Eating Disorders And Alcoholism: A Complex Relationship

Bulimia nervosa is a chronic mental health illness where the affected individual will binge eat and then purge to avoid weight gain. It is one of the most common eating disorders in women and often co-occurs with alcohol use disorders (AUDs). Research has shown that around 30 to 50% of female alcoholics also suffer from bulimia, and 20 to 25% of women seeking treatment for bulimia also suffer from an alcohol use disorder. This deadly combination can lead to severe weight fluctuations and impulsive behaviours, with both disorders bringing about serious physical and mental health risks.

Bulimia nervosa and alcohol use disorder comorbidity

Bulimia nervosa is a chronic mental health illness where the affected individual follows a binge-eating and purging routine to avoid weight gain or lose weight. People with bulimia tend to develop addictions to substances like drugs or alcohol to either help them lose weight or numb negative thoughts. Binge-eating and purging are also ways to distract the individual from reality.

Alcohol use disorder (AUD) occurs when an individual drinks often and in large enough quantities for their body to become dependent and addicted to alcohol. Those with AUD will continue to drink despite negative physical, emotional, and social consequences. AUD is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.

Bulimia nervosa and alcohol use disorder are conditions that frequently co-occur. Research has shown that around 30 to 50% of female alcoholics also suffer from bulimia nervosa, and 20 to 25% of females seeking treatment for bulimia nervosa were found to suffer from AUD. The comorbidity between AUD and eating disorders, especially in young women, is well-documented.

There are several reasons for the high comorbidity between bulimia nervosa and AUD. Firstly, there are overlapping symptoms and behaviours between the two conditions. For example, binge drinking is common to both disorders, and guilt and feelings of body dissatisfaction tend to occur together. Underlying shame and perfectionism also contribute to the development of both disorders. Secondly, individuals with bulimia nervosa and AUD often share certain personality traits, such as anxiety, perfectionism, and impulsivity. These traits can contribute to the development of both disorders. Thirdly, underlying mental health conditions, such as depression, can lead to coping mechanisms such as alcohol misuse and eating disorder behaviours. For instance, alcohol may be used to self-medicate and escape stress, and the deprivation of food and abuse of alcohol can alter pathways in the brain. Finally, there may be genetic factors contributing to the comorbidity, as family epidemiology studies suggest that bulimia nervosa and AUD dependence are transmitted independently in families.

The co-occurrence of bulimia nervosa and AUD can have serious consequences. Both conditions bring considerable physical, mental, and social health risks, and women suffering from both conditions are more likely to suffer from other disorders, including body dysmorphic disorder (BDD), major depressive disorder, and post-traumatic stress disorder (PTSD). In addition, the two illnesses can deplete vital vitamins and minerals in the body, leading to malnutrition. Treatment for co-occurring bulimia nervosa and AUD should address both conditions simultaneously and comprehensively. Cognitive-behavioural therapy (CBT) has been found to be beneficial in treating co-occurring disorders, as it helps individuals change irrational thinking patterns and unhealthy beliefs pertaining to body image.

Overlapping behaviours and symptoms

Bulimia nervosa is a chronic mental health illness where the affected individual follows a binge and purge routine to avoid weight gain or lose weight. Those with bulimia tend to be of average weight, making the illness less obvious than anorexia or compulsive overeating. A bulimic's actions around food are often ritualistic and compulsive, with purging always following a binge.

Alcohol use disorder (AUD) occurs when an individual drinks frequently and in large enough quantities for their body to become dependent on alcohol. People with AUD will continue to drink despite negative physical, emotional, and social consequences. Binge drinking is defined as consuming a large quantity of alcohol in a short time, specifically drinking to get drunk.

There is a high overlap between bulimia and AUD, with around 30 to 50% of female alcoholics also suffering from bulimia. This overlap is due to several overlapping behaviours and symptoms:

• Impulsive behaviour: Bulimics often display impulsive behaviours such as binge eating and purging. This impulsive behaviour can extend to other objects, such as substance abuse. Binge drinking is common to both bulimia nervosa and alcohol misuse.
• Coping mechanism: Both conditions can serve as an unhealthy way of coping. People with bulimia may turn to alcohol to help them lose weight or numb negative thoughts. Alcohol is also a coping mechanism for many, as drinking heavily can be a way to deal with or dampen emotions.
• Guilt and shame: Binge eating and purging often lead to feelings of guilt, shame, and disgust. Similarly, guilt about drinking and feelings of body dissatisfaction tend to occur together, with underlying shame contributing to both symptoms.
• Anxious, perfectionistic, and impulsive personality traits: These traits are common in individuals with both bulimia nervosa and AUD and can contribute to the development of both conditions.
• Malnutrition: Both conditions can lead to malnutrition, as alcohol has no nutritional value, and the binge-and-purge cycle of bulimia can result in the depletion of vital vitamins and minerals.
• Ritualistic behaviour: Bulimics often engage in ritualistic behaviours around food, and this ritualistic behaviour can extend to drinking. For example, those with "drunkorexia" restrict their diet so they can drink heavily without gaining weight.
• Mental health issues: Depression, anxiety, and a history of trauma from physical or sexual abuse can increase the risk of developing both bulimia nervosa and AUD.

Risk factors and causes

Eating disorders and alcohol use disorders are both serious mental health conditions that can have detrimental effects on an individual's health, well-being, and overall functioning. While the exact relationship between bulimia nervosa and alcoholism is complex and not yet fully understood, there are several risk factors and potential causes that have been identified.

Genetic and Biological Factors

Research has suggested that there may be a genetic predisposition for individuals who have an eating disorder to also develop an alcohol use disorder. Certain genetic variations have been identified that are

Treatment and therapy

While I cannot determine if it is common to become an alcoholic after being bulimic, I can provide you with information on the treatment and therapy options available for alcohol use disorder and bulimia.

Alcohol use disorder (AUD) is a common medical condition that can have severe negative consequences on a person's life. Those with AUD will continue to drink despite the negative physical, emotional, and social consequences. Treatment for AUD typically involves a combination of abstinence from alcohol, counselling, support group therapy, and medication.

Behavioural therapy is a critical aspect of AUD treatment. During therapy, individuals learn how to modify their behaviour and develop skills to cope without relying on alcohol. They also learn to identify and avoid triggers and situations that may tempt them to drink.

Inpatient treatment, often called 'rehab', involves residential stays at specialized facilities, typically ranging from 30 to 90 days. This intensive approach combines detox, therapy, and medication to help individuals overcome their addiction. Outpatient treatment programs are also available, offering therapy and counselling without the residential component.

For individuals struggling with both an eating disorder like bulimia and AUD, it is crucial to address both disorders simultaneously to prevent setbacks. The first step is often detoxification from alcohol, which should be done under medical supervision due to potential health risks. After detox, individuals typically transition to inpatient or outpatient treatment, focusing on therapy and counselling for both disorders.

Various therapy options are available, including Cognitive Remediation Therapy, which helps individuals with destructive habits caused by their disorders and teaches healthier alternatives. Motivational Enhancement Therapy (MET) is another approach that helps individuals find the motivation to seek treatment and recover. Acceptance Commitment Therapy, a branch of Cognitive Behavioral Therapy, assists patients in developing personal standards and aligning their behaviours with those standards.

A strong support system, including family, friends, and support groups, can also play a vital role in an individual's recovery journey by providing encouragement and accountability.

The physical and psychological effects

Bulimia nervosa is a chronic mental health illness where the affected individual will follow a binge and purge routine to avoid weight gain or lose weight. It is one of the most common eating disorders in women, and often co-occurs with alcohol use disorders (AUDs). Studies have shown that 30 to 50% of female alcoholics also suffer from bulimia, and 20 to 25% of females seeking treatment for bulimia also suffer from an alcohol use disorder.

Psychologically, both disorders are associated with negative thinking patterns, such as shame, guilt, and perfectionism. They are also often linked to other mental health issues such as depression, PTSD, anxiety, and other personality disorders. The impulsive behaviours associated with bulimia can lead to other risky behaviours such as shoplifting, compulsive exercising, and risky sexual activities. The use of alcohol as a coping mechanism can further alter brain pathways and contribute to long-term alcoholism.

Treatment for co-occurring bulimia and alcoholism is essential and should address both conditions simultaneously. Evidence-based talking therapies, such as cognitive behavioural therapy (CBT), can help individuals identify triggers and negative thought patterns, as well as develop better coping mechanisms. Medication and support groups may also be beneficial during the recovery process.

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