnosis treatment programs are equipped to handle both simultaneously through integrated treatment approaches. While each individual’s case and severity of each disorder may be different, when an individual is engaged in both alcohol use and bulimic behaviors, the most important first step is to make sure they are medically stable. This means the individual should undergo a regulated/monitored detox of alcohol as an initial step to reducing their alcohol abuse. Furthermore, other components of the individual’s physical health should be addressed –malnourishment and nutritional deficits, cardiac issues, gastrointestinal concerns, and fall risk. Related to this is treatment to help the individual with weight restoration (if medically necessary) and to reduce and ultimately stop the eating disorder behaviors and help the individual with their alcohol abstinence. A multidisciplinary team is best for treating co-occurring bulimia and alcohol abuse, including a psychotherapist, psychiatrist, physician, and dietician – their combination of expertise can help address the individual’s physical, emotional, behavioral, and nutritional needs.
If you are reading this post and are struggling with comorbid bulimia and alcohol abuse, you may have realized that these behaviors are no longer serving you. Thankfully, with your willingness to heal and appropriate treatment, you can find better ways of living.
Bahar Moheban, M.A. is a clinical psychology doctoral candidate and registered psychological assistant in Torrance under the supervision of Dr. Nazanin Moali. She provides individual therapy and facilitates a Body Image Group for adults and adolescents with disordered eating, body dissatisfaction, and comorbid disorders. If you are struggling with compulsive exercise or any other type of disordered eating, contact Bahar for a counseling appointment to repair your relationship with food, body image, and movement.